TN 31 (02-97)

NL 00703.765 Representative Payee Advance Notice for Title XVI Postentitlement Situations

(GN 00503.100)

Document Identifier for Word Processor: E3765

DPS

A. EXHIBIT LETTER

3765AWe are writing to tell you that we have information that shows you need help managing your money and meeting your needs. Because of this information, we plan to send your Supplemental Security Income (SSI) payments to (1) . We call this (2) your representative payee.
3765BWe are writing to tell you that we will select (1) as your new representative payee. We have information that shows you still need help managing your money and meeting your needs.

 

Your Representative Payee's Duties

It is your representative payee's duty to manage your SSI money. The representative payee must report changes that can affect your payments and act in your best interest. We will ask your representative payee to show us how the money was used for you.

 

If You Disagree With This Decision

If you think you should get your own payments or that someone else should help you manage your payments, you have the right to appeal. We will review your case and consider any new facts you have. Then, a person who didn't make the first decision will decide your case.

  • You have 60 days to ask for an appeal. However, unless we hear from you within 10 days, we will select the representative payee named above.

  • The 10 days and 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason for waiting more than 60 days to ask for an appeal.

  • You have to ask for an appeal in writing. We will ask you to fill out Form SSA-561-U2, called “Request for Reconsideration.” To get this form, contact one of our offices. We can help you fill out the form.

     

How To Appeal

3769C

 

If You Want Help With Your Appeal

3215E

 

If You Have Any Questions

3765CIf you have any questions, you should call, write or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (1) . The telephone number is (2) .

(3)

B. REQUESTING INSTRUCTIONS

  • The FO will send this notice to a legally competent SSI recipient. In concurrent cases, separate notices are sent. However, if adjudicated simultaneously, a dictated paragraph may be added so that one notice is released. Refer to NL 00703.215 for 3215E text. Refer to NL 00703.763 for 3763A text. Refer to NL 00703.769 for 3769C text.

  • Use 3765A if the recipient is going from direct payment to representative payment.

     

    Fill-ins:

    1. Name of representative payee

    2. person/organization

       

    Paragraph 3765B

    1. Name of new representative payee

       

    Paragraph 3765C:

    1. FO contact

    2. FO contact's telephone number

    3. “Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us to serve you more quickly when you arrive at the office.” Or null if FO does not make appointments.

  • Use paragraph 3765B if the recipient is going from one representative payee to another.

If an application has been filed by the officer of an institution, or entity, show the title of the officer and the name of the institution or entity. Do not show the name of such officer.

C. TYPING INSTRUCTIONS

This notice will be sent by the FO. It may be reproduced on FO letterhead. In concurrent cases, use SSA letterhead.