HA-86 (Submittable Withdraw an Appeals Council Request for Review

Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims

HA-86 Submittable PDF Screen Package

20 CFR 404.971 and 416.1471 (HA-85, Request to Withdraw a Hearing Request; HA-86, Request to Withdraw an Appeals Council Request for Review)

OMB: 0960-0710

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0710 can be found here:

2022-10-19 - Revision of a currently approved collection

Document [pdf]

Download: pdf | pdf

HA86 Online Application
Screen Package
August 11, 2021

HA86 Screen Package

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Application Landing Page:

HA86 Screen Package

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Email Landing Page:

HA86 Screen Package

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Email Confirmation Page:

HA86 Screen Package

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First Email:

HA86 Screen Package

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HA86 Adobe Form:

HA86 Screen Package

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HA86 Adobe Form:

HA86 Screen Package

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HA86 Adobe Form:

HA86 Screen Package

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HA86 Adobe Form:

HA86 Screen Package

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HA86 Adobe Form:

HA86 Screen Package

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HA86 Completion:

HA86 Screen Package

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Final Email:

HA86 Screen Package

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File Type	application/pdf
Author	Kao, Christopher Contractor
File Modified	2021-08-20
File Created	2021-01-21