Social Security Administration |
Supplemental Security Income |
Important Information |
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FO ADDRESS |
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Date: |
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Claim Number: |
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CLAIMANT'S NAME or Payee for Name of Claimant
STREET ADDRESS
CITY/STATE ZIP CODE
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Because of a new law, only U.S. citizens, nationals, or individuals in the alien categories
listed below can qualify for Supplemental Security Income (SSI). Therefore, we looked
at the following proof of your citizenship or status as an alien (or the proof for
the SSI claimant you represent):
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U.S. birth certificate
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U.S. naturalization papers
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An order from an immigration judge withholding deportation or granting asylum
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Alien status card
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U.S. military service identity card (U.S. Form DD-2)
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Discharge Certificate from U.S. Military (Form DD-214)
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Proof of membership in a federally recognized Indian tribe under section 4(e) of the
Indian Self-Determination and Education Assistance Act.
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Other .
We find that you are (or the individual you represent is) in one of the following
categories of people who may qualify for SSI as a citizen or alien:
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A citizen or national of the U.S.
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An alien who is lawfully admitted for permanent residence under the Immigration and
Nationality Act (INA) and who has worked long enough to have at least a total of 40
qualifying quarters of work. An alien may get the 40 quarters of work himself or herself.
Also, work done by a spouse or parent may count toward the 40 quarters of work for
getting SSI only.
We cannot count any quarter of work acquired after December 31, 1996 if the alien
or the worker received certain types of federally funded assistance during that quarter.
To qualify based on 40 quarters of work:
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—The alien had to enter the U.S. before August 22, 1996, or
—if the alien entered the U.S. on or after August 22, 1996, the alien had
##to have been in one or more of the alien eligibility categories listed in
##this letter for 5 years or more.
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One of certain aliens who are blind or disabled and were lawfully residing in the
U.S. on August 22, 1996.
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One of certain aliens who are lawfully residing in the U.S. and who were receiving
SSI benefits on August 22, 1996.
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An American Indian born outside the U.S. who is under section 289 of the Immigration
and Nationality Act (INA) or who is a member of a federally recognized Indian tribe
under section 4(e) of the Indian Self-Determination and Education Assistance Act.
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An alien who is a refugee admitted under section 207 of the Immigration and Nationality
Act (INA) on (date admitted) . You may get SSI only for 7 years from this date. (The 7 years apply even if your
status changes to lawfully admitted for permanent residence.) We will send you another
letter before MM/YY giving you our decision about this limit on your eligibility. You will have the right
to appeal that decision.
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An alien granted asylum under section 208 of the Immigration and Nationality Act (INA)
on (date asylum granted) . You may get SSI only for 7 years from this date. (The 7 years apply even if your
status changes to lawfully admitted for permanent residence.) We will send you another
letter before MM/YY giving you our decision about this limit on your eligibility. You will have the right
to appeal that decision.
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An alien whose deportation has been withheld under section 243(h) of the Immigration
and Nationality Act (INA) as in effect prior to April 1, 1997, or whose removal has
been withheld under section 241(b)(3) of the INA on (date deportation or removal withheld).
You may get SSI only for 7 years from that date. (The 7 years apply even if your status
changes to lawfully admitted for permanent residence.) We will send you another letter
before MM/YY giving you our decision about this limit on your eligibility. You will have the right
to appeal that decision.
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An alien who is a Cuban or Haitian entrant as defined in section 501(e) of the Refugee
Education Assistance Act of 1980 on (date entrant status is granted) . You may get SSI only for 7 years from that date. (The 7 years apply even if your
status changes to lawfully admitted for permanent residence.) We will send you another
letter before MM/YY giving you our decision about this limit on your eligibility. You will have the right
to appeal that decision.
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An alien who is admitted to the U.S. as an Amerasian immigrant on (date admitted) under section 584 of the Foreign Operations, Export Financing, and Related Programs
Appropriations Act, 1988 (as contained in section 101(e) of Public Law 100-202 and
amended by the 9th proviso under “Migration and Refugee Assistance” in title II of the Foreign Operations, Export Financing, and Related Programs Appropriations
Act, 1989, Public Law 100-461, as amended.) You may get SSI only for 7 years from
that date. (The 7 years apply even if your status changes to lawfully admitted for
permanent residence.) We will send you another letter before MM/YY giving you our decision about this limit on your eligibility. You will have the right
to appeal that decision.
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One of certain aliens who is:
— an active duty member of the U.S. armed forces (but not on active
##duty for training purposes only), or
— an honorably discharged veteran of the U.S. armed forces (but
# #not discharged because of alien status), or
— a spouse, including an unremarried widow or widower, or unmarried
##dependent children of people in the above two groups.
Report Any Changes in Your Alien Categories
If you are not a citizen now, let us know right away if you become a citizen, or if
any facts that affect your eligibility as an alien change. This will help us to pay
you correctly.
Do You Disagree With The Decision?
If you disagree with the decision, you have the right to appeal. We will review your
case and consider any new facts you have.
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You have 60 days to ask for an appeal.
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The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us you did not get it within the 5-day
period.
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You must have a good reason for waiting more than 60 days to ask for an appeal.
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To appeal, you must fill out a form called “Request for Reconsideration.” The form number is SSA-561-U2. To get this form, contact one of our offices. We can
help you fill out the form.
How To Appeal
There are two ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide
your case.
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Case Review. You have a right to review the facts in your file. You can give us more facts to add
to your file. Then we'll decide your case again. You won't meet with the person who
decides your case. This is the only kind of appeal you can have to appeal a medical
decision.
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Informal Conference. You'll meet with the person who decides your case. You can tell that person why you
think you're right. You can give us more facts to help prove you're right. You can
bring other people to help explain your case.
If You Want Help With Your Appeal
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 appeal.
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 CLAIMS
REPRESENTATIVE'S NAME. The telephone number is (XXX) XXX-XXXX.
Also, if you plan to visit an office you may call ahead to make an appointment. This
will help us serve you more quickly when you arrive at the office.
Field Office Manager