TN 9 (02-07)
NL 00722.170 T2 Application Cover Letter for Wet Signature
Cover Letter for Wet Signature
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Social Security Administration
Application Development
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Telephone Number
Date:
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Applicant Name
Street address
City, State zip code
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On [date], we talked with you about possible entitlement to [fill-in] [fill-in]. We
filled out the enclosed application based on your statements. However, we cannot decide
if there is entitlement to benefits until you sign the application and give us more
information.
What You Need To Do
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Answer any questions circled on the application
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Correct any information that is wrong and sign your initials next to the corrections
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Sign and date the application and any accompanying forms in the space for your signature.
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Mail the application, any accompanying forms and the information or evidence checked
below to the Social Security office address shown above. A self-addressed envelope
is enclosed for your convenience. Add your return address on the envelope and remember
to place the correct amount of postage on it.
If We Do Not Hear From You
It is important that you sign the application and return it to us within 10 days of
the date of this notice. The sooner we get the signed application, the sooner we can
decide if [fill-in] eligible.
If we receive the signed application after any of the dates shown below, you may lose
benefits.
The statement checked below applies to you.
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If we receive the signed application by we will use the date we talked to you about possible entitlement to benefits, as the filing date.
If we receive the signed application after but no later than we will use the date of the application interview, , as the filing date.
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Things We Need
We need the items checked below. You must send us the original documents except as
noted below. If you do not have the original, you must send a copy certified by the
person who is the custodian of the original record. Do not send copies signed by a
notary public. We will return the item(s) to you. We can accept a photocopy of a W-2
form or a tax return (1040, Schedule C, Schedule SE, etc.). Do not delay signing and
sending us the enclosed application even if you do not have the records we need.
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Birth Certificate or religious record of age for
Marriage Certification for
Divorce or Annulment Decree for
U.S. Passport, Certificate of Citizenship or Naturalization, or current immigration
docuent for
Withholding statement (For W-2) for
Tax return and Schedule ESE for
Certificate of Appointment as legal representative for
Death Ceriticate for
Award letter or correspondence concerning
Military service discharge papers for
Blank check for direct deposit information (write VOID on the front of the check)
OTHER
OTHER
OTHER
OTHER
OTHER
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If You Have Any Questions
If you have any questions, you should call, write or visit any Social Security office.
If you call or visit our office, please have this letter with you and ask for The telephone number is shown above. We can answer most questions over the phone.
Also, if you plan to visit an office, you may call ahead to make an appointment. This
will help us serve you more quickly.
Manager
Enclosure(s):
Application Summary
Envelope