DI 12095.160 Model Language SSI Notice of Decision - Attainment of Age 65, Change of Category

Supplemental Security Income
Notice of Decision

From:

Department of Health and Human Services
Social Security Administration

   

Date:
 
Social Security Number:

We are contacting you in connection with your eligibility for payments under the Supplemental Security Income program.

We recently contacted you and explained the possible advantages to you of changing from the SSI disability category to the SSI aged category. Since you elected to make this change, you will no longer be required to go for treatment for (drug addiction) (alcoholism). 1 In addition, you will receive your SSI check directly.

If you have any questions about this, please contact your social security office as explained on the reverse of this notice.

This information is also being sent to (name of representative payee).

 

        

1Use term(s) that applies.

See other side for important information


Form SSA-L8165-U2 (9-84)


Prior editions may be used until supply is exhausted

GET IN TOUCH WITH SOCIAL SECURITY IF:

  • You have any questions.

  • You want more information about this case.

Call or write to our office if you have questions or need more information. If you like, come to our office and someone will help you. Please bring this notice with you if you come to a Social Security office.


Form SSA-L8165-U2 (9-84)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412095160
DI 12095.160 - Model Language SSI Notice of Decision - Attainment of Age 65, Change of Category - 05/06/1999
Batch run: 04/14/2014
Rev:05/06/1999