Check block 1 and the statements that apply, or check block 2.
Block 1: the claimant and/or the representative wish to appear at a disability hearing. The disability hearing will be with a person called a disability hearing officer.
Block 2: the claimant does not wish to appear and requests that a decision be made based on the evidence in the case.
Waiver: Complete SSA-773 Waiver of Right to Appear - Disability Hearing.
Interpreter: if you need an interpreter, SSA will provide one at no cost to you.
Signature: No signature is required on the SSA-789 to process a reconsideration request.
| Question | Answer |
|---|---|
| Form Name | Form SSA-789 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 42 |
| Avg. time to fill out | 7 min |
| Edition | 04-2026 |
| Issuing agency | Social Security Administration |
| Other names | SSA-789, SSA789, SSA 789, Form SSA-789, SSA-789-U4, Form 789, Request for Reconsideration, Disability Cessation |
| Official source | Form SSA-789 (Rev 04-2026), Social Security Administration |
Ssa 789 U4 Form isn’t the one you’re looking for?