DI 12095.145 Model Language SSI Notice of Decision - Post Eligibility (PE) Review of Noncompliance
Finding Treatment for DA&A Not Appropriate and/or Available - Recipient Still Required
to Receive Payments Through a Representative Payee
Supplemental Security Income
Notice of Decision
Department of Health and Human Services
Social Security Administration
Social Security Number:
We are contacting you in connection with your eligibility for payments under the Supplemental
Security Income Program.
Under the law, a disabled person who is medically determined to be a drug addict or
alcoholic must receive his supplemental security income payments through another person
on his behalf. In addition, he must undergo any appropriate treatment for his condition
as a drug addict or alcoholic, if such treatment is available, in order to be eligible
We informed you that the medical evidence in your claim shows that (drug addiction)
(alcoholism) 1/ contributes to the finding that you are disabled. Therefore, your payments must
be made to another person on your behalf. In addition, you must undergo any appropriate
treatment for your condition as a (drug addict) (alcoholic) 1/, if such treatment is available, in order to be eligible for payments. You have
failed to comply with the treatment requirement on the basis that you believe treatment
is not appropriate and/or available to you.
After further consideration of all the facts in your case, it has been determined
that treatment for your condition as a (drug addict) (alcoholic) 1/ is not appropriate and/or available. However, you continue to be subject to the
representative payee requirement; therefore, your payments must continue to be made
to another person on your behalf.
If you have any questions about this notice, the people in our office will assist
you in any way possible. If you phone, please have this notice nearby so that you
my refer to it. Please bring it with you if you visit an office.
This information is also being sent to (name of representative payee).
1/Use term(s) that applies
NOTE: Send a copy of this notice to the representative payee.
See other side for important information
Form SSA-L8165-U2 (9-84)
Prior editions may be used until supply is exhausted
GET IN TOUCH WITH SOCIAL SECURITY IF:
You want more information about this case.
Call or write to our office if you have questions or need more information. If you
like, come to our office and someone will help you. Please bring this notice with
you if you come to a Social Security office.
||Form SSA-L8165-U2 (9-84)