I-2-6-99.Sample - Waiver by Claimant of Right to Inspect Additional Evidence Under the Provisions of Privacy Act of 1974

WAIVER BY CLAIMANT

TO PROVISIONS OF PRIVACY ACT OF 1974 PERTAINING TO EVIDENCE

RECEIVED SUBSEQUENT TO HEARING

I hereby waive my right to inspect, prior to decision, any additional information received by the Administrative Law Judge in connection with my application for benefits under the Social Security Act, as amended, and request that the information obtained be made a part of the record in my case and considered by the Administrative Law Judge in determining his decision in this matter.