TN 9 (02-07)

NL 00722.170 T2 Application Cover Letter for Wet Signature

Cover Letter for Wet Signature

Social Security Administration
Application Development

 
  
  
 

Telephone Number
Date:

  

Applicant Name
Street address
City, State zip code

 
  
  

On [date], we talked with you about possible entitlement to [fill-in] [fill-in]. We filled out the enclosed application based on your statements. However, we cannot decide if there is entitlement to benefits until you sign the application and give us more information.

What You Need To Do

  • Answer any questions circled on the application

  • Correct any information that is wrong and sign your initials next to the corrections

  • Sign and date the application and any accompanying forms in the space for your signature.

  • Mail the application, any accompanying forms and the information or evidence checked below to the Social Security office address shown above. A self-addressed envelope is enclosed for your convenience. Add your return address on the envelope and remember to place the correct amount of postage on it.

If We Do Not Hear From You

It is important that you sign the application and return it to us within 10 days of the date of this notice. The sooner we get the signed application, the sooner we can decide if [fill-in] eligible.

If we receive the signed application after any of the dates shown below, you may lose benefits.

The statement checked below applies to you.

        If we receive the signed application by                               we will use the date we talked to you about possible entitlement to benefits,                               as the filing date.
        If we receive the signed application after                                but no later than                                we will use the date of the application interview,                               , as the filing date.

Things We Need

We need the items checked below. You must send us the original documents except as noted below. If you do not have the original, you must send a copy certified by the person who is the custodian of the original record. Do not send copies signed by a notary public. We will return the item(s) to you. We can accept a photocopy of a W-2 form or a tax return (1040, Schedule C, Schedule SE, etc.). Do not delay signing and sending us the enclosed application even if you do not have the records we need.

        Birth Certificate or religious record of age for                               
        Marriage Certification for                               
        Divorce or Annulment Decree for                               
        U.S. Passport, Certificate of Citizenship or Naturalization, or current immigration docuent for                              
        Withholding statement (For W-2) for                              
        Tax return and Schedule ESE for                               
        Certificate of Appointment as legal representative for                               
        Death Ceriticate for                              
Award letter or correspondence concerning                              
        Military service discharge papers for                              
        Blank check for direct deposit information (write VOID on the front of the check)
        OTHER                              
        OTHER                              
        OTHER                              
        OTHER                              
        OTHER                              

If You Have Any Questions

If 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                                                   The telephone number is shown above. We can answer most questions over the phone. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

Manager

                              

Enclosure(s):
Application Summary
Envelope


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900722170
NL 00722.170 - T2 Application Cover Letter for Wet Signature - 02/21/2007
Batch run: 01/27/2009
Rev:02/21/2007