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, you will lose your special SSI eligibility status on .
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.
Appeal in 10 Days To Keep Your SSI Case Active
You can ask for an appeal any time within 60 days. But if you want us to keep your SSI case active 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.
However, even if you appeal in 10 days, we may not keep your SSI case active
beginning 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 within the 10 days.
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 we stop your special SSI eligibility status 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: