BASIC (05-05)

HI 03094.010 SSA-L824 - Protective Filing Closeout

A. Purpose/Use

The subsidy protective filing closeout notice (SSA-L824) is available on the 800 number system in English. The protective filing closeout notice is available on DPS in both English and Spanish. See HI 03010.030 for completion instructions.

B. Sample Notice SSA-L824 – Subsidy Protective Filing Closeout

Social Security Administration

Medicare Prescription Drug Assistance

Important Information

Date: December 10, 2005

Social Security Number: 123-00-6789

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

On _______(1)_________, we talked with _________(2)_____ about ___3)_____ eligibility for extra help with Medicare prescription drug plan costs. Before we can decide if _________(4)______ eligible, you must file an application.

What To Do Next

You may complete an application right away on the Social Security Administration’s website at www.socialsecurity.gov on the Internet. If you would like a Social Security representative to take the application for you, call us toll free at 1-800-772-1213 to schedule an appointment.

What Will Happen

You should get in touch with us right away because the date you file an application can make a difference in when the extra help for Medicare prescription drug plan costs begins. If you file the application by ______(6)_________, we will use ____(7)__________, the date _________(7)_________ contacted us, as the filing date.

If you file an application, we will review the claim and make a decision. If you do not agree with what we decide, you will be able to appeal the decision.

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, please have this letter with you. The address and telephone number of the office that serves your area is:

                                             ________________(8)______________

Also, if you plan to visit, you may call ahead to make an appointment. Our toll-free number is 1-800-772-1213. If you are deaf or hard of hearing, you may call our TTY number toll-free at 1-800-325-0778.

This will help us serve you more quickly when you arrive at the office.

                                                                                Manager

SSA-L824 (12/2004)

First Paragraph

  1. Choice 1: Date of interview

    Choice 2: Null

  2. Choice 1: you

    Choice 2: inquirer’s name

  3. Choice 1: your

    Choice 2: claimant’s name

  4. Choice 1: you are

    Choice 2: (claimant’s name) is

What to Do Next

  1. Choice 1: 60 days after the date of the notice (mm/dd/yyyy-must be a workday)

    Choice 2: Null

  2. Choice 1: date of interview

    Choice 2: Null

  3. Choice 1: you

    Choice 2: name of inquirer

If You Have Any Questions

  1. Choice 1: FO address

    Choice 2: Null


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603094010
HI 03094.010 - SSA-L824 - Protective Filing Closeout - 08/29/2008
Batch run: 01/27/2009
Rev:08/29/2008