TN 1 (03-01)

VB 05001.026 Notice to Beneficiary, Legal Guardian or Representative Payee of Voluntary Termination

Document Identifier for Word Processor: TITLE 8 NOTICE TO BENEFICIARY, REP PAYEE OR LEGAL GUARDIAN WHO IS NOT REP PAYEE OF VOLUNTARY TERMINATION OF BENEFITS

A. EXHIBIT LETTER

We are writing to you about ___(1)___ Special Veterans Benefits (SVB).

Based on your request, we ___(2)___ ___(3) ___ entitlement to Special Veterans Benefits (SVB) payments beginning ___(4) ___.

If You Disagree With the Decision

If you disagree with our decision, you have the right to appeal. A person who did not make the first decision will decide your case. We will review those parts of the decision with which you disagree and will look at any new facts you have. We may also review those parts with which you agree and may make them unfavorable or less favorable to you.

  • 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 page one.

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

[Optional Domestic Paragraph-Domestic Addressee]

If You Have Questions or Need Help

If you have questions, you may call, write or visit our office or any U.S. Social Security office. You may also write to us at the address shown at the top of this letter. If you call or visit an office, please have this letter with you. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

[Optional Foreign Paragraph-Foreign Addressee]

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, American 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.

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

  • If you live 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. (your) or (veteran's name), possessive

  2. (have terminated) or (will terminate)

  3. (your) or (veteran's name), possessive

  4. (MM/YY) month and year of termination

B. REQUESTING INSTRUCTIONS

The CPS is responsible for sending this notice.

If a domestic address is involved, select Optional Domestic Paragraph.

If a foreign address is involved, select Optional Foreign Paragraph.

Enclose Pub. 05-10058, “Your Right to Question the Decision Made on Your Social Security Claim”.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1405001026
VB 05001.026 - Notice to Beneficiary, Legal Guardian or Representative Payee of Voluntary Termination - 06/15/2004
Batch run: 01/27/2009
Rev:06/15/2004