SOCIAL SECURITY ADMINISTRATION/OFFICE OF DISABILITY ADJUDICATION AND REVIEW REQUEST TO WITHDRAW A HEARING REQUEST Do not write in this space IMPORTANT NOTICE This is a request to withdraw your hearing.
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How to fill out the SSA HA-85 online
Filling out the SSA HA-85 is an important step for those wishing to withdraw a hearing request. This guide will provide you with clear, step-by-step instructions to assist you in completing the form accurately and efficiently online.
Follow the steps to complete the SSA HA-85 form.
- Click the ‘Get Form’ button to obtain the necessary form and access it in your preferred format.
- Begin by entering your name as the claimant in the designated field. Include your full first name, middle initial (if applicable), and last name.
- Provide your Social Security number (SSN) in the format XXX-XX-XXXX, ensuring accuracy to avoid processing delays.
- If applicable, enter the name of the wage earner (or surviving partner/individual) if it differs from your name.
- If you have a claim number that is different from your SSN, please include it in the relevant field.
- Specify the date of your hearing request to provide context for the withdrawal.
- Indicate the benefits you have applied for by selecting from the available options.
- Outline the type of claim(s) related to your hearing request, accurately categorizing your situation.
- In the designated section, explicitly state your wish to withdraw the hearing request and affirm that your request is voluntary.
- Provide a clear explanation for your withdrawal. If additional space is needed, continue on the reverse side of the form.
- Sign the form where indicated. If you are using a mark (X) to sign, two witnesses are required to sign and provide their addresses.
- Include your telephone number with area code for contact purposes.
- Fill out your complete mailing address, including any relevant information such as apartment number or PO box.
- Indicate the name of the county where you currently reside, if applicable.
- Once you have filled out all sections, review your information for accuracy, then save changes. You may also choose to download, print, or share your completed form.
Complete your SSA HA-85 form online today for a smooth withdrawal process.
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SOCIAL SECURITY ADMINISTRATION/OFFICE OF DISABILITY ... HA-85. REQUEST TO WITHDRAW A...
[45 FR 52096, Aug. 5, 1980, as amended at 50 FR 21439, May 24, 1985; 51 FR 308, Jan. 3...
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The United States Social Security Administration (SSA) is an independent agency of the U.S. federal government that administers Social Security, a social insurance program consisting of retirement, disability, and survivor benefits. ... As of 2018, about 60,000 people were employed by SSA.
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