Social Security Administration
Retirement, Survivors and Disability Insurance
Important Information
SOCIAL SECURITY
3722 ANNEX BLDG
BALTIMORE, MD 21235
Claim Number: XXX-XX-XXXXA
July 1, 2005
EMILY K BREINHOLT
11504 CHERRY HILL DR
SANDY UT 84094-5621
We are writing to tell you that we plan to stop your Social Security benefits.
Beginning January 2005, the law prohibits us from paying Social Security benefits
to individuals who have an outstanding arrest warrant for a crime which is a felony
(or, in jurisdictions that do not define crimes as felonies, a crime that is punishable
by death or imprisonment for a term exceeding 1 year), or who have violated a condition
of probation or parole under Federal or State law. We have information that you fall
into one of these categories.
Based on the information we have, we should have stopped the Social Security benefits
beginning 01/2005.
The Information We Have
Our records show that the ABC Sheriffs Dept., 6401 Security Blvd. Baltimore, MD 21234-6401,
410-123-5678 issued a warrant for your arrest for a non-violent crime on 1/13/2005.
The warrant information we have is:
Warrant number: MD1234567
Originating case number: MA12345790
National Crime Information Center number: NCI123456
Social Security cannot provide further information about the warrant. Please contact
the ABC Sheriffs Dept directly.
How Your Benefits Can Be Paid
We will pay you if you contact us at any time and can show us within 90 days from
the date that you contact us that any of the following apply:
-
•
The warrant was issued incorrectly in your name because someone stole your identity.
To prove this submit a copy of the police report you filed as a victim of identity
theft or another official document from the court or the warrant issuing agency stating
that the warrant was erroneously issued in your name.
-
•
You were found not guilty of the criminal offense. To prove this, submit a copy of
the court docket indicating you were found not guilty of the criminal charges or a
copy of the court decision showing that you were found not guilty of the criminal
charges.
-
•
The underlying charges relating to the criminal offense were dismissed. To prove this,
submit a copy of the court docket indicating charges were dismissed or another official
court or law enforcement agency document stating that it dismissed the criminal charges.
-
•
The warrant for your arrest for the criminal offense was withdrawn. To prove this,
submit a copy of the court docket or another official document from the warrant issuing
agency indicating the warrant in question was withdrawn.
-
•
You were otherwise cleared of the criminal offense. To prove this, submit a copy of
the court docket or other court document indicating you were cleared of the criminal
charges.
If none of the above applies, we also may pay you benefits if you contact us within
12 months from the date of this letter and can show us that:
-
•
The crime for which the warrant was issued or the probation or parole violation was
both nonviolent and not drug related and, if a probation or parole violation is involved,
the original crime(s) for which you were paroled or put on probation was both nonviolent
and not drug related.
And
-
•
You have neither been convicted of nor pled guilty to another felony crime since the
date of the warrant.
And
-
•
The law enforcement agency that issued the warrant reports that it will not extradite
you for the charges on the warrant or that it will not take action on the warrant
for your arrest.
Or
-
•
The crime for which the warrant was issued or the probation or parole violation was
both nonviolent and not drug related and, if a probation or parole violation is involved,
the original crime(s) for which you were paroled or put on probation was both nonviolent
and not drug related.
And
-
•
You have neither been convicted of nor pled guilty to another felony crime since the
date of the warrant.
And
-
•
The only existing warrant was issued 10 or more years ago.
And
-
•
Your medical condition impairs your mental capability to resolve the warrant; or you
are incapable of managing your benefits; or you are legally incompetent; or Social
Security has appointed a representative payee to handle your benefits or you are residing
in a long-term care facility, such as a nursing home or mental treatment/care facility.
What You Can Do
Our records show that you already meet the following requirement(s) for your benefits
to be paid:
-
•
The crime for which the warrant was issued was both nonviolent and not drug related.
-
•
The law enforcement agency that issued the warrant reports that it will not extradite
you for the charges on the warrant or that it will not take action on the warrant
for your arrest.
However, we do not have all the information we need to pay benefits. If you contact
us within 12 months from the date of this letter, we will pay you benefits if you can show us within 90
days from the date that you contact us that:
-
•
You have neither been convicted of nor pled guilty to any other felony crime since
the warrant was issued on 1/13/2005. To prove this, give us a statement as to whether
you have been convicted of or pled guilty to any such crimes since 1/13/2005.
If We Do Not Hear From You
If we do not hear from you within 30 days from the date of this letter, we will assume
the information in this letter is correct and will stop your Social Security benefits.
We will send another letter at that time. It will explain the change in your benefits,
the amount of any overpayment and how to appeal our decision. Also, you will have
60 days to ask for an appeal.
The 60 days will start the day after you receive the next letter.
Things To Remember
Even though your benefits will stop, we can pay other members of your family if they
are entitled on your record.
If You Have Any Questions
We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have specific
questions, you may call us toll-free at 1-800-772-1213, or call your local Social
Security office at 1-123-456-7890. We can answer most questions over the phone. If
you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You
can also write or visit any Social Security office. The office that serves your area
is located at:
Social Security Office
1111 Main Street
Baltimore, MD 21236
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. 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.
NOTE: The referral paragraph and the appropriate signature are also required for this notice.
See NL 00601.040 for additional paragraphs required on post-entitlement notices; e.g., Medicare paragraphs,
etc. See NL 00601.003 for name and signature requirements on notices.