BASIC (02-02)

DI 55099.010 SSA-L1360 (Ticket Notice for the Representative Payee, Legal Guardian, or Authorized Representative)

Social Security Administration

Important Information

Social Security Administration

P. O. Box 1433

Alexandria, VA 22313

Date:

Claim Number:

John Doe

Address

Bar Code

We are sending this letter to you because you receive benefits on behalf of (name of beneficiary/recipient). The following is the exact text of a letter we have sent to (name of beneficiary/recipient) about a new program available to (him/her). Enclosed with that letter was (his/her) Ticket to Work .

Good news! We are writing to tell you about a new program that helps people receiving disability benefits work if they want to or earn more money if they already are working.

A new program called “Ticket to Work and Self-Sufficiency” may help you to get a job if you want one. Enclosed with this letter is your Ticket to Work. The Ticket to Work is a very important paper that you should keep in a safe place.

This program was established by the Congress and is run by the Social Security Administration. A company called MAXIMUS has been hired to help manage the program.

And don't worry. The “Ticket to Work” program is voluntary . You do not have to take part in this program to keep receiving your disability benefits. If you work, we have many work incentive rules to help you. These rules can protect your cash benefits and your health care coverage while you work.

So, if you want to work, this program is for you. Here's how the program works: You can take the enclosed Ticket to Work to any of the new Employment Networks that have been set up in your area to help you or to the State vocational rehabilitation (VR) agency. When you and an Employment Network or State VR agency agree to work together, the Employment Network or State VR agency will help you with any training you might need and will help you get and keep a job.

It won't cost you anything. The Social Security Administration will pay any Employment Network or State VR agency that helps you go to work.

If you are interested, you can get a list of Employment Networks or find the State VR agency in your area by calling MAXIMUS at 1-866-968-7842 (1-866-YOUR TICKET) (toll-free) or 1-866-833-2967 (1-866-TDD 2WORK) (TTY). If you use the Internet, you can find the list at www.yourtickettowork.com.

You may also receive a call from an Employment Network or State VR agency in your area to see if you are interested in the program.

And this is very important. If you are working with an Employment Network or State VR agency and meet certain other requirements, we will not begin a medical review to determine if you are still disabled. For more information, read the enclosed pamphlet.

If you have any questions about this program, you may call MAXIMUS at

1-866-968-7842 (1-866-YOUR TICKET) (toll-free) or 1-866-833-2967. You also can write or visit any Social Security office. The office that serves your area is located at:

(address of local Social Security office)

If you visit a Social Security office, please bring this letter and your Ticket to Work with you.