TN 24 (12-17)

NL 00725.420 “SSA” UTIs – Headings and Signatures

SSAH01 First and Second Line Headings

Social Security Administration

Retirement, Survivors and Disability Insurance

SSAH02 Third Line Heading

Notice of Award

SSAH03 Third Line Heading

Notice of Disapproved Claim

SSAH04 Third Line Heading

Claim Information

SSAH05 Third Line Heading

Important Information

SSAH28 Date

Date:

Claim Number:

SSAH30 Payment Name and Address

Addressee

SSAH40 Return Address

Northeastern Program Service Center
155-10 Jamaica Avenue
Jamaica, New York 11432-3898

SSAH41 Return Address

Mid-Atlantic Program Service Center
300 Spring Garden Street
Philadelphia, Pennsylvania 19123-2992

SSAH42 Return Address

Southeastern Program Service Center
1200 Rev. Abraham Woods, Jr. Blvd
Birmingham, Alabama 35285-0001

SSAH43 Return Address

Great Lakes Program Service Center
600 West Madison Street
Chicago, Illinois 60661-2474

SSAH44 Return Address

Western Program Service Center
P.O. Box 2000
Richmond, California 94802-1000

SSAH45 Return Address

Mid-America Program Service Center
601 East Twelfth Street
Kansas City, Missouri 64106-2859

SSAH46 Return Address

Office of Central Operations
1500 Woodlawn Drive
Baltimore, Maryland 21241-1500

SSAH47 Return Address

Office of Central Operations
P.O. Box 17769
Baltimore, Maryland 21235-7769 U.S.A.

Fill-ins for SSAH40 - SSAH47

(1) TELEPHONE CONTACT/CERTIFIED MAIL/null

(2) Actual telephone number in format ###-###-#### if number is available and if fill-in (1) = TELEPHONE CONTACT, otherwise null.

SSAS01 Signature

(Signature of Commissioner of Social Security)

First Name Last Name

Commissioner of Social Security

SSAS02 Signature

Social Security Administration

SSAS03 Signature

Social Security Administration

SSAS04 Signature

Social Security Administration

SSAS05 Signature

Social Security Administration

SSAS06 Signature

Social Security Administration

SSAS07 Signature

Social Security Administration

SSAS08 Signature

Social Security Administration

SSAS09 Signature

Social Security Administration


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900725420
NL 00725.420 - "SSA" UTIs - Headings and Signatures - 12/21/2017
Batch run: 12/21/2017
Rev:12/21/2017