Request for Review of Decision/Order of Administrative Law Judge

If you do not agree with the decision or order an Administrative Law Judge (ALJ) made on your claim, you may ask the Appeals Council to review the ALJ's action. To do this, you may use this form or write a letter.

If you are not sure this is the form you should use, the notice you received will tell you that to appeal the ALJ's decision or order you must request Appeals Council review. If the notice does not say this, or you are still not sure this is the form you should complete, call 1-800-772-1213 or your local Social Security Office and they will help you to complete the right appeal form.

You must file your appeal within 60 days from the date you got the hearing decision or order. We assume that you got the hearing decision or order within 5 days of the date shown on the notice unless you can show us you did not get it within the 5-day period.

Time to Submit New Evidence: You should submit any new evidence you want the Appeals Council to consider with your request for review. If you need additional time to submit evidence, you must request it when you file your request for review.

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-520:

Request for Review of Decision/Order of Administrative Law Judge Form HA-520

How to Complete the Form

1. NAME OF CLAIMANT: Enter your name or the name of the person on whose behalf you are filing the request for review.
2. NAME OF WAGE EARNER: If you receive or are applying for Social Security benefits on someone else's work record, enter that person's name.
3. SOCIAL SECURITY CLAIM NUMBER: The Social Security claim number depends on the type of claim you are appealing. If you are appealing a claim for:
   • Social Security benefits on your work record, enter your Social Security number (SSN).
   • Social Security benefits on someone else's work record (that is, the wage earner in 2.), 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.
4. SPOUSE'S CLAIM NUMBER: If you are appealing a hearing decision or order on an SSI or concurrent (SSI and Social Security) claim, enter your husband's or wife's SSN.
5. I request that the Appeals Council review the Administrative Law Judge's action on the above claim because: Tell us why you disagree with the hearing decision or order. If you need additional space, you can attach a separate sheet of paper. Include your name and the Social Security claim number on any additional pages, and on all correspondence, you send to us.
6. Signature: Sign and date the form and fill in your address and telephone number. If you are filing on behalf of a child or an incompetent adult, enter your relationship to the claimant (for example, parent or legal guardian).
7. Representative's Signature: If you have a representative he or she should sign and complete this section. Do not delay filing your request for review to get your representative's signature. If you do not have a representative and would like someone to represent you (for example, an attorney), your local Social Security office can provide you with a list of representatives for your area.

Where To Send The Form