DI 12095.130 Model Language SSI Notice of Reconsideration - DA&A Finding Affirmed

Model Language-Clalmant Contests DA&A Finding-DDS Affirms Determination


Supplemental Security Income
Notice of Reconsideration


Department of Health and Human Servitcs
Social Security Administration


Social Security Number:
Reconsideration Filed:

Upon receipt of your request for reconsideration of the disability determination in which it was found that you are disabled and that (drug addiction) (alcoholism) 1/ contributes to the finding that you are disabled, we had your claim independently reviewed by a special group. All the evidence in your case has been carefully evaluated again. On the basis of this evidence, we find that the previous determination was proper under the law.

Since it has been determined that (drug addiction) (alcoholism) 1 / contributes to the finding that you are disabled, your supplemental security income payments must be made to a representative payee on your behalf. In addition, in order to be eligible for payments, you are required to undergo any appropriate treatment for your condition as a (drug addict) (alcoholic) 1/, if such treatment is available.

We want to discuss these provisions with you in greater detail and to obtain information from you which will assist us in selecting someone to receive your supplemental security income payments on your behalf. A decision will be made later as to whether appropriate treatment is available. Therefore, we urge you or someone on your behalf to contact this office, either by telephone, by mail, or in person to discuss the matter. If you phone, please have this notice nearby so that you may refer to it. Please bring it with you if you visit an office.

Your failure to provide information which will assist us in selecting a representative payee to receive your supplemental security income payments on your behalf will result in our being unable to make payments to you (unless we otherwise have sufficient information to select a payee for you). If you believe that the reconsideration determination is not correct, you may request a hearing as explained on the reverse of this letter.


1/ Use term(s) that applies

Important: See other side for an explanation of your appeal rights and other information



Please get in touch with Social Security if:

  • You believe the decision on the other side of this notice is wrong, or

    You have any questions or need more information.

Most questions can be handled by phoning or writing any Social Security office. If you visit a Social Security office, please bring this notice with you. If the decision in your case is based on incorrect information, we will be happy to make whatever change is necessary.


If you are not satisfied with the decision, you may request a hearing of this decision by the Office of Hearings and Appeals. You must request the hearing in writing within 60 days from the date you receive this notice. If you cannot send us a written request for a hearing within 60 days, be sure to contact us by phone. If you wait longer than 60 days, we will not conduct a hearing review of our decision unless you have a good reason for the delay.

If you request a hearing, your case will be assigned to an administrative law judge of the Office of Hearings and Appeals. The administrative law judge will let you know when and where your case will be heard.

The hearing proceedings are informal. The adminstrative law judge will summarize the facts in your case, explain the law, and state what must be decided. Then you will have an opportunity to explain why you disagree with the decision made in your case, to present additional evidence and to have witnesses testify for you. You can also request the adminstrative law judge to subpoena unwilling witnesses to appear for cross-examination and to bring with them any information about your case. If you decide not to appear at the hearing, you still have the right to submit additional evidence. The