Basic (02-02)
DI 55099.015 SSA-L1361 (Ticket Assignment Notice for the Beneficiary/Recipient)
Social Security Administration
Important Information
Social Security Administration
P.O. Box 1433
Alexandria, VA 22313
Date:
Ticket Number:
John Doe
Address
Bar Code
Thank you for taking part in the Ticket to Work program. Our records show that effective (mm/dd/yyyy) you have assigned your ticket to:
(name, address and telephone number of employment network or State VR agency)
This means you and this organization have agreed to work together on your employment
plan.
Report Changes That May Affect Your Ability to Participate in Your Employment Plan
If you are not able to continue participating in your employment plan with (name of employment network/State VR agency), you should report this right away to MAXIMUS Inc. MAXIMUS is the Program Manager
who is helping us to manage the Ticket to Work program. Their toll-free number is
1-866-968-7842 (1-866-YOUR TICKET) or TDD 1-866-833-2967 (1-866-TDD 2WORK).
Medical Reviews
We usually conduct a medical review from time to time to see if you are still disabled
under our rules. As long as you are using your ticket, we will not begin a medical
review. However, if we started a medical review before you assigned your ticket, we
will complete the medical review.
If you have questions about the rules for “using a ticket” you should contact MAXIMUS.
If you get a “Notice of Continuing Disability Review” or a “Disability Update Report”
in the mail, please contact your local Social Security office. Tell them that you
are taking part in the Ticket to Work program. They will tell you what you need to
do.
How the Ticket to Work Program Affects Benefits
Please contact MAXIMUS if you have questions about how taking part in this program
affects your benefits. MAXIMUS can arrange for you to talk to a Benefits Specialist
or someone who can:
-
•
answer any questions you have about how work or earnings may affect your benefits;
-
•
give you information about Social Security or Supplemental Security Income (SSI) work
incentives; and
-
•
give you information about other Federal and State programs that can help you go to
work.
The enclosed fact sheet will tell you about the services of Benefits Specialists.
If You Have Any Questions
Please contact MAXIMUS at 1-866-968-7842 (1-866-YOUR TICKET) or TDD 1-866-833-2967
(1-866-TDD 2WORK) if you have any questions about this letter or the Ticket to Work
program.
For more information about Social Security or SSI work incentives, you may request
the booklet titled Working While Disabled—How We Can Help.
(Situation 1a—TRIDE/DORS can identify local FO)
We invite you to visit our website at www.ssa.gov on the Internet to find general information about Social Security. If you have any
specific questions, you may call us toll free at 1-800-772-1213, or call your local
Social Security office at:
(telephone number of local Social Security office)
We can answer most questions over the phone. If you are deaf or hard of hearing, you
may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security
office. The office that serves your area is located at:
(address of local Social Security office)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly when you arrive at
the office.
(Situation 2a—TRIDE/DORS cannot identify local FO)
We invite you to visit our website at www.ssa.gov on the Internet to find general information about Social Security. If you have any
specific questions, you may call us toll free at 1-800-772-1213. We can answer questions
over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778.
If you prefer to visit one of our offices, please check the local telephone directory
for the office nearest you. Or call us and we can give you the office address. Please
have this letter with you if you call or visit an office. It will help us answer your
questions.
Deputy Commissioner
for Operations
Enclosure:
Fact Sheet on Services of Benefits Specialists