Anyone who knowingly makes or causes to be made a false statement or representation of material fact for use in determining a payment under the Social Security Act, or knowingly …

Form SSA-789 (04-2016) UF Discontinue Previous Editions. Page 1 of 2 Social Security Administration. REQUEST FOR RECONSIDERATION - DISABILITY CESSATION RIGHT TO APPEAR (SEE REVERSE SIDE FOR PAPERWORK/PRIVACY ACT NOTICE) OMB No. 0960-0349. FOR SOCIAL SECURITY OFFICE USE ONLY (DO NOT WRITE IN THIS SPACE) FO …

Complete only one SSA-789 on all claims for entitlement where the individual has received a cessation notice (s). Upon receipt in the field office (FO), the SSA-789 must be date-stamped at the top of the form.

All forms are FREE. Not all forms are listed. If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office and we will help you.

Ask us to reconsider a decision you don't agree with. Once you receive a decision, submit a request for a disability or non-medical reconsideration within 60 days. An examiner from a …

The top of form SSA-789 is dedicated to basic personal information such as your name and Social Security number. If you are filing for SSI, you will also be required to include your spouse’s information.

Anyone who knowingly makes or causes to be made a false statement or representation of material fact for use in determining a payment under the Social Security Act, or knowingly conceals or fails to disclose an event with an intent to affect an initial or continued right to payment, or submits or causes to be submitted any false statement or doc...

2024年12月5日 · Form SSA-789 (XX-XXXX) UF Page 2 of 2 Anyone who knowingly makes or causes to be made a false statement or representation of material fact for use in determining a payment under the Social Security Act, or knowingly conceals or fails to disclose an event with an intent to affect an initial or continued right to payment, or submits or causes to ...

Form SSA-789 Request for Reconsideration--Disability Cessation ⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0349 can be found here:

DI 33095.005 Request for Reconsideration-Disability Cessation (SSA-789-U4) To view this form, go to SSA-789–U4. This website is produced and published at U.S. taxpayer expense.