TN 5 (02-99)
SI 00502.160 Exhibit Notice - Nonqualified Alien Suspension Notice —Pay Version
Social Security Administration
Supplemental Security Income
Notice of Planned Action
Type of Payment:
You Will Lose Your SSI on
We plan to stop your Supplemental Security Income (SSI) payment
We urge you to read this entire letter, including the information about appeal rights and the information about Medicaid eligibility. If you have any questions, you may call us toll-free at 1-800-772-1213, or call your local office at the number shown on the last page of this notice.
Why You are Losing Your SSI
Alien Eligibility Categories
Persons who are lawfully residing in the U.S. and were receiving SSI benefits on August 22, 1996 can continue to receive benefits if they are in one of the following alien eligibility categories:
lawfully admitted for permanent residence under the Department of Homeland Secuirty (DHS);
an American Indian born outside the U.S. who is under section 289 of the INA or who is a member of a federally recognized Indian tribe under section 4(e) of the Indian Self-Determination and Education Assistance Act;
a refugee under section 207 of the INA;
an asylee under section 208 of the INA;
a person whose deportation is withheld under section 243(h) of the INA as in effect prior to April 1, 1997, or whose removal has been withheld under section 241(b)(3) of the INA;
a parolee under section 212(d)(5) of the INA for at least one year;
a person granted conditional entry under section 203(a)(7) of the INA as in effect prior to April 1, 1980;
a Cuban or Haitian entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980; or
a certain alien, or an alien parent of a child, or an alien child of a parent who has:
been battered or subjected to extreme cruelty in the U.S. by a spouse, parent, or certain other family members the alien, parent, and/or child lived with; and
been determined to need SSI because of this abuse; and
a determination from the Department of Homeland Secuirty (DHS); for a certain change in status.
Persons not in any of the categories listed above who were receiving SSI benefits on August 22, 1996 can continue to receive benefits if they are permanently residing in the United States under color of law.
Since we do not have proof that you are a U.S. citizen or national, or that you are in one of the alien eligibility categories listed above, or that you are permanently residing in the United States under color of law, we are stopping your SSI
Information About [Medicaid/Medi-Cal/AHCCCS] (Caption will vary.)
(Language in this section will vary by State. See SI 01730.060 and NL 00804.110)
You Have Important Appeal Rights
Appeal in 10 Days To Keep Getting The Same Check
You can ask for an appeal any time within 60 days. But if you want to keep getting the same check until we decide your case, you must ask for the appeal within the first 10 days.
The 10 days start the day after you get this letter.
If you lose your appeal, you might have to pay back some or all of this money.
However, even if you appeal in 10 days, we may not send you the check in if both of the following are true:
The decision we make on your appeal is the same as our earlier decision, and
We send or give you a letter with our new decision in time to stop the check from being sent.
How To Appeal
If You Want Help With Your Appeal
You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.
Proofs To Bring If You Contact Us
If Your Immigration Status Changes
If you are not a U.S. citizen or national, you may be able to change your immigration status to one of the eligible alien categories. Contact an DHS district office for information on how you can change your immigration status. You can call DHS toll-free at 1-800-755-0777 to get the location and phone number of the DHS office in your area. You should notify us immediately if DHS changes your immigration status to one of the alien eligibility categories.
Things To Remember
Let us know if you become a U.S. citizen or if your alien status changes and you think you may be eligible.
If we stop your SSI and you do not become eligible again before (month /year of 13th month of ineligibility), you may have to file a new application to get SSI.
If You Have Any Questions
If you have any questions, you may call us toll-free at 1-800-772-1213, or call your local office at . We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:
LOCAL OFFICE STREET ADDRESS
CITY, STATE ZIP
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.