Last Update: 9/2/05 (Transmittal I-2-64)
IN THE MATTER OF
Social Security Number
I have requested a postponement of my hearing so that I may obtain a representative to help me in my claim for benefits. I understand that I am entitled to have only one postponement in order to obtain a representative (either an attorney or other qualified representative) and that any subsequent hearing will be rescheduled at least 20 days from today.
I have been advised, both orally and in writing, that if I do not have a representative by the next scheduled hearing, I must be prepared to proceed with the hearing without a representative and, absent extraordinary circumstances, no further postponement will be granted in order for me to get a representative.
Signature of Claimant
Witness Exhibit no. ______