ICE) NAME OF CLAIMANT SOCIAL SECURITY NUMBER NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON (if different from Claimant) SOCIAL SECURITY NUMBER Page 1 of 2 OMB No. 0960-0349 FOR SOCIAL SECURITY OFFICE USE ONLY (DO NOT WRITE IN THIS SPACE) FO Code Benefit Continuation SPOUSE'S NAME AND SOCIAL SECURITY NUMBER (COMPLETE ONLY IN SUPPLEMENTAL SECURITY INCOME CASE) TYPE OF BENEFIT DISABILITY WORKER WIDOW Foreign Language Notice SSI CHILD DISABILITY BLIND CHILD I DO NOT AGREE WITH THE DETERMI.
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How to fill out the Form SSA-789 Request For Reconsideration--Disability online
This guide provides a clear and detailed process for filling out the Form SSA-789, which is used to request reconsideration of a disability cessation decision. By following the outlined steps, users can navigate the form efficiently and ensure that all necessary information is submitted correctly.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to access the form and open it in the editing interface.
- Complete the 'Name of Claimant' field by entering the full name of the individual requesting reconsideration. Ensure that spelling is accurate and formatted correctly.
- Enter the 'Social Security Number' of the claimant in the designated field. Double-check this information to prevent any processing delays.
- If different from the claimant, fill in the 'Name of Wage Earner or Self-Employed Person,' along with their 'Social Security Number.' This is necessary for cases involving a spouse or a dependent.
- Indicate the 'Type of Benefit' by selecting the relevant option, such as Disability Worker, Widow, Child Disability, etc. This clarifies the benefits being reconsidered.
- In the section stating ‘I do not agree with the determination to stop disability benefits and I request reconsideration,’ explain your reasons in detail. Be specific about your circumstances related to the cessation.
- If the notice regarding your benefits was received over 65 days ago, explain the reason for the delay in submitting this request. Include the date of the notice to provide context.
- Include any ‘Additional Information’ you wish to submit by either writing it directly or attaching a separate page if necessary. If there’s no additional information, write 'NONE.'
- Choose to check either Block 1 or Block 2, indicating your preference for a hearing or not. If you need an interpreter for the hearing, specify the language required.
- Complete the address fields for both the claimant and the representative, if applicable. Ensure the 'Street Address,' 'City,' 'State,' and 'ZIP Code' are correctly filled in.
- Enter the telephone numbers for both the claimant and the representative, along with their respective dates.
- Review all information for accuracy. Once confirmed, proceed to save changes, download, print, or share the form as necessary.
Take action today by completing your Form SSA-789 online to ensure your benefits are reconsidered promptly.
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