
ORK ACT statement on reverse and the statements below. Then print, write, or type your response to the statements in the space provided below. If you need additional space, attach a separate page to this form. NAME OF DECEASED CLAIMANT CLAIM FOR WAGE EARNER'S NAME (Leave blank if same as above) SOCIAL SECURITY NUMBER I have been informed that the claimant had requested a hearing but died before action on the request was completed. I understand that the deceased claimant's request for hearin.
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How to fill out the Omb No 0960 0289 online
Filling out the Omb No 0960 0289 form is an essential step for individuals seeking to substitute a party upon the death of a claimant. This guide provides clear, step-by-step instructions to help you navigate and accurately complete the form online.
Follow the steps to complete the Omb No 0960 0289 form online.
- Press the ‘Get Form’ button to obtain the Omb No 0960 0289 form and open it for editing.
- Begin by entering the name of the deceased claimant in the designated field. Ensure the spelling is accurate, as this is crucial for the processing of your request.
- If applicable, fill out the wage earner's name; leave this section blank if it is the same as the deceased claimant's name.
- Enter the social security number of the deceased claimant in the provided space.
- Select your relationship to the deceased claimant by checking the appropriate box. Options include 'Widow/Widower', 'Surviving Divorced Spouse', or 'Other'. If you check 'Other', describe your relationship in the space provided.
- If you have in your care any children under the age of 16 or disabled children of the deceased, check the relevant box.
- Choose your desired course of action by checking either option 1 or 2: (1) to proceed as a substitute party for the hearing, or (2) to come to the hearing in person or request a decision be made without a hearing.
- Sign the form using your full name, making sure to include your first name, middle initial, and last name.
- Indicate the date you are completing the form by entering the month, day, and year.
- Provide your area code and telephone number in the appropriate section.
- Enter your mailing address, including the number and street address, city, state, and ZIP code.
- Once you have completed the form, save any changes you have made. You can then download, print, or share the form as needed.
Complete the Omb No 0960 0289 form online to ensure timely processing of your claim.
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