HA-4608

WAIVER OF YOUR RIGHT TO PERSONAL APPEARANCE BEFORE AN ADMINISTRATIVE LAW JUDGE

Download and Print the HA-4608

Claimant - Wage Earner (Leave blank if same as claimant) - Social Security Claim Number

NOTE:
Please read the PRIVACY 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 more space, attach a separate page to this form.

I have been advised of my right to appear in person before an Administrative Law Judge.

I understand that my personal appearance before an Administrative Law Judge would provide me with the opportunity to present written evidence, my testimony, and the testimony of other witnesses.

I understand that this opportunity to be seen and heard could be helpful to the Administrative Law Judge in making a decision.

Although my right to a personal appearance before an Administrative Law Judge has been explained to me, I do not want to appear in person.

I want to have my case decided on the written evidence. The reason I do not want to appear in person at a hearing is:

And much more...