BASIC (05-05)

HI 03094.105 FO Verification

A. Purpose/Use

FO Verification Letter is used by the field office to request additional development when processing a subsidy claim. It is generated in MAPS from the Verification screen and sent to the local printer.

B. Sample Notice for Field Office Verification

Social Security Administration

Medicare Prescription Drug Assistance

Application Development

Office address: 343 West Road

Burbank, MD 21217

Office Hours: 9:00 AM – 4:00 PM

Telephone: (410) 366-7770

Date: 11/05/05

Social Security Number: 123-00-6789

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

This is a very important letter and could affect whether you get extra help to pay for your prescription drugs. Please read carefully. If there is anything you do not understand, please get in touch with us right away.

What You Need To Do

We need more information to decide if you are eligible for this extra help. Therefore, it is important that you call us immediately at the phone number shown at the top of this letter about the item(s) we listed under “Things We Need.”

If you prefer, you may mail or bring in the requested items to the address shown at the top of this letter. We will return to you any item(s) you submit.

If We Do Not Hear From You

We may deny your Application for Help with Medicare Prescription Drug Plan Costs if you do not respond to this request or contact us by November 20, 2005.

Things We Need

We need to know more about the item(s) shown below.

  • Mortgage statement for property on Jones Road.

  • Court record for settlement of property on Jones Road.

Even if you do not have all of the information, we need to hear from you. We will help you get anything you do not have. If 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 the telephone number shown at the top of this letter and ask for Mr. James Robinson.

Manager

Enclosure(s)

Envelope


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603094105
HI 03094.105 - FO Verification - 07/07/2006
Batch run: 01/27/2009
Rev:07/07/2006