To be completed by Social Security Administration: was the request for hearing received within 65 days of the reconsidered determination?
Evidence: submit your evidence to the hearing office within 10 days.
Not represented: if you are not represented, your Social Security office will give you a list of legal referral and service organizations.
Hearing blocks: do not complete if the appeal is a Medicare issue. Otherwise, check one of the blocks.
Notice of hearing: you will receive notice of the time and place of a hearing at least 75 days before the date of hearing from the Social Security Administration.
| Question | Answer |
|---|---|
| Form Name | HA-501 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 81 |
| Avg. time to fill out | 14 min |
| Edition | 06-2022 |
| Where to send | Your local Social Security office |
| Other names | HA-501, HA501, HA 501, Form HA-501, Social Security HA-501, Request for Hearing by Administrative Law Judge, HA-501-U5 |
| Official source | HA-501 (Rev 06-2022), Office of Hearings Operations |
Form Ha 501 U5 isn’t the one you’re looking for?