Justification for the Non-Substantive Changes - 0960-0671

Justification for the Non-Substantive Revisions to

Form HA-504, Acknowledgement of Receipt (Notice of Hearing)

Form HA-L83, Acknowledgement of Receipt (Notice of Hearing) Cover Letter

Form HA-55, Objection to Appearing by Video Teleconferencing

Form HA-510, Waiver of Written Notice of Hearing

Form HA-2, Objection to Video Teleconferencing – Request to Show Good Cause

20 CFR 404.936, 404.938, 416.1436, 416.1438, 405.316

OMB No. 0960-0671

Revisions to the Collection Instrument

SSA is making the following no-substantive revisions to this collection:

• Change #1: We are modifying Form HA-55 to clarify the meaning of the form and help claimants understand when they return it to the hearing offices. We are adding a checkbox next to the objection statement, and a new statement to inform respondents to return the form only if they are objecting to the video hearing.

Justification #1: After initial use of the Form HA-55 we realized claimants do not properly understand the meaning of the form or when they should submit it back to the hearing offices. We are making minor modifications in the language and formatting to help claimants understand.

• Change #2: We are modifying the language in the cover letter HA-L2. We revised the sentence in the letter explaining who should return the form in the provided envelope if there is a representative on the case.

Justification #2: We are making small revisions to language in the cover letter to provide clarity to the claimant respondents of Form HA-55.

• Change #3: We are adding a new form, Form HA-2, to fill in an area that was not well covered as a result of the video teleconferencing regulation change.

Justification #3: Form HA-2 will accommodate standardization of the requirement for the claimant to request to show good cause when they returned the Objection to Appearing by Video Teleconferencing (HA-55) form after the 30 day time limit. The HA-2 provides a formalized way for respondents to show good cause, as they can use the blank lined section to explain their reasons for not submitting their HA-55 on time. We will continue to accept other good cause requests (even if the respondents choose not to use the new HA-2), so long as the respondents submit these requests in writing.

• Change #4: We are revising the Privacy Act Statements on the HA-55, the HA-504, and the HA-504-OP1.

Justification #4: SSA’s Office of Privacy and Disclosure recently determined we printed the HA-55, the HA-504, and the HA-504-OP1 with the incorrect Privacy Act Statements. We are correcting that oversight now.