BASIC (04-14)

NL 03001.045 Request for Review of Check Replacement Decision Notice When Additional Information Needed

A. When to use notice

Use this notice to inform the beneficiary or recipient that we have received his or her request for review of the decision not to replace his or her check(s) and the beneficiary or recipient did not send new information for review.

B. Request for review of check replacement decision notice when additional information needed

You asked us to look again at our decision not to replace [1] check(s) dated [2] , totaling $[3] . We will need any new information that you have about the check(s). You can use hospital or doctor bills, gasoline bills or statements from friends or relatives to show that you were not at the address shown on the check(s) the day the post office delivered [4].

If you have any questions, call us toll free at 1-800-772-1213 [5]. 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]

 

it or them

[5]

 

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/0903001045
NL 03001.045 - Request for Review of Check Replacement Decision Notice When Additional Information Needed - 04/18/2014