TN 26 (03-92)
SI 02305.815 SSA-L3075-U2, Supplemental Security Income Notice of Appointment 1619(b)
Social Security Administration
Supplemental Security Income
Notice of Appointment (1619b)
Social Security Number:
This is a very important letter about keeping your Supplemental Security Income (SSI)
case active. Please read it carefully. If there is anything you do not understand,
please get in touch with us right away.
You Have An Appointment
Although you don't get SSI now because of your earnings, we keep your SSI case active.
This means that if your earnings go down, we can restart your SSI faster. And if you
have Medicaid, you can usually keep it while you work.
To keep your case active, we must review it every year. We need information from you
to make sure you still meet the SSI rules.
We have set up an appointment for you on at . On that date:
We will call you at . Let us know if this number is wrong.
Come to see us at and ask for .
Your representative payee must come with you to the appointment.
If We Do Not Hear From You
We may close your SSI case if you don't respond to this request or contact us by to tell us why. You could also lose any Medicaid you have now.
Before we close your SSI case, we will send you another letter to explain our decision.
The letter will also explain your right to appeal the decision and how to keep your
SSI case active during the appeal.
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Things We Need for the Appointment
When you talk with us, please try to have all of the items checked for to the present. Even if you don't have all of the information, we need to hear from
you. We will help you get anything you do not have.
Bank statements: savings and checking accounts, and any other bank statements for
Pension records from: the Department of Veterans Affairs, Railroad Retirement Board,
Civil Service, State, military, private pensions for
Pay stubs from work since for
For self-employment, last year's income tax return; if not available, all records
that show last year's business income and expenses for
Unemployment compensation payment records for
Worker's compensation award letter for
Life insurance policies for
Burial contract agreement for
We must see the original document(s) or a certified copy of these item(s). We cannot
accept photocopies. We will return these items to you.
When you call or come in, please have this letter with you.
If You Have Any Questions
If you have any questions or need help, please call us at and ask for .