Form HA4608 Download Fillable PDF or Fill Online Waiver of Your Right
Form Ha 501 U5. 1383(e)(1)(a) and (b)), 1839(i) (42 u.s.c. Collection and use of personal information sections 205(a) (42 u.s.c.
Form HA4608 Download Fillable PDF or Fill Online Waiver of Your Right
902), 1631(e)(1)(a) and (b) (42 u.s.c. Collection and use of personal information sections 205(a) (42 u.s.c. I have additional evidence to submit. To request a hearing, you may use this form or write a letter. Do not complete if the appeal is a medicare issue. I disagree with the determination because: 1383(e)(1)(a) and (b)), 1839(i) (42 u.s.c. Complete processing and development of the request for hearing as instructed in this section. Request for hearing by administrative law judge. To your local social security office, the veterans affairs
Claim number, if different 4. Claim number, if different 4. Otherwise, check one of the blocks i wish to appear at a hearing. Request for hearing by administrative law judge. Collection and use of personal information sections 205(a) (42 u.s.c. To your local social security office, the veterans affairs Do not complete if the appeal is a medicare issue. 1395r), and 1869(b)(1) and (c) (42 902), 1631(e)(1)(a) and (b) (42 u.s.c. I have additional evidence to submit. I request a hearing before an administrative law judge.
