Form Letter to Precede Automated Notice — WC Income Amount Changes Because of
Tennant Court Case
SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
IMPORTANT INFORMATION
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Name
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We looked at your Supplemental Security Income (SSI) case again to see if we owe you
money because of the Tennant court case. This case is about how we figure SSI eligibility and payment amount for
some people who receive or did receive workers' compensation (WC) payments that include
money paid to you for past, current, or future expenses related to the WC claim.
Our review showed that we had counted as unearned income the part of your WC payments
that was paid to you for expenses related to your claim. Therefore, we refigured your
SSI eligibility and payment amount without counting this income and found you are
due (1) .
Because you are due (2) , we are sending you another letter soon telling you:
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how much SSI you will get and for what months;
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when to expect your SSI money;
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the new amount of the WC benefit which we used to figure your SSI; and
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what to do if you disagree with our decision about the amount we owe you.
SSA-L8165
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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 (3) . 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.
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Manager's Name Title
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Fill-ins |
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Choice 1: SSI money
Choice 2: more SSI money
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2–
Choice 1: SSI money
Choice 2: more SSI money
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