Basic (05-05)

HI 03094.705 Acknowledge Receipt of Case Review

A. Purpose/Use

The “Acknowledge Receipt of Case Review” notice acknowledges receipt of a request for case review. This notice is created in the Document Generation System (DGS) used in the Subsidy Appeals Unit.

B. Sample Acknowledgment Notice

 

Social Security Administration

Medicare Prescription Drug Assistance

Acknowledgment Notice

 

                                                                                     SDS return address

                                                                         Date: November 23, 2005

                                                                                     Social Security Number: 123-00-6789

 

 

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

 

 

 

 

We have received your request for a review of your Application for Help with Medicare Prescription Drug Plan Costs. We will review the file to be sure that a proper decision was made. We will send you another notice as soon as the necessary work has been completed.

 

Providing Additional Information

 

If there is more information you want us to see, please send it to us within 10 days from the date of this notice. You can mail the information to Social Security Administration, (address to be determined) or you can call us at (special 800#). If you need help, you should contact us immediately.

 

You May See The Information In Your File

 

If you wish to see the information in your file, you may do so before the date of the review of your case. If you wish to review the file, please call us toll-free at (phone number of SAU).

 

If You Have Any Questions

 

For information about 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.

 

For information about the extra help with the costs related to 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.

 

If you do call, please have this letter with you. It will help us answer your questions.

 

 

 

Subsidy Determination Unit Manager

 

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603094705
HI 03094.705 - Acknowledge Receipt of Case Review - 05/05/2008
Batch run: 07/08/2013
Rev:05/05/2008