Claimant request for hearing form 2025

1. Click ‘Get Form’ to open the claimant request for hearing form in the editor.
2. Begin by entering the last four digits of your Social Security Number (SSN) in the designated field.
3. Print your name clearly in the provided space to ensure accurate identification.
4. Indicate your disagreement with the Notice of Determination(s) by filling in the date and providing a reason if desired.
5. Complete the section regarding your last employer’s name and physical work location, ensuring all details are accurate.
6. If applicable, specify any dates you are unavailable for a hearing and indicate if you require a language other than English.
7. Fill out your contact information, including phone number, email, and mailing address, ensuring clarity for communication.
8. Finally, sign and date the form before submitting it through our platform or mailing it to the specified address.

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