Ha1 form railroad disibility 2025

1. Click ‘Get Form’ to open the HA-1 form in the editor.
2. Begin by entering your RRB Claim Number at the top of the form. This is essential for processing your appeal.
3. Fill in your full name, including first, middle initial, and last name, followed by your complete address (number, street/apartment number, and PO Box if applicable).
4. Provide your city, state, and ZIP code to ensure accurate delivery of correspondence.
5. Enter your telephone number in the designated field for any follow-up communication.
6. Select either Item A or B to indicate whether you are appealing a reconsideration decision or a Hearings Officer’s decision. Fill in the corresponding letter dates.
7. Detail any mistakes of fact or errors of law that you believe occurred. If necessary, attach additional sheets for more information.
8. Indicate if you have additional evidence to submit and provide details if applicable.
9. Sign and date the form. If someone else is filing on your behalf, include their information and relationship to you.

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