TN 2 (07-13)
SI 00605.045 Completing the “Receipt for Your Claim” Tear-Off Page
The detachable receipt provides the following:
Written acknowledgement that the claimant filed a claim for SSI;
An estimate of processing time;
The procedure to follow if a decision is not reached within the estimated processing time;
A request to report if the mailing address changes;
A request to report any change in immigration status;
A request to report admission into a medical facility;
Information about the Privacy Act and possible disclosures, including computer matching programs; and
An estimate of the time it takes to complete this form.
Receipt information for MSSICS applications is in MSOM MSSICS 024.003C.
B. Procedure for completing the tear-off page
Follow the procedure in this subsection when completing the “Receipt for Your Claim” tear-off page:
1. When to complete the tear-off page
Complete this page for each application.
a. Face-to-face interview
At the end of a face-to-face interview:
b. Telephone interview when claimant is capable but not present
At the end of a telephone interview when the claimant is capable:
Complete only the name(s) and social security number(s) (SSN) of the claimant(s).
Retain the tear-off page in the claims folder.
Upon receipt of the signed application, complete the tear-off sheet per SI 00605.045B.2. and mail it to the claimant.
2. How to complete the tear-off page
To complete the tear-off page:
Enter the name(s) and SSN(s) of the claimant(s).
Enter the telephone number and address of the servicing field office (FO).
Enter in the first paragraph the number of days (based on average regional processing times or regional instructions for the type of claim filed) by which the claimant should hear something from us.
3. What to tell the claimant
In deferred development claims, tell the claimant to:
Contact the FO if we do not contact him or her by the date shown on the form.
Advise us of any moves or changes in mailing address. (Be sure the claimant understands that we may need more information before we can decide eligibility, and that we need to have an address or telephone number to contact him or her to expedite processing.)
Notify us as soon as possible if a medical facility admits him or her.
REMINDER: Failure to notify us quickly could result in a loss of payments for the months he or she is in the medical facility. For information on temporary institutionalization, see SI 00520.140.