Basic (05-05)

HI 03094.701 Hearing Appointment

A. Purpose/Use

The Hearing Appointment notice advises the individual of the date and time of the telephone appointment. This notice is created in the Document Generation System (DGS) used in the Subsidy Appeals Unit.

B. Sample Hearing Appointment Notice


Social Security Administration

Medicare Prescription Drug Assistance

Hearing Appointment Notice



                                                                  SDS return address

Date: November 23, 2005

                                                                  Social Security Number: 123-00-6789








We have received your request for a hearing by telephone on your Application for Help with Medicare Prescription Drug Plan Costs. This letter tells you about the hearing process and how to prepare for the hearing.


The Hearing Appointment


The time and date scheduled for your hearing is (time and date).


The telephone number we will use to contact you for the hearing is 999-999-9999.


We will call you at this number. If it is not correct, please call us right away toll-free at 1-800-772-1213 with the correct number.


Please be ready at least 15 minutes before the scheduled time.


Conference Call Instructions (replace the above 3 paragraphs with this UTI for conference calls)


You indicated on the appeal form that you will have other people present at the hearing talking to us from more than one telephone number. We will use a telephone conference call to conduct the hearing.


At least 15 minutes before the scheduled time, all participants must call us at this number: 1-800-123-4567. The pass code for the call is 9999. We will begin the hearing when everyone has called in.


About the Hearing


During the call, we will discuss (hearing issue).


The hearing is your chance to show that the issues should be decided in your favor. Therefore, we need to make sure that your file has everything you want us to consider. You are responsible for submitting any additional evidence. After we review the evidence in the file, we may ask for more evidence to consider at the hearing. You can have a lawyer, friend, or other party present at the telephone hearing. You may ask us to issue a subpoena that requires a person to submit documents or testify at your hearing.


We will make a decision based on the information in the file and any additional information you provide.


Providing Additional Information


If there is more information you want us to see, please send it to us within 10 days from the date of this notice. You can mail the information to Social Security Administration, (address to be determined) or you can call us at (special 800#). If you need help, you should contact us immediately.


You May See The Information In Your File


If you wish to see the information in your file, you may do so before the date of the review of your case. If you wish to review the file, please call us toll-free at (phone number of SAU).


If You Want To Reschedule Or Change Phone Numbers


If you cannot be present at the time of the hearing, please call us to reschedule. If you change your phone number, you need to notify us right away at (special 800#). If you do not reschedule and are not present at the time of the hearing, we will make a decision based solely on the information currently in your file.


When You Will Receive a Decision


We will send another notice when we make a decision on the issue(s).


If You Have Any Questions


For information about Medicare prescription drug plans or other Medicare issues, visit on the Internet or call toll-free 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing, you may call the Medicare TTY number toll-free at 1-877-486-2048.


For information about the extra help with the costs related to Medicare prescription drug plans or general information about Social Security, visit our website at on the Internet. You may also call Social Security toll-free at 1-800-772-1213. If you are deaf or hard of hearing, you may call our TTY number toll-free at 1-800-325-0778. We can answer most questions by phone.


If you do call, please have this letter with you. It will help us answer your questions.



                                                                             Subsidy Determination Unit Manager


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HI 03094.701 - Hearing Appointment - 05/05/2008
Batch run: 07/08/2013