Witness Information Form – Income Security Appeal

Large-print version of official source

Witness Information Form – Income Security Appeal (PDF 336.11 KB)

Complete this form if you plan to bring a witness (other than yourself) to your hearing. If you expect to bring more than one witness, send us additional copies of this form OR use extra pages. You can find this form on the Tribunal’s website here: https://www.sst-tss.gc.ca/en/your-appeal/social-security-tribunal-forms

IMPORTANT: If you are bringing a witness, you are responsible for notifying them of the date and time of the hearing.

1 - Appeal and Party information

Tribunal File Number

Party name

2 - Witness identification

First name

Last name

Relationship to the party bringing them to the hearing

3 - Language and Interpreters

Specify the language the witness will use to testify:

English

French

Other

At the hearing, they will need an interpreter. (The Tribunal will get the interpreter for them.)

The interpreter must speak this / these language(s):

Witness dialect or country of origin (if applicable):

4 - Witness information for witnesses testifying in their professional capacity

This section is optional for health professionals who treated the person asking for benefits.
This section is mandatory for all other professionals (such as a non-treating physician, or professionals outside the health sector).

Attach a copy of their résumé.

This witness will give evidence about information in the following documents in the appeal file:

OR

Here is a summary of the evidence this witness will give. Attach extra pages if necessary:

5 - Alternate arrangements

We want to ensure that people can participate; to find out more on our policy and how to request see our website:
www.sst-tss.gc.ca/en/decisions-laws-and-policies/social-security-tribunal-acommodation-and-accessibility-policy

How to submit this application

Send us a copy of this form by email, fax, or mail.

Email:
info.sst-tss@canada.gc.ca

Fax:
1‑855‑814‑4117 (toll-free in Canada and the United States)
1‑613‑941‑5121 (long distance charges may apply)

Mail:
Social Security Tribunal of Canada
PO Box 9812
Station T
Ottawa ON K1G 6S3

Questions?

Email us at info.sst-tss@canada.gc.ca or call us at 1-877-227-8577 (toll-free in Canada or the United States) or 1-613-437-1640 (from outside Canada and the United States – long distance charges may apply).

TTY–for those who are deaf or hard of hearing:1-866-873-8381 (toll-free in Canada and the United States) or1-613-948-8181 (from outside Canada and the United States – long distance charges may apply).

You can call us from 7:00a.m. to 7:00p.m. Eastern Time – Monday to Friday. Please leave a message if we can’t answer the phone and we’ll call you back.

Website: www.sst-tss.gc.ca/en

Tips

Email is the fastest way to send us information.
You must tell us if your contact information changes. If we can’t reach you, we may proceed in your absence.
Keep all letters or documents we send you. They are numbered for easy reference and will be needed at your hearing.
If you change your representative, tell us right away.
Everything you send us must be in either English or French: If you need information about translation, visit our website here: www.sst-tss.gc.ca/en/your-appeal/interpreters-and-translation