Request for Change in Time/Place of Disability Hearing

OMB 0960-0348

Claimants use Form SSA-769 to request a change in the time or place of a scheduled disability hearing. Disability hearing officers (DHO) use the form to determine whether to grant the requested change. When DHOs grant the request, they also use the form to reschedule and document the hearing. Respondents are claimants who wish to request a change in time or place of their hearing.

The latest form for Request for Change in Time/Place of Disability Hearing expires 2022-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-769 Request for Change in Time/Place of Disability Hearing Form
Supporting Statement - 0348 (Final).docx Supporting Statement A
Addendum - 0348 (Final).docx Supplementary Document
Request for Change in Time/Place of Disability Hearing Form

All Historical Document Collections

202201-0960-003 Approved without change	Revision of a currently approved collection	2022-05-25
201810-0960-009 Approved without change	Revision of a currently approved collection	2019-02-04
201511-0960-002 Approved without change	Revision of a currently approved collection	2016-02-23
201301-0960-003 Approved without change	Revision of a currently approved collection	2013-04-23
201004-0960-009 Approved without change	Revision of a currently approved collection	2010-08-05
200707-0960-004 Approved without change	Extension without change of a currently approved collection	2007-08-23
200408-0960-005 Approved without change	Extension without change of a currently approved collection	2004-08-20
200108-0960-004 Approved without change	Extension without change of a currently approved collection	2001-08-08
199808-0960-008 Approved without change	Extension without change of a currently approved collection	1998-08-31
199506-0960-015 Approved without change	Revision of a currently approved collection	1995-06-30
199207-0960-002 Approved without change	Revision of a currently approved collection	1992-07-01
198906-0960-009 Approved without change	Revision of a currently approved collection	1989-06-28
198904-0960-031 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-25
198709-0960-010 Approved with change	No material or nonsubstantive change to a currently approved collection	1987-09-01
198606-0960-005 Approved without change	Revision of a currently approved collection	1986-06-12
198508-0960-043 Approved with change	No material or nonsubstantive change to a currently approved collection	1985-08-15
198308-0960-007 Approved without change	New collection (Request for a new OMB Control Number)	1983-08-12