If you do not agree with the reconsideration decision we made on your application for benefits, you may request a hearing before an Administrative Law Judge (ALJ). To request a hearing, you may use this form or write a letter.
If you are not sure this is the form you should use, the Notice of Reconsideration (reconsideration determination) that you received will tell you that to appeal our decision, you should request a hearing before an ALJ. If the notice does not say this, or if you still are not sure this is the form you should complete, call 1-800-772-1213 (TTY 1-800-325-0778) or your local Social Security office and we will help you to complete the right appeal form.
If you are requesting a hearing on the denial of a claim for disability benefits, you must complete and sign additional forms. These forms are:
You may also need to complete a form SSA-1696, Appointment of Representative, if you are appointing a representative. Your representative should also sign the SSA-1696 before you send it to us.
You must appeal within 60 days from the date you got the reconsideration decision. We assume you got the reconsideration decision within 5 days of the date shown on that 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 ALJ to consider with the request for hearing or within 10 days after filing the request. You should make sure that all evidence is received by the ALJ or is available at the time and place set for the hearing. However, if your claim is filed in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, or Connecticut, you must submit any evidence you wish to be considered at the hearing no later than 5 business days before the scheduled hearing. Failure to comply with this requirement may result in the ALJ declining to consider the evidence.