Either the claimant or his/her representative may sign the form. However a signature
is not required to process the reconsideration request (see GN 03103.020D.). If we have a writing that clearly shows dissatisfaction with an initial determination
and it clearly originated with the claimant, process the request without the signature.
If the representative signs, either the "attorney" or "nonattorney" block should be
checked, as appropriate. When the claimant signs and has a representative, insert
the name and address of the representative. Obtain an SSA-1696-U4, Appointment of
Representative, whenever none was previously filed for that representative (see GN 03910.040). Be sure to include all identifying information requested, including zip and area
codes. If the individual's actual place of residence is different from the mailing
address, record the actual residence on an SSA-795 statement. This is important for
scheduling the hearing conveniently and for possible reimbursement for travel expenses.
If the individual wishes to have the hearing held at a site other than a cite closest
to his/her place of residence, take an SSA-795 statement providing the location requested
and an explanation (e.g., temporary residence in another city for medical treatments).
For foreign claims in which the claimant wants a personal appearance, take an SSA-795
statement indicating the hearing site requested. (Claimant's requests for hearing
sites will be considered in relation to potential administrative costs. However, generally
claimants will not have to travel more than 75 miles within the U.S. to reach the
hearing site and therefore reimbursement for claimant travel will not generally be
necessary.) Attach an SSA-795 statement concerning the scheduling of the hearing to
the DHU-S copy of the SSA-789-U4 and forward to the DHU. Place a photocopy of the
SSA-795 in the claims folder. In foreign and railroad claims, attach the SSA-795 to
the SSA-789-U4 and forward to INTPSC or GLPSC with the claims folder.