DI 12095.150 Model Language SSI Notice of Reconsideration - DA&A Recipient Who Is in Noncompliance
with Treatment Requirement
Supplemental Security Income
Notice of Reconsideration
Department of Health and Human Services
Social Security Administration
Social Security Number:
Upon receipt of your request for reconsideration, we looked again at all the information
and facts about your noncompliance with the treatment for (drug addiction) (alcoholism)
1 which is required in your case. We find that the previous decision was correct.
Under the law, a disabled person who is medicaliy determined to be a (drug addict) (alcoholic) must undergo any appropriate treatment for the condition if such treatment is available
in order to be eligible for payments.
(Personalized paragraph such as;
Arrangements were made at the treatment center for you. However, you missed 3 appointments
and you have indicated you do not plan to go for treatment.)
Since you are not complying with the treatment requirement, Supplemental Security
lncome payments cannot be paid. If you decide to cooperate with the necessary treatment,
please contact us immediately.
This information is also being sent to (name of representative payee).
1Use term(s) that applies.
Important: See other side for an explantion of you appeal rights and other information
||Form SSA-L8155-U2 (2-82)
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.
YOUR RIGHT TO APPEAL
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 administrative 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 administrative law judge will render a decision based on the evidence in your
file plus any new evidence submitted.
In having your case heard, you can represent yourself or be represented by a lawyer,
a friend, or any other person. Contact your Social Security office for names of organizations
that can help you.