Addendum to the Supporting Statement for 0960-0269

Addendum to Supporting Statement

Request for Hearing By Administrative Law Judge SSA-HA-501-U5

20 CFR 404.929, 404.933, 416.1429, 416.1433, 42 CFR 405.722, 20 CFR 418.1350

OMB No. 0960-0269

Justification of the Requirement for Claimant Representatives to use of the i501

Effective October 12, 2011, the Requiring the Use of Electronic Services by Certain Claimant Representatives Final Rules (20 CFR 404.1713 and 416.1513) require representatives to use our electronic services at the times and in the manner we prescribe on matters for which they request direct fee payment. The requirement acknowledges the use of technology in claimant representatives’ business practices and allows us to improve the management of our workloads.

Revisions to the Collection Instrument

Justification of Revisions: 20 CFR 404.933 and 416.1433 require respondents to file a written request for hearing with us if they wish to appeal a reconsidered determination or revised determination, but the regulations do not require a signature on the written request for hearing. However, Social Security’s long-standing practice supported by its Program Operations Manual System (POMS), forms and other instructions require a signature on a request for hearing. Therefore, we are updating the instructions and forms to eliminate the signature requirement and to comply with the regulatory rules.

Below is a list of the revisions we are making to the HA-501-U5. Please note the attached iteration of the form is not the most current version. We submitted a clearance package to OMB in February of 2011, but we have not, yet, had time to print the newer version of the form.

• We are removing the word “signed” from under the title of the form.

• We are removing the perjury statement from the form.

• We are adding the word residence in front of the word address to the claimant’s address block.

• We are deleting the word “signature” from the claimant’s representative block.

• SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on this form.

Justification for Resubmitting the ICR Within One Year of Approval

SSA is resubmitting this ICR within a year of the last approval because we made the decision to mandate the use of the i501 after we had sent it to the Office of Management and Budget for the previous clearance.

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