DI 12095.050 SSA-773-U4 (Waiver of Right to Appear - Disability Hearing)

Go to OS 15020.080 to obtain the most current Form.

A. General

The SSA-773-U4 is designed to allow the claimant or representative to officially waive the right to appear at the disability hearing.

Explain to the claimant the consequences of not appearing as described on the form. The claimant must understand that he/she is not waiving the disability hearing process, but only the personal appearance. If the claimant waives the right to appear the decision will be made based solely on the evidence in file.

The waiver is not irrevocable. It can be reversed by the claimant's written request at any time prior to writing the decision.

B. Completion of the Form

All identifying information is completed following the format for completing this information for the SSA-789-U4.

If completed in conjunction with an SSA-789-U4 or SSA-770-U4, attach the SSA-773-U4 completing only the Name of Claimant, Identifying SSN, Signature and Date Blocks.

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DI 12095.050 - SSA-773-U4 (Waiver of Right to Appear - Disability Hearing) - 05/18/2011
Batch run: 03/06/2014