Addendum - 0710

Addendum to the Supporting Statement for the HA-85, HA-86, and Regulations

Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for

Adjudicating Initial Disability Claims

20 CFR Parts 404, 405, and 416

OMB No. 0960-0710

Revision to the Collection Instrument:

SSA is making the following revisions:

• Change #1: We removed witness signature fields from the HA-85 and HA-86 forms and added more lines to write the reason for withdrawal.

Justification #1: Our regulations require the claimant to submit the withdrawals in writing, but there is no signature requirement. The form has an optional signature block, and since it is optional, there is no need for witness signatures. Therefore, we are removing the witness signature fields.

• Change #2: We replaced “Administration Law Judge decision” to “decision of the judge” on the HA-86 in two places. We also changed the box label from "Date of ALJ decision" to "Date of Judge Decision."

Justification #2: The Final Rule, Hearings Held by Administrative Appeals Judges of the Appeals Council, which became effective on December 16, 2020 (85 FR 73138), clarifies that the Appeals Council also has the authority to hold hearings and issue decisions. Therefore, we removed references to the Administrative Law Judge (ALJ) and replaced them with generic "judge," to reflect that both ALJs and Administrative Appeals Judges may hold hearings and issue decisions.

• Change #3: We are revising the PRA statements on these forms.

Justification #3: We are revising the PRA statements to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the forms, is now outdated.

• Change #4: We are revising the Privacy Act Statement on these forms.

Justification #4: 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 Statements on these forms.

These revisions will not affect the burden for this information collection. We will implement these revisions upon OMB’s approval.