NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.
SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
NOTICE OF REVISED DETERMINATION
We are writing to tell you about changes in your past Supplemental Security Income
(SSI) payments. The following chart shows the SSI money due you for the months we
changed. The rest of this letter will tell you more about this change.
Your Payments Will Be Changed As Follows:
||Amount Due Each Month
Information About Your Payments
We are sending you a check for $ . This is money due for MM/YY through MM/YY.
You should receive this check no later than MM/DD/YY.
Your Payment Is Based On These Facts
We looked at your SSI case again to see if we owed you (3) because of the Anderson court case. This case is about how we figure SSI for some people who get Veterans
benefits that are called Old Law, Section 306, or protected pensions.
The court has made a new decision in the Anderson case. Because of this, we have gotten new information from the Department of Veterans
Affairs (VA) on the amount of your VA benefit that we count as your income. Therefore,
we refigured your SSI payment and find your are (4) .
As we told you in another letter about the Anderson court case, sometimes the Department
of Veterans Affairs (VA) pays more money to a person who has a wife, husband, or child
than to someone who has no dependent family members. The amount of your VA benefit
we are now counting as income still does not include the part of your VA benefit you
got for a dependent family member.
You have monthly income which must be considered in figuring your payment as follows:
Your VA pension of $ for MM/YY through MM/YY.
Things To Remember
This determination replaces all previous determinations for the above periods.
Do You Disagree With The Decision?
If you disagree with our decision, you have the right to ask for a hearing before
an Administrative Law Judge (ALJ). The ALJ will review your entire case, even the
parts you agree with. The ALJ also will consider any new facts you have and make a
new decision. The new decision could be more favorable to you than the one you already
have. But, keep in mind that the new decision also could be the same as or less favorable
than the decision you already have.
You have 60 days to ask for a hearing.
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
You must have a good reason if you wait more than 60 days to ask for a hearing.
You have to ask for a hearing in writing. We'll ask you to sign an SSA form HA-501,
called “Request for Hearing.' Contact one of our offices if you want help.
How The Hearing Process Works
The ALJ will mail you a letter at least 20 days before the hearing to tell you its
date, time and place. The letter will explain the law in your case and tell you what
has to be decided. Since the ALJ will review all facts in your case, it is important
that you give us any new facts as soon as you can.
The hearing is your chance to tell the ALJ why you disagree with the decision in your
case. You can give the ALJ new evidence and bring people to testify for you. The ALJ
also can require people to bring important papers to your hearing and give facts about
your case. You can question these people at your hearing.
It Is Important To Go To The Hearing
It is very important that you go to the hearing. If for any reason you can't go, contact
the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule
the hearing if you have a good reason.
If you don't go to the hearing and you don't have a good reason for not going, the
ALJ may dismiss your request for a hearing.
If You Want Help With Your Hearing
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 hearing.
If you get someone to help you, you should let us know. If you hire someone, we must
approve of the fee before he or she can collect it.
Please read the enclosed pamphlet “Your Right To An Administrative Law Judge Hearing
and Appeals Council Review of Your Social Security Case.' It has more information
about the hearing.
If You Have Any Questions
If you have any questions, you may call, write or visit any Social Security office.
If you call or visit our office, please have this letter with you and ask for (5) . The telephone number is (xxx) xxx-xxxx.
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.
||Also, you are due money for Month/Day/Year through Month /Day/Year. You will receive
another letter telling you how much you will get for these months, and when you will
get it. If you disagree with our decision about the amount we owe you, the letter
will tell you what to do. (Use this fill-in when recipient will also receive a systems-generated
payment and notice.)
||This action does not change your current payment.
||more SSI money than we already paid you
||due SSI money
||due more SSI money than we already paid you
Name of contact person