TN 5 (09-22)

DI 33010.090 Language for Cancelling or Postponing a Scheduled Disability Hearing — Exhibit

We are writing about your Disability Hearing.

Your hearing scheduled for (1) has been (2) . (3) .

(4)

 

Need More Help?

 

1. If you have any questions, you can call the Disability Hearing Unit. The number is (5) .

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

3. Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm. If you are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention this letter when you call.

4. You may also call your local office at (6) (Field Office General Inquiry Line phone number).

(7) (Office name)

(8)

(9)

(10)

(11)

(12)

 

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

 

Fill-ins:

1. 1. 

   Date of hearing (in the format “January 1, 2022”

2. 2. 

   Hearing action taken

   Choice 1: postponed

   Choice 2: cancelled

3. 3. 

   Reason hearing was postponed/cancelled

4. 4. 

   Reschedule statement

   Choice 1: If hearing is postponed USE: “We will let you know when we set a new date and place for your hearing.”

   Choice 2: If hearing is cancelled USE: NULL
   

5. 5. 

   DHU phone number

6. 6. 

   FO Phone contact info

   Choice 1 – Business Number from DOORS (Preferred choice when present)

   Choice 2 – T2 Number from DOORS for T2 Notices (Use only when Business Number is not present)

   Choice 3 – T16 Number from DOORS for SSI Notices (Use only when Business Number is not present)

7. 7. 

   Line 1 of FO Address in DOORS

8. 8. 

   Line 2 of FO Address in DOORS

9. 9. 

   Line 3 of FO Address in DOORS

10. 10. 

    Line 4 of FO Address in DOORS

11. 11. 

    Line 5 of FO Address in DOORS

12. 12. 

    Line 6 of FO Address in DOORS

    Choice 1 - Line 6 of FO Address in DOORS

    Choice 2 – Null (use when address is less than 6 lines)