BASIC (05-05)

HI 03094.015 Protective Filing Closeout for Third Party Internet Filer

A. Purpose/Use

The “Subsidy Protective Filing Closeout for Third Party Internet Filer” notice is issued automatically by the internet system. It is issued when a third party starts an internet subsidy application but does not finish it by the end of the day. The notice is sent to the claimant. No notice is sent to the third party filer.

B. Sample Notice – Subsidy Protective Filing Closeout for Third Party Internet Filer

Social Security Administration

Medicare Prescription Drug Assistance

Important Information

Date: December 11, 2005

Social Security Number: 123-00-6789

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

On December 10, 2005, we received a partially completed Internet application for help with Medicare prescription drug plan costs for you. Before we can decide if you are eligible, you must file an application.

What To Do Next

The date an application is filed can make a difference in when the help for Medicare prescription drug plan costs begins. If your application is filed by February 9, 2006, we will use December 10, 2005, the date John Smith first started the Internet application, as the filing date.

What Will Happen

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

For information about the Medicare prescription drug plans or other Medicare issues, visit www.medicare.gov on the Internet or call toll-free 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing, you may call the Medicare TTY number toll-free at 1-877-486-2048. If you do call, please have this letter with you. It will help us answer your questions.

For information about the extra help with the costs related to the Medicare prescription drug plans or general information about Social Security, visit our website at www.socialsecurity.gov on the Internet. You may also call Social Security toll-free at 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. We can answer most questions by phone.

Regional Commissioner


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603094015
HI 03094.015 - Protective Filing Closeout for Third Party Internet Filer - 07/07/2006
Batch run: 01/27/2009
Rev:07/07/2006