Waiver of Written Notice of Hearing

Our rules require that we notify you in writing of the date, time, and place of the hearing at least 20 days before the date that we have scheduled a hearing for you. You use this form to tell us that you are waiving the right to receive written notice of when we schedule a hearing for you. If you waive your right to written notice of the hearing, we will let you know as soon as possible the date, time, and place we have scheduled a hearing for you. It is possible that waiving your right to written notice of the hearing could help us to schedule your hearing sooner than we would be able to do otherwise.

If you have questions about waiving your right to written notice of hearing, you may call 1-800-772-1213 or contact the hearing office where your claim is located.

How to Obtain the Form

After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the HA-510:

Waiver of Written Notice of Hearing, Form HA-510

How to Complete the Form

Claimant: Enter your name or the name of the person on whose behalf the request for hearing was filed.

Wage Earner: If the claimant receives or is applying for Social Security benefits on someone else's work record, enter that person's name.

Claim for

Enter the type of claim under appeal; for example, Social Security disability, Supplemental Security Income (SSI) disability, SSI Overpayment, Retirement.

Social Security Number: The Social Security number (SSN) you enter depends on the type of claim you are appealing. If the appeal is on a claim for:

• Social Security benefits on your work record, enter your SSN.
• Social Security benefits on someone else's work record (the wage earner, above) enter that person's SSN.
• Social Security benefits on your work record and on the wage earner's work record, enter both SSNs.
• Supplemental Security Income (SSI), enter your SSN.
• Social Security benefits on the wage earner's work record and SSI, enter both SSNs.

Sign and date the form, and include your address and telephone number. If you are signing on behalf of a child or incompetent adult, show your relationship to the claimant (for example, parent or legal guardian) with your signature.