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If you are requesting a hearing on the denial of a claim for disability benefits, you must complete and sign additional forms. (Take or mail the completed original to your local Social Security office, the Veterans Affairs Regional.Please complete the ALJ Hearing Request Form included with the reconsidered determination letter you received. A request for an ALJ hearing must be filed with OMHA within 60 days of receipt of the reconsideration decision. Return the completed Hearing Request Form to the Office of Administrative Hearings within 30 days of the date the adverse decision was mailed to you. Complete this form and send it to the address for requesting a hearing (not the payment address) shown on your CDP notice. Include a copy of your CDP. 4–5: complete them if it orders a hearing. Enrollee Name, Enrollee Telephone Number, Enrollee Social Security Number. Complete this form and send it to the address for requesting a hearing (not the payment address) shown on your CDP notice.