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Form Approved OMB No. 09600269SOCIAL SECURITY ADMINISTRATION OFFICE OF DISABILITY ADJUDICATION AND REVIEWREQUEST FOR HEARING BY ADMINISTRATIVE LAW Judges Privacy Act Notice(Take or mail the signed
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HA-501 revised versionpdf is a form used by the Social Security Administration to collect information about the claimant's work history and earnings.
Individuals who are applying for Social Security Disability benefits are required to file the HA-501 revised versionpdf form.
The HA-501 revised versionpdf form must be filled out accurately and completely with information about the claimant's work history, earnings, and medical conditions.
The purpose of the HA-501 revised versionpdf form is to help the Social Security Administration determine the claimant's eligibility for Disability benefits.
Information such as work history, earnings, medical conditions, and treatment providers must be reported on the HA-501 revised versionpdf form.
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