TN 20 (04-10)

SI 00502.306 Exhibits for Supplemental Security Income (SSI) Extension for Elderly and Disabled Refugees Act

A. Exhibit 1 - Declaration of Good Faith

Exhibit 1 - Declaration of Good Faith

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Exhibit 1 - Page 2 - Privacy Act Statement

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B. Exhibit 2 - Notice to Terminated Beneficiaries

Exhibit 2 - Notice to Terminated Beneficiaries

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Page 2 - Exhibit 2 - Notice to Terminated Beneficiaries - continues

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C. Exhibit 3 – Notice of Change in Payment SSA-L8151 (benefits reinstated/continued)

G-SI_00502.306C-1

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G-SI_00502.306C-2

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G-SI_00502.306C-3

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D. Exhibit 4 – Notice of Planned Action SSA-L8155 (benefits suspended)

G-SI_00502.306D-1

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G-SI_00502.306D-2

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G-SI_00502.306D-3

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G-SI_00502.306D-4

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E. Exhibit 5 — Notice to Terminated Beneficiaries, Re-Contact Notice

G-SI_00502.306E-1

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G-SI_00502.306E-2

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G-SI_00502.306E-3

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