Basic (02-02)

DI 55099.020 SSA-L1362 (Ticket Assignment Notice for the Representative Payee, Legal Guardian, or Authorized Representative)

 

Social Security Administration

Important Information

 

Social Security Administration

P.O. Box 1433

Alexandria, VA 22313

Date:

Ticket Number:

 

John Doe

Address

Bar Code

 

We are sending this letter to you because you receive benefits on behalf of (name of beneficiary/recipient). The following is the exact text of a letter we have sent to (name of beneficiary.)

 

Thank you for taking part in the Ticket to Work program. Our records show that effective (mm/dd/yyyy) you have assigned your ticket to:

 

(name, address and telephone number of employment network or State VR agency)

 

This means you and this organization have agreed to work together on your employment plan.

 

Report Changes That May Affect Your Ability to Participate in Your Employment Plan

 

If you are not able to continue participating in your employment plan with (name of employment network/State VR agency), you should report this right away to MAXIMUS Inc. MAXIMUS is the Program Manager who is helping us to manage the Ticket to Work program. Their toll-free number is 1-866-968-7842 (1-866-YOUR TICKET) or TDD 1-866-833-2967 (1-866-TDD 2WORK).

 

Medical Reviews

 

We usually conduct a medical review from time to time to see if you are still disabled under our rules. As long as you are using your ticket, we will not begin a medical review. However, if we started a medical review before you assigned your ticket, we will complete the medical review.

 

If you have questions about the rules for “using a ticket” you should contact MAXIMUS.

 

If you get a “Notice of Continuing Disability Review” or a “Disability Update Report” in the mail, please contact your local Social Security office. Tell them that you are taking part in the Ticket to Work program. They will tell you what you need to do.

 

How the Ticket to Work Program Affects Benefits

 

Please contact MAXIMUS if you have questions about how taking part in this program affects your benefits. MAXIMUS can arrange for you to talk to a Benefits Specialist or someone who can:

 

• •

  answer any questions you have about how work or earnings may affect your benefits;

• •

  give you information about Social Security or Supplemental Security Income (SSI) work incentives; and

• •

  give you information about other Federal and State programs that can help you go to work.

 

The enclosed fact sheet will tell you about the services of Benefits Specialists.

 

If You Have Any Questions

 

Please contact MAXIMUS at 1-866-968-7842 (1-866-YOUR TICKET) or TDD 1-866-833-2967 (1-866-TDD 2WORK) if you have any questions about this letter or the Ticket to Work program.

 

For more information about Social Security or SSI work incentives, you may request the booklet titled Working While Disabled—How We Can Help.

 

(Situation 1a—TRIDE/DORS can identify local FO)

We invite you to visit our website at www.ssa.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll free at 1-800-772-1213, or call your local Social Security office at:

 

(telephone number of local Social Security office)

 

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:

 

(address of local Social Security office)

 

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.

 

(Situation 2a—TRIDE/DORS cannot identify local FO)

We invite you to visit our website at www.ssa.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll free at 1-800-772-1213. We can answer questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. If you prefer to visit one of our offices, please check the local telephone directory for the office nearest you. Or call us and we can give you the office address. Please have this letter with you if you call or visit an office. It will help us answer your questions.

 

Deputy Commissioner

for Operations

 

Enclosure:

Fact Sheet on Services of Benefits Specialists