TN 1 (07-13)

NL 00756.200 No Social Security Benefits for Prisoners (NSSBP) Title XVI Notices

Use these notices, located in the post-entitlement folder in the Document Processing System (DPS), to inform a current or terminated Title XVI recipient that we are holding an underpayment subject to the NSSBP provisions. For information on the Title XVI NSSBP provisions, see SI 00529.001.

A. Exhibit of initial determination notice for recipients subject to the NSSBP provisions as a prisoner or confined in a public institution based on a court order for a criminal act (CPICO)

This exhibit illustrates the T16 (NSSBP) Prison initial determination notice with possible fill-in choices in the DPS.

   

Social Security Administration

Supplemental Security Income

Important Information

[Date of mailing]

Claim Number: SSN

   

Payee name and address

   

Salutation:

   

Our records show (_*F1_) due a Supplemental Security Income (SSI) back payment of $(_*F2_).

However, we cannot pay the back payment while (_*F3_) confined throughout the month in a public institution that is a jail, prison, or other correctional facility.

Please contact us when (_*F4_) released. We may be able to pay the back payment then.

   

You Can Review The Information In (_*F5_) Case

The decisions in this letter are based on the law and information in our records. You have a right to review and get copies of the information in our records that we used to make the decisions explained in this letter. You also have a right to review and copy the laws, regulations, and policy statements used in deciding (_*F6_) case. To do so, please contact us. Our telephone number and address are shown under the heading "If You Have Questions."

   

If You Disagree With The Decision

If you disagree with the decision, you have the right to appeal. We will review your case and look at any new facts you have.

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you get 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 if you wait more than 60 days to ask for an appeal.

  • To appeal, you must fill out a form called "Request for Reconsideration." The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out the form.

   

How To Appeal

There are two ways to appeal. You can pick the way you want. If you meet with us in person, it may help us decide your case.

  • Case Review - You have the right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case.

  • Informal Conference - You'll meet with the person who decides your case. You can tell that person why you think you're right. You have the right to review the facts in your file. You can give us more facts to help prove you are right. You can bring other people to help explain your case.

   

If You Want Help With Your Appeal

You can have a friend, representative, or someone else help you. There are groups that can help you find a representative or give you free legal services if you qualify. There also are representatives who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

   

If You Have Questions

For general information about SSI, visit our website at http://www.socialsecurity.gov/ on the Internet. You will find the law and regulations about SSI eligibility and SSI payment amounts at http://www.socialsecurity.gov/SSIrules/.

   

For general questions about SSI or specific questions about (_*F7_) case, you may call us toll-free at 1-800-772-1213 or call your local Social Security office at (_*F8_). If you call or visit our office, please bring this letter with you and ask for (_*F9_).

   

Social Security Administration

   

Fill-ins:

*F1 – you are

*F1 – recipient name is

*F2 – amount of back payment

*F3 – you are

*F3 – he is

*F3 – she is

*F3 - recipient name is

*F4 – you are

*F4 – he is

*F4 – she is

*F4 – recipient name is

*F5 – Your

*F5 – His

*F5 – Her

*F5 – recipient name (possessive)

*F6 – your

*F6 – his

*F6 – her

*F6 – recipient name (possessive)

*F7 – your

*F7 – recipient name (possessive)

*F8 – User phone number

*F9 – User name

B. Exhibit of initial determination notice for recipients subject to the NSSBP provisions as a fugitive felon (FF) or a probation or parole violator (PPV)

This exhibit illustrates the T16 (NSSBP) Felon initial determination notice with possible fill-in choices in the DPS.

   

Social Security Administration

Supplemental Security Income

Important Information

[Date of mailing]

Claim Number: SSN

   

Payee name and address

   

Salutation:

   

Our records show (_*F1_) due a Supplemental Security Income (SSI) back payment of $(_*F2_).

However, we cannot pay the back payment while (_*F3_):

  • Fleeing to avoid prosecution, custody, or confinement for a crime that is punishable by death or a prison term of over 1 year, or

  • Violating probation or parole under Federal or State law.

Please contact us when (_*F4_) the arrest warrant or (_*F5_) probation or parole violation ends. We may be able to pay the back payment then.

   

You Can Review The Information In (_*F6_) Case

The decisions in this letter are based on the law and information in our records. You have a right to review and get copies of the information in our records that we used to make the decisions explained in this letter. You also have a right to review and copy the laws, regulations, and policy statements used in deciding (_*F7_) case. To do so, please contact us. Our telephone number and address are shown under the heading "If You Have Questions."

   

If You Disagree With The Decision

If you disagree with the decision, you have the right to appeal. We will review your case and look at any new facts you have.

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you get 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 if you wait more than 60 days to ask for an appeal.

  • To appeal, you must fill out a form called "Request for Reconsideration." The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out the form.

   

How To Appeal

There are two ways to appeal. You can pick the way you want. If you meet with us in person, it may help us decide your case.

  • Case Review - You have the right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case.

  • Informal Conference - You'll meet with the person who decides your case. You can tell that person why you think you're right. You have the right to review the facts in your file. You can give us more facts to help prove you are right. You can bring other people to help explain your case.

   

If You Want Help With Your Appeal

You can have a friend, representative, or someone else help you. There are groups that can help you find a representative or give you free legal services if you qualify. There also are representatives who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

   

If You Have Questions

For general information about SSI, visit our website at http://www.socialsecurity.gov on the Internet. You will find the law and regulations about SSI eligibility and SSI payment amounts at http://www.socialsecurity.gov/ssi/law-regs-finder.htm/.
For general questions about SSI or specific questions about (_*F8_) case, you may call us toll-free at 1-800-772-1213 or call your local Social Security office at (_*F9_). If you call or visit our office, please bring this letter with you and ask for (_*F10_).

   

Social Security Administration

   

Fill-ins:

*F1 – you are

*F1 – recipient name is

*F2 – amount of back payment

*F3 – you are

*F3 – he is

*F3 – she is

*F3 – recipient name is

*F4 – you resolve

*F4 – he resolves

*F4 – she resolves

*F5 – your

*F5 – his

*F5 – her

*F5 – recipient name (possessive)

*F6 – Your

*F6 – His

*F6 – Her

*F6 – recipient name (possessive)

*F7 – your

*F7 – his

*F7 – her

*F7– recipient name (possessive)

*F8 – your

*F8 – recipient name (possessive)

*F9 – User phone number

*F10 – User name


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900756200
NL 00756.200 - No Social Security Benefits for Prisoners (NSSBP) Title XVI Notices - 07/30/2013
Batch run: 07/30/2013
Rev:07/30/2013