After receiving your inquiry, we carefully checked any information you provided and our records. We have informally decided that (1) not qualified for Special Veterans Benefits (SVB).

Why __(2)__ Not Qualified

We believe _(3)_ not qualified for SVB for the following reason(s).

[OPTIONAL PARAGRAPHS FOR SPECIFIC DENIAL REASONS]

[Age 65]

_(1)_ did not turn age 65 on or before December 14, 1999,

the date the title VIII law was enacted.

[WWII Veteran]

_(2)_ not meet WWII Veteran requirements.

[SSI Eligibility]

_(3)_ not eligible for Supplemental Security Income under

title XVI of the Social Security Act for December 1999, the

month the title VIII law was enacted.

[Benefit Income]

_(4)_ benefit income that is equal to or over

$_(5)_, which is the maximum SVB payable at this time.

[Optional Paragraph for Miscellaneous Events (e.g., Deportation, etc.)]

Why You May Want To Complete an Application

You may want to complete an application for SVB if:

• •

  You want a formal decision about whether _(4)_ qualified, or

• •

  You disagree with our informal decision, or

• •

  You want to give us more information.

If you decide to file, you should do so right away. The sooner we get your signed application, the sooner we can make a formal decision about whether __(5)__ qualified. If we do not receive your signed application by _(6)_, it could affect your entitlement to SVB.

If You Have Questions or Need Help

[Domestic Paragraph]

If you have questions or need help, you may call, write, or visit our office or any U.S. Social Security office. Please have this letter with you. If you call or visit our office, please ask for _(1)_. The telephone number is shown at the top of page one.

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.

[Foreign Paragraph]

If you have questions, you should contact one of the offices shown below. You may also write to us at the address shown at the top of this letter. However, if you call or visit an office, please have this letter with you.

• •

  If you live in Canada, you should contact any U.S. Social Security office.

• •

  If you live in Guam, Puerto Rico, Samoa or the U.S. Virgin Islands, you should contact the nearest U.S. Social Security Office.

• •

  If you live in Mexico, you should contact the nearest U.S. Social Security office or the nearest United States Embassy or consulate.

• •

  If you live in the Philippines, you should contact the Foreign Service Post (FSP) in Manila.

• •

  If you live in any other country, you should contact the nearest United States Embassy or consulate.

Notice Fill-ins:

1. (1) 

   (you are) or (veteran's name is)

2. (2) 

   (You Are) or (veteran's name Is)

3. (3) 

   (you are) or (veteran's name is)

4. (4) 

   (you are) or (veteran's name is)

5. (5) 

   (you are) or (veteran's name is)

6. (6) 

   (60 days after date of notice)

Denial Paragraphs Fill-ins:

1. (1) 

   (You) or (He, She)

2. (2) 

   (You do) or ( He does, She does)

3. (3) 

   (You were) or (He was, She was)

4. (4) 

   (You have) or (He has, She has)

5. (5) 

   (Amount of maximum SVB payment)

Domestic paragraphs Fill-ins:

1. (1) 

   (contact's name)

The servicing FO or the FSP is responsible for sending this notice. In situations, where the contact does not live in an FO service area or the Philippines, the Central Processing Site (CPS) is responsible for sending this notice.

Select the paragraph(s) which shows the specific denial reason. If there is more than one denial reason, provide paragraphs for all that apply.

Select the Domestic paragraph when the contact lives in an area serviced by a U.S. Social Security office. Otherwise, select the Foreign paragraph.