Skip to content Social Security Online |
Social Security Forms |
www.socialsecurity.gov |
Forms Home Page |
Notice Regarding Substitution of Party Upon Death of Claimant - Form HA - 539 |
Introduction |
If a claimant dies before the Administrative Law Judge (ALJ) completes his or her action on a request for hearing, an eligible individual may ask to substitute for the deceased and pursue the claim for benefits. You use this form to notify us that you want to pursue the deceased's claim. Note: If you have not previously told us about the claimant's
death, please do so by either contacting your local Social Security office
or telephoning us at If you have questions about whether you may qualify as a substitute
party or how to complete this form, you may call |
|
How to Obtain the Form |
Below you will find Form in Portable Document Format (PDF). To print the PDF version, you will need the Adobe Acrobat reader software. If you do not already have this special software, see our page on downloading and printing PDF documents. After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the HA-539:
Notice Regarding Substitution of Party Upon Death of Claimant Form HA-539 |
|
Where To Send The Form |
CLAIM FOR: If you know the type of claim (for example, Retirement, Social Security disability, SSI disability) the deceased filed, enter it here. SOCIAL SECURITY NUMBER: The Social Security number (SSN) you enter here depends on the type of claim the deceased filed. If the he or she filed for:
Relationship to the Deceased: In the next section, check the block that corresponds to your relationship to the deceased. If none of the categories is appropriate, check "Other" and tell us your relationship to the deceased. If you wish to be made substitute party for the deceased, check item 1., and complete either a. or b., stating whether you want to appear at a hearing. If you do not want to appear at a hearing, the ALJ will issue a decision based on the written record. SIGNATURE, DATE, ADDRESS AND TELEPHONE NUMBER: Sign and date the form,
and fill in your full name (please print), address and telephone number. |
|
Send the Form |
Print the PDF HA-539 form on 8 1/2 x 11 inch paper, complete and sign the form, and mail it to the hearing office where the deceased's claim is located. The address and telephone number of the hearing office are on the letter acknowledging receipt of the request for hearing that we sent. |
Privacy Policy | Website
Policies & Other Important Information | Site
Map
Last reviewed or modified Monday Jan 14, 2008 |