Waiver of Right to Personal Appearance Before a Judge

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SOCIAL SECURITY ADMINISTRATION
Refer To: Claimn
[ClaimantFirstName] [ClaimantMiddleName]
[ClaimantLastName] [ClaimantSuffix]
BNC#: [BeneficiaryNoticeControl]

[LocalOfficeAddress]
Tel: [LocalOfficePhone] / Fax:
[LocalOfficeFax]
[Today's Date]

<if Rep>
[RepFirstName][RepMiddleName][RepLastName][RepSuffix]
[RepFirmName]
[RepAddress]
<elseif OBO>[OBOFirstName] [OBOMiddleName][OBOLastName][OBOSuffix] on behalf of
[ClaimantFirstName][ClaimantMiddleName][ClaimantLastName][ClaimantSuffix]
[OBO Address]
<else>
[ClaimantFirstName][ClaimantMiddleName][ClaimantLastName][ClaimantSuffix]
[ClaimantAddress]
<endif>
Dear <if Rep>[RepFirstName][RepMiddleName][RepLastName][RepSuffix]<elseif OBO>
[OBOFirstName][OBOMiddleName][OBOLastName][OBOSuffix]<else>[ClaimantFirstName]
[ClaimantMiddleName][ClaimantLastName][ClaimantSuffix]<endif>:
<if SNO indicator=3, 4, 6 or 7>You will receive this document in both a <if SNO=3
Braille>standard print and Braille version. <elseif SNO=4 DataCD>standard print version and on
a compact disc in Microsoft Word format. <elseif SNO=6 Audio Disc>standard print version and
on an audio compact disc. <elseif SNO=7 Large Print>standard print and large print
version.<endif> You will receive them separately.<endif>
Please complete the enclosed HA-4608 (Waiver of Your Right To Personal Appearance Before
A Judge) and return it to us as soon as possible. <else> [Claimant] You may also complete and
submit this form online by accessing the following webpage: https://www.ssa.gov/forms/ha4608.html or online through https://www.ssa.gov/myaccount/.
<if Rep>Registered representatives should use the “Upload New File” function available when
viewing a claimant's electronic folder in Appointed Representative Services (ARS), the
application that provides you with electronic folder access, to upload documents. This process
does not require a barcode. Alternatively, representatives can also submit documents with a
barcode using the “Send Individual Response” function in ARS or the Electronic Records
Express, the application that can only be used to upload documents. Representatives should use
these methods to submit any documents to us electronically, whenever possible.<endif>

Form HA-4608
<if ClmtCopy>Claimant<elseif RepCopy>Representative<endif>

See Next Page

If You Have Any Questions
If you have any questions, please call or write this office. Our telephone number and address are
shown above.

Form HA-4608
<if ClmtCopy>Claimant<elseif RepCopy>Representative<endif>

See Next Page

Sincerely,

Social Security Administration
Enclosures:
HA-4608 (Waiver of Your Right To Personal Appearance Before A Judge)

<if Rep>
cc: <if OBO>[OBOFirstName] [OBOMiddleName][OBOLastName][OBOSuffix]on behalf of
[ClaimantFirstName][ClaimantMiddleName][ClaimantLastName][ClaimantSuffix]
[OBOAddress]
<else>
[ClaimantFirstName][ClaimantMiddleName][ClaimantLastName][ClaimantSuffix]
[ClaimantAddress]
<endif>