Addendum to the Supporting Statement for 0960-0269

Addendum - 0269.docx

Request for Hearing By Administrative Law Judge

Addendum to the Supporting Statement for 0960-0269

OMB: 0960-0269

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Addendum to the Supporting Statement for Form SSA-HA-501-U5

Request for Hearing By Administrative Law Judge

20 CFR 404.929, 404.933, 416.1429, 416.1433, 418.1350, and 422.203

OMB No. 0960-0269



Minor Revisions to the Collection Instrument


SSA is making the following revisions:


  • Change #1: We are changing the name of our hearings office from Office of Disability Adjudication and Review to Office of Hearings Operations.


Justification #1: We are making this change to reflect the current name of the hearings office.


  • Change #2: We are adding language and identifying the number of days before the set hearing date that an individual will receive notice of the hearing before the Department of Health and Human Services.


Justification #2: The Department of Health and Human Services provides a notice concerning the time and place of a hearing at least 20 days before the date set for the hearing. The Social Security Administration provides notice 75 days prior to the hearing. We are updating the language to reflect these notice times.


  • Change #3: We are revising the Privacy Act Statement on this form.


Justification #3: 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 the form.


  • Change #4: We are revising the PRA statement on this form.


Justification #4: We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.


We will implement these changes upon OMB’s approval. These revisions do not affect the public reporting burden for this application.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
File Modified0000-00-00
File Created2021-01-15

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