TN 5 (09-22)

DI 33010.085 Language for Disability Hearing Scheduling Notice for Foreign Claims — Exhibit

We are writing about your Social Security case.

We have scheduled a disability hearing for you before a Disability Hearing Officer. The hearing will be held:

 

Date: (1)

 

Time: (2)

 

Place: (3)

 

The hearing will start on time. Please do not be late.

 

You Can Look At Your Case File Before The Hearing

 

You can look at your case file before the hearing. If you have a representative, that person can look at your case file too. You can look at the file at the place and date shown above, between the hours of (4) and (5) .

If you or your representative need to look at your case file before that time, contact the Disability Hearing Unit. We will arrange another time and/or place.

The address of the Disability Hearing Unit is:

(6)

The phone number is: (7)

 

If You Do Not Plan To Come To The Hearing

 

If you do not plan to come to the hearing, please contact the Disability Hearing Unit right away. If you do not come, the Disability Hearing Officer will decide your case using the information in your case file.

 

If You Need A Different Hearing Place Or Date

 

If you need a different time or place for the hearing, please contact the Disability Hearing Unit right away.

 

Payment For The Cost Of Travel To The Hearing

 

We can sometimes pay costs for travel to the hearing. You, your representative, and any witnesses we decide are needed for the hearing can ask us to pay travel costs. We can pay costs for travel in the United States if the distance is more than 75 miles one way. We measure the distance from the person's place of entry into the United States to the place where we hold the hearing. If the travel is only in the United States, we measure the distance from the person's home or office, whichever the person travels from.

We have a limit on how much we can pay your representative for travel costs. We cannot pay your representative more than a maximum amount set for the area where we hold the hearing. If you or your representative want more information about this, please contact the Disability Hearing Unit.

 

Asking For Payment Of Travel Costs

 

You or the person asking for payment must give the Disability Hearing Officer proof of the travel costs. The request for payment and proofs can be given at the hearing. If you expect to have unusual costs, contact the Disability Hearing Unit right away. Some examples of unusual costs are: ambulance, attendant services, meals, lodging or taxicabs. The Disability Hearing Officer must approve payment for these unusual costs before the hearing, unless these costs are unexpected or unavoidable.

 

Payment For Travel Costs Before The Hearing

 

If you need payment for travel costs before the hearing, contact the Disability Hearing Unit right away. If we pay the travel costs before the hearing, you must give the Disability Hearing Officer proof of the actual costs within 20 days after your trip. If we pay you too much, you will have to pay back the extra money within 20 days from the day we tell you how much you owe.

 

Need More Help?

 

1. If you have any questions, you should call the Disability Hearing Unit at the telephone number shown above. We can answer your questions over the phone.

2. Visit www.ssa.gov for fast, simple, and secure online service.

3. If you are in the United States, American Samoa, Guam, Northern Mariana Islands, Puerto Rico, or the U.S. Virgin Islands, call us at 1-800-772-1213. If you are deaf or hard of hearing, call TTY 1-800-325-0778.

4. You may also call your local Social Security office.  

 

If you are outside the United States or its territories:  

• •

  If you are in Canada, visit (8) to find the office that services your area. 

• •

  Contact your nearest Federal Benefits Unit (FBU). Visit (9) for a list of FBUs.

• •

  Write to the Social Security Administration at:

  P.O. Box 17769 Baltimore, Maryland 21235-7769, USA

 

If you contact us, please refer to this letter. It will help us answer your questions.

 

How Are We Doing? Go to www.ssa.gov/feedback to tell us.

 

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