The following are sample Notices Of Reconsideration. The shaded paragraphs indicate
paragraphs or revisions of existing paragraphs that can be used in " Stieberger notices."
Situation 1: Disability Approved For All Months (IC)--Not Currently Getting SSI Based on Another
Application
SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
NOTICE OF RECONSIDERATION
|
Office Address: |
|
Office Hours: |
|
Telephone Number: |
|
Social Security Number: |
|
Date: |
Name
Street Address
City/State/Zip Code
We looked at your Supplemental Security Income (SSI) case again to see if we owed
you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.
We decided you are eligible to receive SSI payments. The following chart shows the
amount of SSI money due you and for what months the money is due. This letter will
also tell you more about our decision.
How Much We'll Pay You
From |
Through |
Amount Due Each Month |
MM/DD/YY |
MM/DD/YY |
$xxx.xx |
MM/DD/YY |
MM/DD/YY |
$xxx.xx |
Information About Your Disability
We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had
not applied the special Stieberger rules.
Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you
were disabled. We decided you were disabled beginning MM/YY through MM/YY.
SSA-L8455-U2
Page 2
Your Payment Is Based On These Facts
-
•
You first met all requirements for eligibility on MM/DD/YY. The law prohibits payment
of benefits for any days in a month before you meet all eligibility requirements.
-
•
You were living in the State of XXX for MM/YY on.
-
•
The amount of money we pay you from the State where you live depends on its rules.
--You are living with others in the County of YYY in the State of XXX for MM/YY on.
-
•
You have monthly income which must be considered in figuring your payment as follows:
--Your assistance payments based on need of $xxx.xx for MM/YY through MM/YY.
Information About Your Back Payment
We are sending you a Supplemental Security Income check for $xxx.xx in MM/ YY. We
will not count the part of this money which was due for back payments as your resource
for 6 months. If the money is not spent before MM/DD/YY, we will count any money left
over as part of your resources. But things bought with this money may count as resources
the month after they are bought. Your Social Security office can tell you which things
count as resources. You cannot get SSI if the resources we count have a value of more
than $2000.00.
Information About Medicaid
An agency of your State will advise you about the Medicaid program. If you have questions
about your eligibility for Medicaid or need immediate medical assistance, you should
get in touch with (name of State agency).
Things To Remember
-
•
Payments may change if your circumstances change. Therefore, you are required to report
any change in your situation that may affect your Supplemental Security Income payment.
For example, you should tell us if you move, if anyone else moves from or into your
household, if your marital status changes, if income or resources for you or members
of your household change, if you stop or start attending school regularly, if your
medical condition improves or if you go to work.
Page 3
Read the booklet “When You Get SSI-What You Need to Know” carefully for additional information about this requirement.
-
•
The doctors and other trained personnel who decided that you are disabled believe
that your health may improve. Therefore, we will review your case in about 3 years.
We will send you a letter before we start the review. Based on that review, your SSI
will continue if you are still disabled. But it will end if you are no longer disabled.
If You Disagree With The Decision
If you disagree with the decision, you have the right to ask for a hearing before
an Administrative Law Judge (ALJ). The ALJ will review your entire case, even the
parts you agree with. The ALJ also will consider any new facts you have and then will
make a new decision. The new decision could be more favorable to you than the one
you already have. But, keep in mind that the new decision also could be the same as
or less favorable than the decision you already have.
-
•
You have 60 days to ask for a hearing.
-
•
The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason if you wait more than 60 days to ask for a hearing.
-
•
You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called
“Request for Hearing.” Contact one of our offices if you want help.
How The Hearing Process Works
The ALJ will mail you a letter at least 20 days before the hearing to tell you its
date, time and place. The letter will explain the law in your case and tell you what
has to be decided. Since the ALJ will review all the facts in your case, it is important
that you give us any new facts as soon as you can.
The hearing is your chance to tell the ALJ why you disagree with the decision in your
case. You can give the ALJ new evidence and bring people to testify for you. The ALJ
also can require people to bring important papers to your hearing and give facts about
your case. You can question these people at your hearing.
Page 4
Please read the enclosed pamphlet "Your Right To An Administrative Law Judge Hearing
And Appeals Council Review Of Your Social Security Case." It has more information
about the hearing.
It Is Important To Go To The Hearing
It is very important that you go to the hearing. If for any reason you can't go, contact
the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule
the hearing if you have a good reason.
If you don't go to the hearing and don't have a good reason for not going, the ALJ
may dismiss your request for a hearing.
If You Want Help With Your Hearing
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your hearing.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it.
If You Have Any Questions
If you have any questions, you may call, write or visit any Social Security Office.
If you call or visit our office, please have this letter with you and ask for (name
of field office contact). The telephone number is shown at the top of page 1.
Also, if you plan to visit an office, you may call ahead to make an appointment. This
will help us serve you more quickly.
Enclosures (2)
Situation 2: Disability Denied For Some Months (IC)--Not Currently Getting SSI Based on Another
Application
SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
NOTICE OF RECONSIDERATION
|
Office Address: |
|
Office Hours: |
|
Telephone Number: |
|
Social Security Number: |
|
Date: |
Name
Street Address
City/State/Zip Code
We looked at your Supplemental Security Income (SSI) case again to see if we owed
you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.
We decided you are eligible to receive SSI payments. The following chart shows the
amount of SSI money due you and for what months the money is due. This letter will
also tell you more about our decision.
How Much We'll Pay You
From |
Through |
Amount Due Each Month |
MM/DD/YY |
MM/DD/YY |
$xxx.xx |
MM/DD/YY |
MM/DD/YY |
$xxx.xx |
Information About Your Disability
We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had
not applied the special Stieberger rules.
Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you
were disabled. We decided you were disabled beginning MM/YY through MM/YY. We decided
you were not disabled for MM/YY because (reason for denial for those months).
SSA-L8455-U2
Page 2
Your Payment Is Based On These Facts
-
•
You first met all requirements for eligibility on MM/DD/YY. The law prohibits payment
of benefits for any days in a month before you meet all eligibility requirements.
-
•
You were living in the State of XXX for MM/YY on.
-
•
The amount of money we pay you from the State where you live depends on its rules.
--You are living with others in the County of YYY in the State of XXX for MM/YY on.
-
•
You have monthly income which must be considered in figuring your payment as follows:
--Your assistance payments based on need of $xxx.xx for MM/YY through MM/YY.
Information About Your Back Payment
We are sending you a Supplemental Security Income check for $xxx.xx in MM/ YY. We
will not count the part of this money which was due for back payments as your resource
for 6 months. If the money is not spent before MM/DD/YY, we will count any money left
over as part f your resources. But things bought with this money may count as resources
the month after they are bought. Your Social Security office can tell you which things
count as resources. You cannot get SSI if the resources we count have a value of more
than $2000.00.
Information About Medicaid
An agency of your State will advise you about the Medicaid program. If you have questions
about your eligibility for Medicaid or need immediate medical assistance, you should
get in touch with (name of State agency).
Things To Remember
-
•
Payments may change if your circumstances change. Therefore, you are required to report
any change in your situation that may affect your Supplemental Security Income payment.
For example, you should tell us if you move, if anyone else moves from or into your
household, if your marital status changes, if income or resources for you or members
of your household change, if you stop or start attending school regularly, if your
medical condition improves or if you go to work.
Page 3
Read the booklet "When You Get SSI-What You Need to Know" carefully for additional information about this requirement.
-
•
The doctors and other trained personnel who decided that you are disabled believe
that your health may improve. Therefore, we will review your case in about 3 years.
We will send you a letter before we start the review. Based on that review, your SSI
will continue if you are still disabled. But it will end if you are no longer disabled.
If You Disagree With The Decision
If you disagree with the decision, you have the right to ask for a hearing before
an Administrative Law Judge (ALJ). The ALJ will review your entire case, even the
parts you agree with. The ALJ also will consider any new facts you have and then will
make a new decision. The new decision could be more favorable to you than the one
you already have. But, keep in mind that the new decision also could be the same as
or less favorable than the decision you already have.
-
•
You have 60 days to ask for a hearing.
-
•
The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason if you wait more than 60 days to ask for a hearing.
-
•
You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called
“Request for Hearing.” Contact one of our offices if you want help.
How The Hearing Process Works
The ALJ will mail you a letter at least 20 days before the hearing to tell you its
date, time and place. The letter will explain the law in your case and tell you what
has to be decided. Since the ALJ will review all the facts in your case, it is important
that you give us any new facts as soon as you can.
The hearing is your chance to tell the ALJ why you disagree with the decision in your
case. You can give the ALJ new evidence and bring people to testify for you. The ALJ
also can require people to bring important papers to your hearing and give facts about
your case. You can question these people at your hearing.
Page 4
Please read the enclosed pamphlet “Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your
Social Security Case.” It has more information about the hearing.
It Is Important To Go To The Hearing
It is very important that you go to the hearing. If for any reason you can't go, contact
the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule
the hearing if you have a good reason.
If you don't go to the hearing and don't have a good reason for not going, the ALJ
may dismiss your request for a hearing.
If You Want Help With Your Hearing
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your hearing.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it.
If You Have Any Questions
If you have any questions, you may call, write or visit any Social Security Office.
If you call or visit our office, please have this letter with you and ask for (name
of field office contact). The telephone number is shown at the top of page 1.
Also, if you plan to visit an office, you may call ahead to make an appointment. This
will help us serve you more quickly.
Enclosures (2)
Situation 3: Disability Approved But No Money Due Because Individual Ineligible for Nonmedical
Reasons--Individual Not Currently Getting SSI Based on Another Application
SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
NOTICE OF RECONSIDERATION
|
Office Address: |
|
Office Hours: |
|
Telephone Number: |
|
Social Security Number: |
|
Date: |
We have decided you are not eligible to receive Supplemental Security Income (SSI)
payments.
Why We Can't Pay You
We looked at your SSI case again to see if we owed you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.
We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had
not applied the special Stieberger rules.
Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you
were disabled. Even though we decided you were disabled for these months, we cannot
pay you any SSI money because you had too much income for those months.
Our Decision Is Based On These Facts
-
•
You are living in the State of XXX for MM/YY on.
-
•
Whether we can pay you money from the State where you live depends on its rules.
--You are living with others in the County of YYY in the State of XXX for MM/YY on.
SSA-L8456-U2
Page 2
-
•
You have monthly income which must be considered in figuring your eligibility as follows:
--Your Social Security benefits--before deductions for Medicare premiums, if any--of
$xxx.xx for MM/YY on.
Information About Medicaid
Since you are not receiving SSI payments, you are not automatically eligible for medical
assistance under the Medicaid program. However, if you need help with medical bills,
you still may be eligible for medical assistance. Contact (name of State agency) which
handles eligibility for medical assistance about the eligibility requirements of the
State's medical assistance programs.
Things To Remember
-
•
Although you are not eligible for the reasons given above, we have determined that
you are disabled.
-
•
This decision refers only to your claim for SSI payments.
-
•
If at any time in the future you think you qualify for payment, please contact us
immediately about filing a new application. We cannot make payment for any month before
the month in which you apply.
If You Disagree With The Decision
If you disagree with the decision, you have the right to ask for a hearing. At the
hearing, a person who has not seen your case before will look at it. That person is
an Administrative Law Judge (ALJ). The ALJ will review your case and consider any
new facts you have.
-
•
You have 60 days to ask for a hearing.
-
•
The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason if you wait more than 60 days to ask for a hearing.
-
•
You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called
"Request for Hearing." Contact one of our offices if you want help.
Page 3
How The Hearing Process Works
The ALJ will mail you a letter at least 20 days before the hearing to tell you its
date, time and place. The letter will explain the law in your case and tell you what
has to be decided. Since the ALJ will review all the facts in your case, it important
that you give us any new facts as soon as you can.
The hearing is your chance to tell the ALJ why you disagree with the decision in your
case. You can give the ALJ new evidence and bring people to testify for you. The ALJ
also can require people to bring important papers to your hearing and give facts about
your case. You can question these people at your hearing.
Please read the enclosed pamphlet "Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of
Your Social Security Case." It has more information about the hearing.
It Is Important To Go To The Hearing
It is very important that you go to the hearing. If for any reason you can't go, contact
the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule
the hearing if you have a good reason.
If you don't go to the hearing and don't have a good reason for not going, the ALJ
may dismiss your request for a hearing.
If You Want Help With Your Hearing
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your hearing. If you get someone to help
you, you should let us know. If you hire someone, we must approve the fee before he
or she can collect it.
New Application
You have the right to file a new application at any time, but filing a new application
is not the same as appealing this decision. If you disagree with this decision and
you file a new application instead of appealing, you might lose some benefits, or
not qualify for any benefits. So, if you disagree with this decision, you should file
an appeal within 60 days.
Page 4
If You Have Any Questions
If you have any questions, you may call, write or visit any Social Security Office.
If you call or visit our office, please have this letter with you and ask for (name
of field office contact). The telephone number is shown above.
Also, if you plan to visit an office, you may call ahead to make an appointment. This
will help us serve you more quickly.
Enclosure
Situation 4: Disability Approved For All Months (PE) (Stieberger Months Outside Current Eligibility
Period)
SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
NOTICE OF RECONSIDERATION
|
Office Address: |
|
Office Hours: |
|
Telephone Number: |
|
Social Security Number: |
|
Date: |
Name
Street Address
City/State/Zip Code
We looked at your Supplemental Security Income (SSI) case again to see if we owed
you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.
We decided you are due more SSI payments. This decision does not affect the payments
you are now getting. The following chart shows the amount of SSI money due you and
for what months the money is due. This letter will also tell you more about our decision.
How Much We'll Pay You
From |
Through |
Amount Due Each Month |
MM/DD/YY |
MM/DD/YY |
$xxx.xx |
MM/DD/YY |
MM/DD/YY |
$xxx.xx |
Information About Your Disability
We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had
not applied the special Stieberger rules.
Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you
were disabled. We decided you were disabled beginning MM/YY through MM/YY.
SSA-L8457-U2
Page 2
Your Payment Is Based On These Facts
-
•
You were living in the State of XXX for MM/YY on.
-
•
The amount of money we pay you from the State where you live depends on its rules.
--You are living with others in the County of YYY in the State of XXX for MM/YY on.
-
•
You have monthly income which must be considered in figuring your payment as follows:
--Your assistance payments based on need of $xxx.xx for MM/YY through MM /YY.
Information About Your Back Payment
We are sending you a Supplemental Security Income check for $xxx.xx in MM/ YY. We
will not count the part of this money which was due for back payments as your resource
for 6 months. If the money is not spent before MM/DD/YY, we will count any money left
over as part of your resources. But things bought with this money may count as resources
the month after they are bought. Your Social Security office can tell you which things
count as resources. You cannot get SSI if the resources we count have a value of more
than $2000.00.
Information About Medicaid
For information about any change for MM/YY to MM/YY in your Medicaid eligibility caused
by this action, you should get in touch with (Name of State Agency).
Things To Remember
This determination replaces all previous determinations for the above periods.
If You Disagree With The Decision
If you disagree with the decision, you have the right to ask for a hearing. At the
hearing, a person who has not seen your case before will look at it. That person is
an Administrative Law Judge (ALJ). The ALJ will review your case and consider any
new facts you have.
Page 3
-
•
You have 60 days to ask for a hearing.
-
•
The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason if you wait more than 60 days to ask for a hearing.
-
•
You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called
"Request for Hearing." Contact one of our offices if you want help.
How The Hearing Process Works
The ALJ will mail you a letter at least 20 days before the hearing to tell you its
date, time and place. The letter will explain the law in your case and tell you what
has to be decided. Since the ALJ will review all the facts in your case, it is important
that you give us any new facts a soon as you can.
The hearing is your chance to tell the ALJ why you disagree with the decision in your
case. You can give the ALJ new evidence and bring people to testify for you. The ALJ
also can require people to bring important papers to your hearing and give facts about
your case. You can question these people at your hearing.
Please read the enclosed pamphlet "Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of
Your Social Security Case." It has more information about the hearing.
It Is Important To Go To The Hearing
It is very important that you go to the hearing. If for any reason you can't go, contact
the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule
the hearing if you have a good reason.
If you don't go to the hearing and don't have a good reason or not going, the ALJ
may dismiss your request for a hearing.
If You Want Help With Your Hearing
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your hearing.
Page 4
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it.
If You Have Any Questions
If you have any questions, you may call, write or visit any Social Security Office.
If you call or visit our office, please have this letter with you and ask for (name
of field office contact). The telephone number is shown at the top of page 1.
Also, if you plan to visit an office, you may call ahead to make an appointment. This
will help us serve you more quickly.
Enclosure
Situation 5: Disability Approved But No Money Due Because Individual Ineligible for Nonmedical
Reasons (IC) (Individual Currently Getting SSI Based on Another Application)
SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
NOTICE OF RECONSIDERATION
|
Office Address: |
|
Office Hours: |
|
Telephone Number: |
|
Social Security Number: |
|
Date: |
We looked at your SSI case again to see if we owed you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.
Why We Can't Pay You
We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had
not applied the special Stieberger rules.
Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you
were disabled. Even though we decided you were disabled for these months, we cannot
pay you any more SSI money because you had too much income for those months.
This decision does not affect the payments you are now getting.
Our Decision Is Based On These Facts
-
•
You are living in the State of XXX for MM/YY on.
-
•
Whether we can pay you money from the State where you live depends on its rules.
--You are living with others in the County of YYY in the State of XXX for MM/YY on.
-
•
You have monthly income which must be considered in figuring your eligibility as follows:
SSA-L8456-U2
Page 2
-
--Your Social Security benefits--before deductions for Medicare premiums, if any--of
$xxx.xx for MM/YY on.
Information About Medicaid
For information about any change for MM/YY to MM/YY in your Medicaid eligibility caused
by this action, you should get in touch with (Name of State Agency).
Things To Remember
-
•
Although you are not eligible for the reasons given above, we have determined that
you are disabled.
-
•
This decision refers only to your claim for SSI payments.
If You Disagree With The Decision
If you disagree with the decision, you have the right to ask for a hearing. At the
hearing, a person who has not seen your case before will look at it. That person is
an Administrative Law Judge (ALJ). The ALJ will review your case and consider any
new facts you have.
-
•
You have 60 days to ask for a hearing.
-
•
The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason if you wait more than 60 days to ask for a hearing.
-
•
You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called
“Request for Hearing.” Contact one of our offices if you want help.
How The Hearing Process Works
The ALJ will mail you a letter at least 20 days before the hearing to tell you its
date, time and place. The letter will explain the law in your case and tell you what
has to be decided. Since the ALJ will review all the facts in your case, it important
that you give us any new facts as soon as you can.
Page 3
The hearing is your chance to tell the ALJ why you disagree with the decision in your
case. You can give the ALJ new evidence and bring people to testify for you. The ALJ
also can require people to bring important papers to your hearing and give facts about
your case. You can question these people at your hearing.
Please read the enclosed pamphlet “Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your
Social Security Case.” It has more information about the hearing.
It Is Important To Go To The Hearing
It is very important that you go to the hearing. If for any reason you can't go, contact
the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule
the hearing if you have a good reason.
If you don't go to the hearing and don't have a good reason for not going, the ALJ
may dismiss your request for a hearing.
If You Want Help With Your Hearing
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your hearing.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it.
New Application
You have the right to file a new application at any time, but filing a new application
is not the same as appealing this decision. If you disagree with this decision and
you file a new application instead of appealing, you might lose some benefits, or
not qualify for any benefits. So, if you disagree with this decision, you should file
an appeal within 60 days.
If You Have Any Questions
If you have any questions, you may call, write or visit any Social Security Office.
If you call or visit our office, please have this letter with you and ask for (name
of field office contact). The telephone number is shown at the top of page 1.
Page 4
Also, if you plan to visit an office, you may call ahead to make an appointment. This
will help us serve you more quickly.
Enclosure