Please rate Request For Hearing Template 06-2022
Take or mail the completed original to your local Social Security office, the Veterans Affairs Regional Office in Manila or any U.S. Foreign Service post and keep a copy for your records.
Additional evidence: if you have additional evidence to submit, submit your evidence to the hearing office within 10 days.
Line 6: do not complete if the appeal is a Medicare issue; otherwise check one of the blocks.
Waiver: if you do not wish to appear at a hearing and request that a decision be made based on the evidence in your case, complete Waiver Form HA-4608.
| Question | Answer |
|---|---|
| Form Name | Form HA-501 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 81 |
| Avg. time to fill out | 14 min |
| Edition | Rev 06-2022 |
| Issuing agency | Office of Hearings Operations |
| Where to file | Your local Social Security office, the Veterans Affairs Regional Office in Manila or any U.S. Foreign Service post |
| Other names | HA-501, HA501, Form HA-501, request for hearing, Request for Hearing by Administrative Law Judge |
| Official source | Form HA-501 (Rev 06-2022), Office of Hearings Operations |
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Please rate Request For Hearing Template 06-2022
