HA-86 PDF Form & Guide

Quick answer

What is HA-86 used for?

This form belongs to an administrative review process. The decision or notice being challenged, its date, the level of review, and any deadline are more important than a general disagreement with SSA.

A request asks an agency to take a defined action. State the requested outcome clearly, connect it to the relevant claim or notice, and keep proof of when and how the request was delivered.

For HA-86, the transaction named by the government is “Request to Withdraw an Appeals Council Request for Review.” Use that title to distinguish this PDF from forms that collect related facts but produce a different agency action.

What to prepare before filling HA-86

01
Confirm that HA-86 — Request to Withdraw an Appeals Council Request for Review — matches the action described in your SSA, CMS, or IRS notice. Similar form numbers may serve different programs or review stages.
02
Keep the determination, hearing notice, case identifiers, representative details, and a dated explanation of the issue together. Add medical or vocational evidence only when it bears on the decision and the instructions permit it.
03
Download a fresh copy of HA-86 from the official link below. SSA warns that browser PDF viewers may not fill forms consistently, so save the PDF and use current Adobe Reader when needed.
04
Write names, Social Security or claim numbers, dates, addresses, and amounts exactly as they appear in the records you are using. Mark nonapplicable items as the instructions direct instead of inventing an answer.
05
Review HA-86 for signatures, dates, attachments, continuation pages, and any case-specific return instructions. Keep a complete copy and delivery record.

Questions specific to “Request to Withdraw an Appeals Council Request for Review”

Use these prompts to test whether your records actually support the subjects named in the official HA-86 title.

If an agency reviewer asks about “request,” can you trace the HA-86 entry to a named person, document, account, notice, or event?
Is “withdraw” a current fact, a historical fact, or an estimate here, and have you labeled that distinction wherever HA-86 allows?
How does “appeals” relate to the specific request to withdraw an appeals council request for review transaction, and have you kept unrelated background information out of the response?
How does “council” relate to the specific request to withdraw an appeals council request for review transaction, and have you kept unrelated background information out of the response?
Before signing, can you independently recheck every date, amount, relationship, or identifier connected with “review” rather than relying on the working draft?
For the “identity” part of HA-86, which dated record supports the answer, and does that record cover the full period requested by the PDF?

Evidence review

Keep the determination, hearing notice, case identifiers, representative details, and a dated explanation of the issue together. Add medical or vocational evidence only when it bears on the decision and the instructions permit it.

Before you sign

Confirm that you selected the correct review level and understand whether the form requests review, changes a hearing arrangement, or gives up a procedural right. A withdrawal or waiver can have consequences that a later filing may not undo.

A reliable way to complete HA-86

Map the source records

Start with the government notice or instruction that led you to this form. Highlight the program, issue, response date, office, and case identifier, then copy those items to a control sheet. Recheck them after filling. This keeps the response connected to the triggering matter and reduces the risk of sending a complete form to the wrong workflow.

Review fields and branches

Review names, dates, and numbers horizontally across the entire PDF, not merely one page at a time. Search for every occurrence of the key identifier and verify that each version agrees. Then review vertically by topic—identity, event, amount, explanation, signature—to catch contradictions that a page-by-page proofreading pass may miss.

Package and track the filing

If a representative, employer, clinician, teacher, or household member completes part of the form, establish who will assemble and send the final package. Give each contributor the relevant deadline and preserve their signed section without later edits. The filer should still review the complete package for consistency before delivery.

Official HA-86 PDF and resources

These government links were verified in the SSA forms directory on 2026-08-09. Download a fresh PDF before filing because agencies can revise forms and instructions.

English HA-86 PDF Spanish PDF

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Prepare HA-86 from your records

Add the blank government PDF and your source documents. Clerks AI can map supported facts to fields and flag gaps for review. You remain responsible for eligibility, signatures, accuracy, evidence, and submission.

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HA-86 FAQ

Is HA-86 free to download?

Yes. SSA says all forms in its official directory are free. Use the government PDF link on this page; do not pay a third party merely for the blank form.

Can I fill HA-86 in a web browser?

Possibly, but SSA says browser PDF viewers do not work consistently for filling or screen reading. Download the file and use current Adobe Reader if fields, saving, or accessibility features do not work correctly.

Where do I submit HA-86?

Follow the address, office, upload route, or case-specific instruction in the PDF and any notice you received. The SSA directory says paper forms may generally be mailed or faxed unless the form states otherwise, but not every form uses the same destination.

Related appeals & hearings forms

HA-85

HA-86: Request to Withdraw an Appeals Council Request for Review