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Form HA-501 (06-2022)

Discontinue Prior Editions

Office of Hearings Operations

REQUEST FOR HEARING BY ADMINISTRATIVE LAW JUDGE)

1. Claimant Name

Clifford Ray Hackett.

2. Claimant SSN 522270084.

3. Claim Number, if different

OMB. No. 0960-0269

4. I REQUEST A HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE. I disagree with the determination because my disability is permanent and worsening, and does not require recertification

Mahalo

SIGNATURE:
Clifford "RAY" Hackett www.rayis.me RESUME: www.rayis.me/resume

I founded www.adapt.org in 1980 it now has over 50 million members.
$500 of material=World’s fastest hydrofoil sailboat. http://sunrun.biz