BASIC (04-14)

NL 03001.040 Request for Review of Check Replacement Decision Notice when the Beneficiary or Recipient Submits New Information

A. When to use notice

Use this notice when the beneficiary or recipient has sent new information and requests us to review the decision not to replace his or her check(s).

B. Request for review of check replacement decision notice when claimant submits new information

We received the new information you sent us about [1] checks(s) dated [2] totaling $[3]. You asked us to consider these new facts and look again at our decision not to replace the check(s). We are reviewing the information and will write to you again when we finish.

If you have any questions, call us toll free at 1-800-772-1213 [4]. We can answer most questions over the phone. You can also write or visit any Social Security office.

The office that serves your area is:

  • District Office Address City, State Zip

If you do call or visit an office, please have this letter with you. It will help us answer your questions. If you plan to visit an office, you should call ahead to make an appointment. This will help us serve you more quickly.

Fill-ins:

  

[1]

Choice 1 -
Choice 2 -

your
person's name, possessive, in format: John Smith's

[2]

 

Date of check(s), in format: May 3, 2011

[3]

 

Amount of check(s)

[4]

 

or call your local Social Security office at (field office phone number is taken from the DOORS).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0903001040
NL 03001.040 - Request for Review of Check Replacement Decision Notice when the Beneficiary or Recipient Submits New Information - 04/18/2014
Batch run: 04/18/2014
Rev: