I-2-6-97.Sample - Acknowledgement of Postponement In Order to Obtain Representation

Last Update: 9/2/05 (Transmittal I-2-64)

Acknowledgment of Postponement In Order To Obtain Representation

IN THE MATTER OF

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Claimant

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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.

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Signature of Claimant

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Date

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Witness                                                                      Exhibit no. ______