Ssa 789 u4 request for reconsideration 2026

1. Click ‘Get Form’ to open the SSA 789 U4 request for reconsideration in the editor.
2. Begin by entering your name and Social Security number in the designated fields. If applicable, include the name and Social Security number of the wage earner or self-employed person.
3. Indicate your type of benefit by checking the appropriate box (e.g., Disability Worker, Widow, SSI).
4. In the section stating your disagreement with the determination, clearly outline your reasons for requesting reconsideration. Be specific and relate your reasons to the basis for stopping benefits.
5. If you are submitting additional information, note it in the provided space. Attach any necessary documents if needed.
6. Choose whether you wish to appear at a disability hearing by checking Block 1 or Block 2. If you need an interpreter, specify the language required.
7. Sign and date the form at the bottom. Ensure that either you or your representative signs it. If signed by mark (X), include two witnesses' signatures.

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