Basic (05-05)

HI 03094.720 Notice to Living with Spouse Who Does Not Appeal

A. Purpose/Use

“Notice to Living With Spouse Who Does Not Appeal” is sent to the living with spouse when an applicant files a request for appeal but the living with spouse does not. This notice is created in the Document Generation System (DGS) used in the Subsidy Appeals Unit.


B. Sample Important Information Notice for Living With Spouse Who Does Not Appeal


Social Security Administration

Medicare Prescription Drug Assistance

Important Information



                                                                             SDS return address

                                                                             Date: November 23, 2005

                                                                             Social Security Number: 123-00-6789








Based on an appeal filed by your spouse, we may change the amount of your subsidy. We are writing to tell you that you can present additional information for us to consider before we make a decision on your spouse’s appeal.


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.


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




                                                                             Subsidy Determination Unit Supervisor

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HI 03094.720 - Notice to Living with Spouse Who Does Not Appeal - 05/24/2005
Batch run: 07/08/2013