TN 1 (10-02)

DI 55099.090 SSA-L1367 (Beneficiary/Recipient Notice Review of Ticket Eligibility Explanation Prior Explanation Correct Individual Remains Ineligible – Different Reason or Set of Reasons)

Social Security Administration

Important Information

Social Security Administration

(1)

(2)

Date: (3)

Social Security Number: (4)

(5)

(6)

(7)

This is a notice about whether you are eligible to receive a Ticket to participate in the Ticket to Work program. Please read it carefully.

Why You Are Not Eligible for a Ticket

You asked us to review our explanation of (8) about whether you are eligible to get a Ticket to participate in the Ticket to Work program. (9).

We have reviewed our records and prior explanation. We find that our prior explanation was correct. We also find that (10) that we gave you for why you were not eligible for a Ticket no longer (11). However, our records show that you are not currently eligible for a Ticket because: (12)

You May Be Eligible for a Ticket at a Later Date

On a regular basis, we identify individuals who become eligible to receive a Ticket. If your situation changes and the reason(s) listed above no longer exists, and you meet all of the other requirements for getting a Ticket, we will identify your record automatically and send you a Ticket in the mail. For this reason, you should report any changes that might mean you could become eligible for a Ticket.

If You Disagree with this Explanation

If you disagree with our explanation of why you are not currently eligible to receive a Ticket, you may ask us to review this explanation. We will consider any new facts you have and send you another notice.

  • You have 30 days to ask for a review.

  • The 30 days start the day after you receive this notice. We assume you got this notice 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason for waiting more than 30 days to ask for a review.

  • You may request a review in person at any Social Security office or by letter.

If You Have Any Questions

We invite you to visit our website at www.ssa.gov on the Internet to find general information about the programs of the Social Security Administration. Also, you may wish to go directly to www.ssa.gov/work for specific information on employment supports for people with disabilities. If you have specific questions or you want to let us know about a change that affects your eligibility for a Ticket, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (13). We can answer most questions over the phone. If you have difficulty hearing or talking on a telephone, you may call our TTY/TDD number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

(14)

(15).

If you do call or visit an office, please have this notice with you. It will help us answer your questions. You may call before you visit an office to make an appointment. This will help us serve you more quickly when you arrive.

Deputy Commissioner

for Operations

Fill-ins

(1) Street address of FO/PC

(2) City, State, and zip code of FO/PC

(3) Date

(4) Social Security Number

(5) Name of beneficiary/recipient

(6) Address

(7) City, State, and zip code

(8) Date of explanation notice

(9)

  • You also asked us to consider whether you are now eligible for a Ticket because you say your situation has changed.

  • null (no fill in is necessary)

(10)

  • the reasons

  • one reason

  • some of the reasons

(11)

  • exists

  • exist

(12)

  • You are under age 18.

  • You are age 65 or older.

  • You are not eligible for benefits under the Social Security or Supplemental Security Income disability program.

  • You are not receiving a Federal cash disability-based benefit from us.

  • We previously decided you recovered enough to work and are now paying you benefits under special rules while you participate in an approved vocational rehabilitation program. We are not issuing Tickets to individuals who are receiving benefits under these special rules.

  • We previously decided you recovered enough to work and are