TN 11 (08-23)

DI 12026.026 Completion of the SSA-769-U4 Request for Change in Time/Place of Disability Hearing

A. Overview of the SSA-769-U4

The individual has the right to request a change in the time or place of a scheduled disability hearing; however, the disability hearing unit (DHU) decides whether to reschedule the hearing. The SSA-769-U4 allows the individual or an appointed representative to request a change in the time or place of a scheduled disability hearing or both.

B. Completing a request for changing a currently scheduled hearing

Complete the SSA-769-U4 as follows:

  1. 1. 

    Complete the identifying information following the same format used to complete the SSA-789 (Request for Reconsideration-Disability Cessation Right to Appear). For additional information on completing form SSA-789, see, DI 12026.021B.

  2. 2. 

    Complete the type of benefit - Title II Social Security Disability Insurance (Disability) and/or Title XVI Supplemental Security Income (SSI).

  3. 3. 

    Complete the identifying information of the appointed representative, if applicable.

  4. 4. 

    Complete the information regarding the scheduled hearing including the date, time, and location.

    • If a postponement is requested, the individual must indicate the number of days needed for the postponement.

    • If the request is for a change in location, specifically indicate the proposed new location and reason for the requested change.

  5. 5. 

    Enter the reason for the request. The DHU will not grant a postponement if the individual cannot show good cause. For additional information on reasons for requesting a change in time or place, see paragraph C, below.

  6. 6. 

    Ensure the individual or appointed representative completes the identifying information in the designated space and signs the form.

  7. 7. 

    Witnesses’ signature are only required if the individual signs their name with the mark ‘X.’ If this occurs, the witness(es) must sign in the designated spaces, providing their name, address, area code and telephone number.

  8. 8. 

    Notify the DHU by telephone if the individual requests to reschedule a hearing fewer than 10 days before the scheduled hearing date. For additional information, see, DI 33010.005E Scheduling, Postponing, Changing Place of Disability Hearing.

C. Reason for the request

  1. 1. 

    Good cause

    The DHU will not grant a request to postpone or change the time of a hearing unless the individual can show good cause. The individual should state specifically their reason for requesting a change in the time or location of a hearing. For example, “I am scheduled to go into the hospital that week, and the facility is outside of my town,” or “I have a new doctor giving me extra tests that will not be completed until ____.”

  2. 2. 

    Change in a specific date or time

    Inform the individual that the DHU may not be able to accommodate requests for changes in specific dates or times. For additional information regarding ‘good cause’ reasons to postpone or change the date or time of a disability hearing, see:

  • DI 33010.040 Transfer of Case to a Different DHU and,

  • DI 33010.005E Scheduling, Postponing, Canceling or Changing Place of Disability Hearing

    Note: To the extent possible, the DHU will make every attempt to grant requests for changes in a hearing location. However, no reimbursement is available for additional travel due to changes in the hearing location.

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DI 12026.026 - Completion of the SSA-769-U4 Request for Change in Time/Place of Disability Hearing - 08/01/2023
Batch run: 08/01/2023