BASIC (04-00)

VB 05001.019 Rep Payee Appointment Notice

Document Identifier for Word Processor: TITLE 8 REP. PAYEE APPT. NOTICE

A. EXHIBIT LETTER

The information we have shows you need help managing your money and meeting your daily needs. Because of this information, we plan to send your Special Veterans Benefits (SVB) payments under title VIII of the Social Security Act to __(1)__. We call this __(2)__ your representative payee. Your payee will get your payments each month and will use this money for your needs.

It is your representative payee's duty to manage your SVB money. The representative payee must report changes that can affect your payments and act in your best interest. We will ask your representative payee to show us how the money was used.

OPTIONAL PARAGRAPHS FOR COMPETENT BENEFICIARIES, NUMBERS 1 THROUGH 4, FOLLOW:

[Optional Paragraph #1—When First Payment Is The Same As The Regular Payment]

Information About Your Payments

We __(1)__ sending your regular monthly payment of $__(2)__ to __(3)__ on or about __(4)__.

[Optional Paragraph #2-When First Payment Is Different From The Regular Payment]

Information About Your Payments

We __(1)__ $__(2)__ to __(3)__ for you around __(4)__. We will begin sending your regular monthly payment of $__(5)__ to __(6)__ around __(7)__.

[Optional Paragraph #3—Initial Award Situations (Copy Of Award Notice Sent)

We are enclosing a copy of a letter that we sent to your representative payee. Please be sure to read it. It contains important information.

[Optional Paragraph #4-Appeals Language]

Do You Disagree With The Decision?

If you think you should get your own payments or that someone else should help you and manage your SVB money, you have the right to appeal. We will review your case againand consider any new facts you have. Then a person who did not make the first decision will decide your case again.

  • You have 60 days to ask for an appeal.

  • You must put the request for an appeal in writing.

  • The 60 days start the day after you receive this letter.

  • You must have a good reason if you wait more than 60 days to ask for an appeal.

  • You may make your request through any U.S. Social Security office, United States Embassy or consulate, or the U.S. Veterans Affairs Regional Office in Manila. Or, you may write to us at the address shown at the top of this letter.

Please read the enclosed leaflet, “Your Right to Question the Decision Made on Your Social Security Claim.” It contains more information about an appeal.

If You Have Questions or Need Help

  • If you live in Canada, contact any U.S. Social Security office.

  • If you live in Guam, Puerto Rico, Samoa or the U.S. Virgin Islands, you should contact the nearest U.S. Social Security office.

  • If you live in Mexico, contact any U.S. Social Security office or the nearest United States Embassy or consulate.

  • In the Philippines, please call 523-1001 extensions 2516 or 2645 from 8:00am to 2:00p.m. or write/visit SSA Division, U.S. Department of Veterans Affairs, 1131 Roxas Boulevard, 0930 Manila.

  • In any other country, you should contact the nearest United States Embassy or consulate.

If you call or visit an office, please have this letter with you.

Notice Fill-ins:

  1. (name of representative payee) or (name of institution or entity)

  2. (person) or (organization)

Optional Paragraph #1 Fill-ins:

  1. (will begin) or (began)

  2. (monthly payment amount)

  3. (payee name)

  4. (month, day, year change is effective)

Optional Paragraph #2 Fill-ins:

  1. (sent) or (will send)

  2. (amount of first payment)

  3. (payee name)

  4. (month, day, year of first payment)

  5. (regular monthly benefit amount)

  6. (him) or (her) or (them)

  7. (month, day, year regular payment is due)

B. REQUESTING INSTRUCTIONS

The CPS is responsible for sending this notice.

If the veteran is competent: Select Optional Paragraphs 1 or 2, and Optional Paragraphs 3 and 4. Also, enclose a copy of the award notice and SSA Pub. 05-10058, “Your Right to Question the Decision Made on Your Social Security Claim.”


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