TN 28 (07-19)

NL 00725.420 “SSA” UTIs – Headings and Signatures

First and Second Line Headings

Social Security Administration

Retirement, Survivors and Disability Insurance

Third Line Heading

Notice of Award

Third Line Heading

Notice of Disapproved Claim

Third Line Heading

Claim Information

Third Line Heading

Important Information

Third Line Heading

BNC#:

Third Line Heading

Date:

BNC#:

Payment Name and Address

Addressee

Return Address

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

Return Address

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

Return Address

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

Return Address

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

Return Address

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

Return Address

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

Return Address

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

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.

Signature

(Signature of Commissioner of Social Security)

First Name Last Name

Commissioner of Social Security

Signature

Social Security Administration

Signature

Social Security Administration

Signature

Social Security Administration

Signature

Social Security Administration

Signature

Social Security Administration

Signature

Social Security Administration

Signature

Social Security Administration

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 - 07/17/2019
Batch run: 07/17/2019
Rev:07/17/2019