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10. To give you time to prepare for the hearing, we must allow at least 20 days between the date
of your request and the date we schedule the hearing. Do you want a hearing sooner if
scheduling permits?
YES
NO
11. Do you need an interpreter?
YES (Specify language):
NO
12. Are you hearing impaired?
YES
NO
13. Will you have other people at the hearing?
YES
NO
If YES, will you and the other people need to talk to us from more than one telephone number?
We call this a conference call. When we send you the notice scheduling the hearing,
YES
we will give you a telephone number to use for this conference call and additional
instructions for setting up this call.
NO
Please return your completed appeal form, including the signature page, and any additional
information to:
Social Security Administration
Wilkes-Barre Data Operations Center
P.O. Box 1030
Wilkes-Barre, PA 18767-1030
Form SSA-1021 (07-2014)
Page 2

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