DI 12095.155 Model Language SSI Notice of Change - Reinstatement Notice to DAA Recipient Who Was in Noncompliance with Treatment Requirement

Supplemental Security Income
Notice of Change

From:

Department of Health and Human Services
Social Security Administration

 
  

Date:
 
Claim Number:

We have received information that affects your payments (or those of the individual named above, on whose behalf you applied to receive payments). Based on this information, we are taking the following action:

Since you are (undergoing) (willing to have) appropriate and available treament for your condition of (drug addiction) (alcoholism) (drug addiction and alcoholism) you are eligible to receive Supplemental Security Income payments.

You continue to be subject to the representative payee requirement. Therefore, your payments must continue to be made to another person on your behalf.

You must report to us if -

  • You go to work regardless of how much you earn, or if there is any increase in your work duties, hours worked, or earnings; or

  • Your medical condition improves. These changes can affect our finding that you are disabled.

This information is also being sent to (name of representative payee).

Enclosure:

TURN THIS OVER IF YOU THINK WE ARE WRONG


Form SSA-L8151-U2 (6-83)


Use prior editions until exhausted

(Reverse Side)

YOUR RIGHT TO APPEAL

If you think we are wrong, you have the right to appeal. If you appeal, we will review our decision. If we made a mistake, we will fix it. If you have any questions, get in touch with us. Please bring this notice with you if you come to a Social Security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

HOW TO APPEAL

There are two different kinds of appeals. You can pick the one you want unless you do not agree with what we decided about your medical condition. Then, the only appeal you can have is a case review. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the two kinds of appeals:

  1. CASE REVIEW

    You can give us more facts to add to your file. Then, we will decide your case again. You will not meet with the person who will decide your case. This is the only kind of appeal you can have if you do not agree with what we decided about your medical condition.

  2. INFORMAL CONFERENCE

    You will meet with the person who will decide your case. You can tell that person why you think you are right. You can also give us more facts to help prove you are right. You can bring other people to help explain your case. You can pick this kind of appeal unless you do not agree with what we decided about your medical condition.

    REMEMBER, YOU PICK THE KIND OF APPEAL YOU WANT. BUT, IF YOU APPEAR IN PERSON, IT MAY HELP US TO DECIDE YOUR CASE.

TO APPEAL, YOU MUST MAKE A REQUEST IN WRITING. Be sure to tell us your name, social security number, and why you think we are wrong. Also tell us what kind of appeal you want-CASE REVIEW OR INFORMAL CONFERENCE. If you cannot write to us, call our office or come in and someone will help you.

There are groups that can help you with your appeal. Some groups may be able to give you the name of a lawyer who will help you for free. Let us know if you want the names of these groups.

You have other rights because you are eligible under the supplemental security income program. There are also some things you must do. The enclosed booklet tells you what you should know. Please read this booklet and keep it in case you have questions later.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412095155</