DI 12095.055 SSA-769-U4 (Request for Change in Time/Place of Disability Hearing)
Go to OS 15020.076 to obtain the most current Form.
The SSA-769-U4 is designed to allow the claimant or representative to officially request a change in the time or place of a scheduled disability hearing. The claimant always has the right to request a change; however, DHU makes the decision whether to reschedule.
B. Completion of Form
All identifying information is completed following the format for completing this information for the SSA-789-U4.
Complete the current disability hearing schedule to assure that the claimant understands the schedule which he/she wishes to amend.
The claimant must indicate the number of days postponement requested; the claimant must be informed that the DHU may not be able to accomodate requests for specific dates or times. If the request is for a change in location, specifically indicate the location requested. The reason for the request for change in time/place should be clearly identified. DHU will not grant a postponement if the claimant does not have good cause. Therefore, the claimant should be specific in stating the reason. (For example, “I am scheduled to go into the hospital that week,” or “I have a new doctor giving me extra tests that will not be fininshed until .”) To the extent possible, requests for changes in location will be granted, although reimbursement for additional travel will not be made.
Notify the DHU by telephone when a request to reschedule is made less than 10 days before the scheduled hearing date.