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 Immigration and Nationality Act
                              (INA);
                            
 
 
- 
                     
                        — 
                           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 Security (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 cannot find you eligible for
                  SSI beginning                 because of your alien status.
               
               
               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 
               
               If you disagree with the decision, you have the right to appeal. We will review your
                  case and consider any new facts you have.
               
               
               
                  - 
                     
                        • 
                           You have 60 days to ask for an appeal. 
 
 
- 
                     
                        • 
                           The 60 days start the day after you get this letter. We assume you got this letter
                              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 60 days to ask for an appeal. 
 
 
- 
                     
                        • 
                           To appeal, you must fill out a form called “Request  for Reconsideration.” The form number is SSA-561. To get this form, contact one of our offices. The address
                              and phone numbers are shown on the last page of this letter. We can help you fill
                              out the form.
                            
 
 
How To Appeal 
               
               There are three ways to appeal. You can pick the one  you want. If you meet with us in person, it may help us decide
                     your  case. 
               
               
                  - 
                     
                        • 
                           Case Review. You have a right to review the facts in your file. You can give us more facts to
                              add to your file. Then we'll decide your case again. You won't meet with the person
                              who decides your case.
                            
 
 
- 
                     
                        • 
                           Informal Conference. You'll meet with the person who decides your case. You can tell that person why
                              you think you're right. You can give us more facts to help prove you're right. You
                              can bring other people to help explain your case.
                            
 
 
- 
                     
                        • 
                           Formal Conference. This is a meeting like an informal conference. The difference is you can ask us
                              to make people come to help prove you're right. We can make them bring important papers
                              about your case, even if they don't want to help you. You can question these people
                              at your meeting.
                            
 
 
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 you contact us, the types of documents you can show us include:
               
               
                  - 
                     
                        • 
                           U.S. birth certificate; or 
 
 
- 
                     
                        • 
                           U.S. naturalization papers or U.S. passport; or 
 
 
- 
                     
                        • 
                           Proof of your alien status (for example, an DHS Form I-551 or Form I-94 that has not
                              expired); or
                            
 
 
- 
                     
                        • 
                           An order from an immigration judge withholding deportation or removal or granting
                              asylum; or
                            
 
 
- 
                     
                        • 
                           Proof that you are a member of a federally recognized Indian tribe. 
 
 
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 you ask for an appeal and we decide in your favor, you will be able to get an SSI
                              payment only if you meet all other eligibility rules.
                            
 
 
- 
                     
                        • 
                           If 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: