Identification Number:
NL 00725 TN 32
Intended Audience:See Transmittal Sheet
Originating Office:DCO OPSOS
Title:Modernized Claims System (MCS) Notices
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part NL – Notices, Letters and Paragraphs
Chapter 007 – Letters and Paragraphs for Title II, Title XVI, and Title XVIII
Subchapter 25 – Modernized Claims System (MCS) Notices
Transmittal No. 32, 12/08/2020

Audience

PSC: BA, CA, CCRE, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, NPR, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, BTE, CC, CCRE, CDT, CR, CTE, ERE, FDE, PETL, RECONE, RECONR, RECOVR;
OCO-ODO: BTE, CCE, CR, CST, CT, CTE, CTE TE, DE, DEC, DS, DSE, PAS, PETE, PETL, RCOVTA, RECOVR;
FO/TSC: CS, CS TII, CSR, DRT, DT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OITBS

Effective Date

Upon Receipt

Background

We are updating Program Operations Manual System (POMS) sections in NL 00725 of Modernized Claims System (MCS) effective August 28, 2020. Language changes for notices in the attached sections are a direct result of updates requested by the Office of Income Security Programs (OISP). All U.S. Embassies, Consulate Generals, and Consular Agencies outside the designated 21 Federal Benefits Unit (FBU) posts are considered non-claims taking posts (NCTPs). Effective 10/1/2017, NCTPs refers all SSA inquiries to an assigned FBU, except for inquiries concerning the following: interviews for Social Security number (SSN) applicants above age 12; consultative exams (CEs) and medical appointments, field investigations, travel, investigations, in office representative payee verification, services related to restricted countries, authentication/certification of documents and intake of initial claims. NCTPs may perform these specific tasks with prior authorization from a Regional Federal Benefits Officer (RFBO). Therefore, instructions directing beneficiaries to U.S. Embassies, Consulate Generals, and Consular Agencies are revised to direct applicants or customers to FBUs for most services, which will be provided only by the 21 U.S. Embassies, Consulate Generals, and Consular Agencies designated as FBUs.

We revised the Univeral Text Identifiers (UTIs) below used in noticces to remove references to the U.S. Embassies, Consulate or Veterans Administration Regional Office (VARO). We also added new language regarding question about Medicare, updating the language for the attorney fee to remove “lawyer” and replace with “representative” and adding the benefit type “Lump Sum Death Payment (LSDP)” to the closeout UTI.

Summary of Changes

NL 00725.120 “ALS” UTIs – Appeals

We are making changes to the UTI ALS049 to update the appeal language by providing beneficiaries the opportunity to file appeals online via the iAppeals URL. We also coded all URL’s as fill-in’s and updated the “If You Have Questions” section to include the Northern Mariana Islands as a U.S. territory. Updating this UTI will create uniformity throughout the notice systems.

NL 00725.130 <Quote>ATY</Quote> UTIs – Attorney Fee

We are making changes to UTI ATYR15 to revise the language to simplify the policy for the appointment of multiple representatives from multiple firms. For UTI ATYR15, we revised fill-in 2 choice E and deleted fill-in 2 choice F to reflect policy. No distinction is needed because an attorney is a representative. We are making changes to both captions UTI ATYC01 and ATYC03 to remove the fill-in option and code “Representative” into the text.

NL 00725.160 “CLO” UTIs – Closeout

We are making changes to UTI CLOR05 to add the benefit type option “Lump Sum Death Payment (LSDP)” to fill-ins 1 and 4. We are also removing the term “children” from the fill-in choices and replacing it with “child’s” since it is the appropriate and correct benefit identifier.

NL 00725.375 <Quote>REF</Quote> UTIs – Referral

We are making changes to the UTI REF002, which will be obsolete for MCS notices with this release. REF002 will now be replaced with the new UTI REF185 to revise the layout of the referral language to a bulleted format to improve readability and appearance of the notice. We also coded all URL’s as fill-in’s and updated the “If You Have Questions” section to include the Northern Mariana Islands as a U.S. territory.

NL 00725.120 “ALS” UTIs – Appeals

ALSC02 Caption

Do You Disagree With the Decision?

ALSC05 Caption

How The Hearing Process Works

ALSC08 Caption

It Is Important To Go To The Hearing

ALSC12 Caption

If You Disagree With The Decisions

ALSC26 Caption

About The Appeals

ALSC27 Caption

If You Want To Appeal

ALSC28 Caption

If You Ask For A Reconsideration And A Hearing

ALS023 Appeals Language – Powell Decision

If you do not agree with this decision, you have the right to appeal. We will review  (1)  case and look at any new facts you have. A person who did not make the first decision will decide  (2)  case. We will review the parts of the decision that you think are wrong and correct any mistakes. We may also review the parts of our decision that you think are right. We will make a decision that may or may not be in  (3)  favor.

You have 60 days to ask for an appeal.

The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not receive it within the 5-day period.

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

You can file an appeal with any Social Security office. You must ask for an appeal in writing. Please use our “Request for Reconsideration” form, SSA-561-U2. You may go to our website at  (4)  to find the form. You can also call, write, or visit us to request the form. If you need help to fill out the form, we can help you by phone or in person.


Fill-ins:
(1) “your”/name, possessive
(2) “your”/”his”/”her”
(3) “your”/”his”/”her”

ALS040 Appeals Language – Administrative Law Judge

If you disagree with our decision, you have the right to request a hearing. A person who has not seen  (1)  case before will look at it. That person is an Administrative Law Judge. The Administrative Law Judge will review our decisions and look at any new facts you have.


Fill-in:
(1) SN

ALS041 Appeals Language – Res Judicata

If there are no new facts, the judge may find that the application presents the same issues as the prior application, and dismiss the hearings request.

ALS042 Hearing Appeals Period

You have 60 days to ask for a hearing.

The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not receive it within the 5-day period.

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

You can file a hearing with any Social Security office. You must ask for a hearing in writing. Please use our “Request for Hearing” form, HA-501. You may go to our website at  (1)  to find the form. You can also call, write, or visit us to request the form. If you need help to fill out the form, we can help you by phone or in person.

If you want to make a request, please contact one of our offices. We can help you complete the required form.

Please read the enclosed pamphlet, “Your Right to an Administrative Law Judge Hearing and Appeals Council Review of Your Social Security Case.” It contains more information about the hearing.


ALS043 Appeals Language – Hearings Request – Living in Foreign Country

You have 60 days to ask for a hearing.

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 a hearing.

You can only have a hearing in the United States. You would have to pay any costs for traveling to the United States for the hearing. If you cannot come to the hearing, the ALJ will review your case plus any new information you send us. We will send you a letter about the ALJ's decision.

You have to ask for a hearing in writing. Contact us if you want help.

ALS046 Reconsideration Hearing for Domestic and Foreign Appeals Cases

This action results from reconsideration of your claim and replaces our previous determination.

If you think we are wrong, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. In the rest of our letter, we will call this person an ALJ. The ALJ will review those parts of the decision which you believe are wrong. The ALJ will look at any new facts you have and correct any mistakes. The ALJ may also review those parts which you believe are correct and may make them unfavorable or less favorable to you.

ALS047 ALJ Level; Supersedes Previous Determination; Domestic and Foreign

We previously informed you of your appeal rights concerning the administrative law judge's (ALJ) decision. We also informed you of what you must do to have that decision reviewed.

If you believe that we decided any other part of  (1)  case incorrectly, you may request reconsideration on that part of  (2)  case.


Fill-ins:
(1) “your”/”his”/”her”
(2) “your”/”his”/”her”

ALS048 Domestic ALJ Cases; If ALS047 and SCC Present

If you do not agree with this decision, you have the right to appeal. We will review  (1)  case and look at any new facts you have. A person who did not make the first decision will decide  (2)  case. We may also review the parts of the decision that you think are right. We will make a decision that may or may not be in  (3)  favor.

You have 60 days to ask for an appeal.

The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not receive it within the 5-day period.

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

You can file an appeal with any Social Security office. You must ask for an appeal in writing. Please use our “Request for Review of Hearing Decision/Order” form HA-520-U5. You may go to our website at  (4)  to find the form. You can also call, write, or visit us to request the form. If you need help to fill out the form, we can help you by phone or in person.


Fill-ins:
(1) “your”/name, possessive
(2) “your”/“his”/“her”
(3) “your”/“his”/“her”

ALS049 Foreign ALJ Cases; If ALS047 and Consul Code Present

If you want this reconsideration, you must request it no later than 60 days from the date you receive this notice. 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. Visit our website at  (1)  if you would like to request a reconsideration.

If you are in the United States, American Samoa, Guam, Northern Mariana Islands, Puerto Rico, or the U.S. Virgin Islands:

  • Call us toll-free at 800-772-1213 (TTY 800-325-0778).

  • Contact your nearest Social Security office.

If you are outside the United States or its territories:

  • If you are in Canada, visit  (2)  to find the office that services your area.

  • Contact your nearest Federal Benefits Unit (FBU). Visit  (3)  for a list of FBUs.

  • Write to the Social Security Administration at:

P.O. Box 17769,

Baltimore, Maryland 21235-7769

USA

If additional evidence is available, you should submit it with your request.

Please be sure to include  (4)  Social Security claim number if you do write. If you visit an office, please take this letter with you. It will help us answer your questions .


ALS054

It is very important that you go to the hearing. If for any reason you can't go, contact the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule the hearing if you have a good reason.

If you don't go to the hearing and don't have a good reason for not going, the ALJ may dismiss your request for a hearing.

ALS061

This action supersedes our previous determination and is in accordance with the decision on your hearing request. You have already been notified of your appeal rights regarding the decision made on your hearing request and what you must do to have that decision reexamined. If you want this reconsideration, you may request it through any Social Security office. If additional evidence is available, you should submit it with your request. We will review the case and consider any new facts you have. A person who did not make the first decision will decide.

 (1)  case. We will correct any mistakes. We will review those parts of the decision which you believe are wrong and will look at any new facts you have. We may also review those parts which you believe are correct and may make them unfavorable or less favorable to  (2)  .

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 for waiting more than 60 days to ask for an appeal.

You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2, called “Request for Reconsideration”. Contact one of our offices if you want help.

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


Fill-ins:
(1) “your”/name, possessive
(2) “you”/“her”/“him”

ALS070 English Translation for Spanish Cover Letter – Awards – Domestic/Foreign Address

If you do not agree with the decision, you may ask to have your case reviewed. But you must request this reconsideration from any Social Security office within 60 days from the date that you receive this notice. You can submit any additional evidence or information you feel would be helpful.

ALS072 English Translation for Spanish Cover Letter – Affirmation of Denial on Reconsideration – Domestic/Foreign Address

If you do not agree with this final decision, you can ask that your claim be reviewed by an Administrative Law Judge of the Office of Hearings Operations. But you must go to any Social Security office to request the review within 60 days from the date you receive this notice.

The enclosed pamphlet explains your right to appeal.

ALS113

If you disagree with the decisions, 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 decisions you disagree with and will look at any new facts you have. We may also review those parts of the case that you believe are correct and may make them unfavorable or less favorable to you.

ALS073 English Translation for Spanish Cover Letter – Affirmation of Denial on Reconsideration – Mexico Address

If you do not agree with this final decision, you can ask that your case be reviewed by an Administrative Law Judge of the Office of Hearings Operations. But you must request this review from any Social Security office within 60 days from the date you receive this notice.

ALS121

If you disagree with the nonmedical decisions we made on your case, the appeal is called a reconsideration. Some examples of nonmedical decisions are the amount of your payment, and the month your payment starts. You will not meet with the person who decides your case.

If you disagree with the disability (medical) decision made by the state, the appeal is called a hearing. Some examples of medical decisions are the date your disability started or whether you are still disabled.

ALS122

You have 60 days to ask for an appeal.

The 60 days start the day after you receive this letter. We assume you received 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.

You can file an appeal with any Social Security office. You must ask for an appeal in writing. Please use our “Request for Reconsideration” form SSA-561-U2, or “Request for Hearing” form HA-501. You may go to our website at  (1)  to find the forms. You can also call, write, or visit us to request the forms. If you need help to fill out the forms, we can help you by phone or in person.


ALS123

If you ask for both a reconsideration and a hearing, we will process the hearing first, even if you made the reconsideration request first. When we make our decisions, we will send you letters explaining our decisions on both the reconsideration and the hearing.

ALS125

After we send your case for a hearing, an Administrative Law Judge (ALJ) will mail you a letter at least 20 days before the hearing to tell you its date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it is important that you give us any new facts as soon as you can.

The hearing is your chance to tell the ALJ why you disagree with the decisions in your case. You can give the ALJ new evidence and bring people to testify for you. The ALJ also can require people to bring important papers to your hearing and give facts about your case. You can question these people at your hearing.

ALSR01 Hearings Level Decision by Someone Other Than an ALJ

We previously informed you of your appeal rights concerning the administrative law judge's (ALJ) decision. We also informed you of what you must do to have that decision reviewed.

If you believe that we decided any other part of  (1)  case incorrectly, you may request reconsideration on that part of  (2)  case. We will review  (3)  case and look at any new facts you have. A person who did not make the first decision will decide  (4)  case. We will review the parts of the decision that you think are wrong and correct any mistakes. We may also review the parts of our decision that you think are right. We will make a decision that may or may not be in  (5)  favor.

You have 60 days to ask for an appeal.

The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not receive it within the 5-day period.

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

You can file an appeal with any Social Security office. You must ask for an appeal in writing. Please use our “Request for Reconsideration” form, SSA-561-U2. You may go to our website at  (6)  to find the form. You can also call, write, or visit us to request the form. If you need help to fill out the form, we can help you by phone or in person.


Fill-ins:
(1) “your”/”his”/”her”
(2) “your”/”his”/”her”
(3) “your”/name, possessive
(4) “your”/”his”/”her”
(5) “your”/”his”/”her”

NL 00725.130 ATY UTIs – Attorney Fee

ATYC01 Caption

Information About Representatives Fees

ATYC02 Caption

How To Ask Us To Review the  (1) 


Fill-in:
(1) “Determination On The Fee Amount”/“Determination On The Fee Agreement”

ATYC03 Caption

Information About Past-Due Benefits Withheld To Pay A Representative

ATY052 Attorney or Eligible Representative Not Registered with SSA

We withhold past-due benefits if the representative is a  (1)  and registers with us to receive direct fee payment. Although your representative is a  (2)  , he or she did not register for direct payment before we completed our work on your claim. For that reason, we did not withhold from your past-due benefits to pay the fee we approve. Therefore, the Social Security Administration is not involved in paying the fee. This is a matter between  (3)  and the  (4)  .


Fill-ins:
(1) lawyer/participant in the non-attorney direct payment demonstration project
(2) lawyer/participant in the demonstration project
(3) first and last name of number holder/you
(4) “lawyer”/“representative”

ATYR01 Attorney Fee Withheld and Paid to Lawyer

We took  (1)  out of  (2)  first check. We are paying this money to the lawyer who helped with this Social Security claim.


Fill-ins:
(1) attorney fee amount *
(2) SN
(*) indicates that the fill-in is manual

ATYR02 Fee Amount Unknown – Past-Due Benefits Unknown

We base the amount of  (1)  fee on past-due benefits, if any. As soon as we  (2)  determine the amount of benefits, we will tell you the amount of the fee  (3)  can charge.


Fill-ins:
(1) “your attorney's”/“your representative's”/“the attorney's”/“the representative's”
(2) “make a decision on your spouse's/family's/child's/children's/null claim” *
(3) “your attorney”/“your representative”/“the attorney”/“the representative”
(*) indicates that the fill-ins are manual

ATY002 Attorney Involved - Petition

When a lawyer wants to charge for helping with a Social Security claim, we must first approve the fee. We usually withhold 25 percent of past due benefits in order to pay for approved lawyer's fee.

ATYR03 Fee Agreement Subsequently Disapproved and No Past Due Benefits are Available

We wrote you before and said we had approved the fee agreement between  (1)  and the  (2)  . We also said we would tell  (3)  and the  (4)  the amount of the fee he or she can charge  (5)  .

We base the fee amount we allow under a fee agreement on  (6)  past-due benefits. There are no past-due benefits. Therefore, we no longer approve the fee agreement between  (7)  and the  (8)  .

Even though we no longer approve the fee agreement, the  (9)  can still charge a fee for his or her services. If the  (10)  wants to charge a fee, he or she must ask us in writing to approve the fee. The  (11)  must give  (12)  a copy of his or her fee request and each attachment to the request. If the  (13)  does not want to charge a fee, he or she should tell us.


Fill-ins:
(1) Manual fill-in 1 input name of beneficiary who actually hired the attorney or representative*
(2) “lawyer”/“representative”
(3) Ms. plus BLN/Mr. plus BLN/BGN/BGN plus BLN/“you”
(4) “lawyer”/“representative”
(5) Ms. plus BLN/Mr plus BLN/BGN/BGN plus BLN
(6) “her”/ “his”/ “your”
(7) Manual fill-in 2 input name of beneficiary who actually hired the attorney or representative*
(8) “lawyer”/“representative”
(9) “lawyer”/“representative”
(10) “lawyer”/“representative”
(11) “lawyer”/“representative”
(12) “her”/ “him”/ “you”
(13) “lawyer”/“representative”
(*) indicates that the fill-in is manual

ATY003 Attorney Fees Withheld - Petition

Because a lawyer  (1)  with this claim, we withheld  (2)  from  (3)   (4)  check.


Fill-ins:
(1) “helped”/“may have helped”
(2) amount withheld
(3) “your”/“her”/“his”
(4) “first”

ATYR04 Notify a Beneficiary with a Lawyer or Representative Eligible for Direct Payment that Fee Authorization Cannot Be Released at the Time of Effectuation. (Additional Information Pending)

When a  (1)  wants to charge for helping with a Social Security claim, we must approve the fee. We usually withhold 25 percent of past-due benefits in order to pay the approved  (2)  fee. We withheld $  (3)  from  (4)  in case we need to pay  (5)   (6)  .

We cannot tell you how much the  (7)  can charge at this time. When processing  (8)  claim we found we needed more information. To decide how much  (9)  benefits will be for  (10)  , we need  (11)   (12)   (13)  . When we get that information, we will decide the amount of  (14)  past-due benefits and send another letter telling you how much the  (15)  can charge. You can help us finish the work on  (16)  claim by taking the information to any Social Security office.


Fill-ins:
(1) “representative”
(2) “representative's”
(3) show the total fee amount withheld from all PICs/Show the single PICs fee amount withheld
(4) “the benefits due you and your family”/“your benefits”
(5) always use “the”
(6) “representative”
(7) “representative”
(8) Ms. plus BLN (possessive)/ Mr. plus BLN (possessive)/“your”
(9) “her”/“his”/“your”
(10) Month YYYY/Month YYYY and Month YYYY/Month YYYY through Month YYYY
(11) Manual fill-in 1 which can include choices A or B
A. proof of
B. more information about
(12) “her”/“his”/“your”
(13) Manual fill-in 2 which can include choices of workers' compensation benefits/public disability benefits/workers' compensation and public disability benefits/military service/date of birth/or free format reason*
(14) “her”/“his”/“your”
(15) “representative”
(16) “her”/“his”/“your”
(*) indicates that the fill-in is manual

ATY004 Fee Petition not Received/Approved and Direct Payment Not Waived

We generally must approve any fee  (1)  representative wants to charge for helping with  (2)  Social Security claim. The representative should send us a fee request when he or she has finished all work on the claim. If the representative will not charge a fee, he or she must tell us by sending a signed and dated statement.


Fill-ins:
(1) “your”/name, possessive
(2) “your”/“his”/“her”

ATYR05 Fee Agreement Amount - Auxiliary

 (1)  past-due benefits are  (2)  for  (3)  . Under the fee agreement between  (4)  and the  (5)  , the  (6)  cannot charge more than  (7)  for his or her work.


Fill-ins:
(1) FN possessive
(2) amount
(3) month and year/month and year through month and year
(4) person that signs the fee agreement*
(5) “lawyer”/“representative”
(6) “lawyer”/“representative”
(7) money amount *
(*) indicates that the fill-ins are manual

ATY005 Attorney Fees Withheld - Petition

When the amount of the fee is decided, we will pay the lawyer from the benefits we withheld.

ATY005 Attorney Fees Withheld - Petition

If the approved fee is more than the money we have withheld, the Social Security Administration is not involved in paying the rest of the fee.

ATYR06 Notify a Beneficiary with Representative that Fee Authorization Cannot be Released at Time of Effectuation. (WC/PDB Decision or Appeal of a Denied WC/PDB Claim is Pending)

When a representative wants to charge for helping with a Social Security claim, we must approve the fee.

We cannot tell you how much the representative can charge at this time. When processing  (1)  claim we found we needed more information. To decide how much  (2)  benefits will be for  (3)  , we need  (4)   (5)   (6)  . When we get that information, we will decide the amount of  (7)  past-due benefits and send another letter telling you how much the representative can charge. You can help us finish the work on  (8)  claim by taking the information to any Social Security office.


Fill-ins:
(1) Ms. plus BLN (possessive)/Mr. plus BLN (possessive)/“your”
(2) “her”/“his”/“your”
(3) Month YYYY/Month YYYY and Month YYYY/Month YYYY through Month YYYY
(4) Manual fill-in 1 which can include choices A or B
A. proof of
B. more information about
(5) “her”/“his”/“your”
(6) Manual fill-in 2 which can include choices of workers' compensation benefits/public disability benefits/workers' compensation and public disability benefits/military service/date of birth/or free format reason*
(7) “her”/“his”/“your”
(8) “her”/“his”/“your”
(*) indicates that the fill-in is manual

ATY007 Fee Withholding Information - Petition

If the approved fee is less than the money we have withheld, we will send  (1)   (2)  .


Fill-ins:
(1) SN
(2) “the rest of the money”

ATY008 Attorney Appointment Questionable Award

We need more information to decide whether a lawyer represents  (1)  in  (2)  claim for Social Security benefits. We will contact you for this information.


Fill-ins:
(1) SN
(2) “your”/“her”/“his”

ATY009 Attorney Representation Questionable

We need more information to decide whether a lawyer represents  (1)  After we decide this, we will let you know if  (2)   (3)  due any of the money we have withheld.


Fill-ins:
(1) Beneficiary's full name
(2) SN
(3) “is”/“are”

ATY010 Non-Attorney Representative, Fee Not Waived, Award

Your representative must receive approval from the Social Security Administration before a fee can be charged. If the representative wants to charge a fee, a request for approval must be sent to us as soon as all work for  (1)  is finished. If no fee will be charged, we should also be told right away.


Fill-in:
(1) SN

ATY011 Address for Sending Fee Petition

Any request for fee approval should be sent to:  (1) 


Fill-in:
(1) Address to which petition is sent

ATY012 Attorney Waived Option to Direct Payment

However, the lawyer has asked us to send all past due benefits to  (1)  .


Fill-in:
(1) “you”/“her”/“him”

ATYR12 Explanation of Withholding - Auxiliary

Because of the law, we usually withhold 25 percent of the total past-due benefits to pay an approved lawyer's fee. We withheld $ (1)  from  (2)  past-due benefits to pay  (3)  lawyer.


Fill-ins:
(1) money amount
(2) “your”/name, possessive
(3) “the”

ATY013 Attorney has not Waived Fee, No Past Due Benefits

However, there are no past due benefits available to be paid to the lawyer.

ATY014 Attorney Waived Fee, Award

However, the lawyer has told us that no fee will be charged for services on this Social Security claim. For this reason, no past due benefits have been withheld to pay the lawyer.

ATYR15 Disapproval of Fee Agreement

We cannot approve the fee agreement between you and your representative because  (1) (1). Even though we cannot approve the fee agreement, your representative can still charge you a fee for his or her services. If your representative wants to charge a fee, he or she must ask us in writing to approve the amount of the fee. Your representative must give you a copy of his or her fee request and each attachment to the request. If your representative does not want to charge a fee, he or she should tell us.


Fill-ins:
(1) Manual fill-in 1, choice of A through H:
(A) we did not get a written agreement before we decided your claim.
(B) both you and your representative did not sign the agreement.
(C) it sets a fee amount that is more than the lesser of 25 percent of past-due benefits or $6000.00.
(D) there are no past-due benefits. We base the fee amount we allow under a fee agreement on your past-due benefits. Since we do not owe you any past-due benefits, we cannot approve the fee agreement.
(E) you appointed more than one representative, and not all representatives signed onto a single fee agreement.
(F) you discharged a representative, or a representative withdrew from the case, before we favorably decided the claim (unless the former representative waived any fee in your case).
(G) your representative died before we issued the favorable decision.
(H) you were declared legally incompetent by a State court and your guardian did not sign the fee agreement.*

ATY016 Explanation of Attorney Fee Assessment (With Cap)

We are paying the  (1)  from the benefits we withheld. Therefore, we must collect a service charge from him or her. The service charge is 6.3 percent of the fee amount we pay, but not more than $97, which is the most we can collect in each case under the law. We will subtract the service charge from the amount payable to the  (2)  .  (3) 

The  (4)  cannot ask you to pay for the service charge. If the  (5)  disagrees with the amount of the service charge, he or she must write to the address shown at the top of this letter. The  (6)  must tell us why he or she disagrees within 15 days from the day he or she gets this letter.


Fill-ins:
(1) “representative”
(2) “representative”
(3) After we subtract the amount we are paying towards the fee, we will send you the balance of the amount we withheld/NULL
(4) “representative”
(5) “representative”
(6) “representative”

ATY018 Non-Attorney Representative, Fee Waived, Award

Your representative told us that a fee will not be charged. If a fee is charged, your representative must receive approval from the Social Security Administration.

ATYR20 Fee Amount – Number Holder Only – Delayed Auxiliary Claims Pending or Expected

We base the amount of the  (1)  fee on the total past-due benefits for you and your family. Your past-due benefits are

$ (2)  for  (3)  . Under the fee agreement, the  (4)  can charge you $ (5)  for his or her work. As soon as we make a decision on your family's claim(s) and decide the amount of their past-due benefits, we will tell them if the  (6)  can charge an additional fee. We also will say how much that fee amount will be.

The amount of the fee for your and your family's claim(s) does not include any out-of-pocket expenses (for example, costs to get copies of doctors' or hospitals' reports). This is a matter between you and the  (7)  .


Fill-ins:
(1) “lawyer's”/“representative's”
(2) Show amount of the N/H's past-due benefits in format “$$$$.¢¢”
(3) MM/YYYY or MM/YYYY through MM/YYYY
(4) “lawyer”/“representative”
(5) Show amount of the fee in $$$$.¢¢ format.
(6) “lawyer”/“representative”
(7) “lawyer”/“representative”

ATYR22 Fee Amount – Number Holder and Non-Delayed Auxiliary Beneficiary(ies) – Delayed Auxiliary Claims Pending or Expected

We base the amount of the  (1)  fee on the total past-due benefits for you and your family. Your past-due benefits are $ (2)  for  (3)  .  (4)  past-due benefits are $ (5)  for  (6)  . Under the fee agreement, the  (7)  can charge you and  (8)  $ (9)  for his or her work. As soon as we make a decision on your  (10)  and decide the amount of the past-due benefits, we will tell  (11)  if the  (12)  can charge an additional fee. We also will say how much that fee amount will be.

The amount of the fee for your and your family's claim(s) does not include any out-of-pocket expenses (for example, costs to get copies of doctors' or hospitals' reports). This is a matter between you and the  (13)  .


Fill-ins:
(1)
Choice 1 - lawyer's
Choice 2 - representative's
(2) The amount of the N/H's past-due benefits in $$$$.¢¢ format.
(3)
Choice 1 - MM/YYYY
Choice 2 - MM/YYYY through MM/YYYY
(4)
Choice 1 - (current action involves only one auxiliary beneficiary) - insert possessive case of name of auxiliary beneficiary, in the format First Name, Last Name. Example: Henry James.
Choice 2 - (current action involves two or more auxiliary beneficiaries) - insert possessive case of names of auxiliary beneficiaries, in the format First Name, Last Name, (separated by commas and/or “and,” as appropriate). Example: Henry James, William Jones, and Alice James. *
(5) The amount of the non-delayed auxiliary beneficiary's (ies') past-due benefits *
(6)
Choice 1 – MM/YYYY
Choice 2 - MM/YYYY through MM/YYYY
(7)
Choice 1 - lawyer
Choice 2 - representative
(8)
Choice 1 - (current action involves only one auxiliary beneficiary) - insert name of auxiliary beneficiary, in the format First Name, Last Name. Example: Henry James.
Choice 2 - (current action involves two or more auxiliary beneficiaries) - insert names of auxiliary beneficiaries, in the format First Name, Last Name, (separated by commas and/or “and,” as appropriate). Example: Henry James, William James, and Alice James. *
(9) The amount of the fee based on total past-due benefits for the N/H's claim and any non-delayed auxiliary claims *
(10)
Choice 1 - spouse's claim
Choice 2 - other child's claim
Choice 3 - other children's claims
Choice 4 - spouse's and other child's claims
Choice 5 - spouse's and other children's claims *
(11)
Choice 1 - him
Choice 2 - her
Choice 3 - them *
(12)
Choice 1 - lawyer
Choice 2 - representative
(13)
Choice 1 - lawyer
Choice 2 - representative
(*) indicates that the fill-ins are manual

ATY023 Auxiliary's Past-Due Benefit (s) Withheld – SSI Pending

We also withheld  (1)  from  (2)  family's past-due benefits.


Fill-ins:
(1) legal payment deduction amount
(2) “your”/“her”/“his”

ATY079 Claim is Denied and No Fee Agreement Type is Present

 (1)   (2)  must ask us for approval before charging a fee. If  (3)   (4)  wants to charge a fee, a request for approval must be sent to us as soon as all work on this case for  (5)   (6)  is finished.


Fill-ins:
(1) SN possessive
(2) “lawyer”/“representative”
(3) SN possessive
(4) “lawyer”/“representative”
(5) SN
(6) null

ATY080 Attorney/Non-Attorney Representation Questionable, Disallowance

An attorney or other representative must ask us for approval before charging a fee. If  (1)  a representative who wants to charge a fee, a request for approval must be sent to us as soon as all work on this case is finished. If no fee will be charged, we should also be told right away. If the fee is approved, the Social Security Administration will not be involved in paying the fee.


Fill-in:
(1) “you have”/“she has”/“he has”

ATY081 Non-Attorney/Attorney Fee Waived, Disallowance

 (1)  has told us that a fee will not be charged for helping  (2)   (3)  with  (4)  claim.


Fill-ins:
(1) attorney name/representative name
(2) SN
(3)
“and [3a] family members”/null
[3a] “your”/“her”/“his”
(4)

ATY800 Fee Agreement Approval – Number Holder

We have approved the fee agreement between you and your  (1)  .


Fill-in:
(1) “lawyer”/“representative”

ATY801 Fee Agreement Approval - Auxiliary

When  (1)  filed  (2)  claim for benefits,  (3)  used a  (4)  to help with the claim. We have approved a fee agreement between  (5)  and  (6)   (7)  . The  (8)  work involved the benefits of everyone on the record.


Fill-ins:
(1) beneficiary name
(2) “your”/“her”/“his”
(3) “you”/“she”/“he”
(4) “lawyer”/“representative”
(5) beneficiary name
(6) “the”
(7) “lawyer”/“representative”
(8) “lawyer's”/“representative's”

ATY804 Fee Agreement Amount – Number Holder

 (1)  past-due benefits are  (2)  for  (3)  . Under the fee agreement, the  (4)  cannot charge you more than  (5)  for his or her work. The amount of the fee does not include any out-of-pocket expenses (for example, costs to get copies of doctors or hospitals reports). This is a matter between you and your  (6)  .


Fill-ins:
(1) “Your”/FN possessive
(2) money amount
(3) month and year/month and year through month and year
(4) “lawyer”/“representative”
(5) pending fee amount
(6) “lawyer”/“representative”

ATY808 Procedure for Review of Fee Under Fee Agreement – Number Holder

You, the  (1)  or the person who decided your case can ask us to review the amount of the fee we say the  (2)  can charge.  (3) 

If you think the amount of the fee is too high, write us within 15 days from the day you get this letter. Tell us that you disagree with the amount of the fee and give your reasons. Send your request to this address:

Social Security Administration
Office of Hearings Operations
Attorney Fee Branch
5107 Leesburg Pike,
Falls Church, Virginia 22041-3255

The  (4)  also has 15 days to write us if he or she thinks the amount of fee is too low.  (5) 

If we do not hear from you or the  (6)  , we will assume you both agree with the amount of the fee shown.


Fill-ins:
(1) “lawyer”/“representative”
(2) “lawyer”/“representative”
(3) “Your family members who have filed claims on your Social Security number (SSN) also may ask us to review the amount of the fee.”/null
(4) “lawyer”/“representative”
(5) “null”
(6) “lawyer”/“representative”

ATY809 Procedure for Review of Fee Under Fee Agreement - Auxiliary

You,  (1)  , the  (2)  or the person who decided your case can ask us to review the amount of the fee we say the  (3)  can charge.

If you think the amount of the fee is too high, write us within 15 days from the day you get this letter. Tell us that you disagree with the amount of the fee and give your reasons. Send your request to this address:

Social Security Administration
Office of Hearings Operations
Attorney Fee Branch
5107 Leesburg Pike,
Falls Church, Virginia 22041-3255

The  (4)  also has 15 days to write us if he or she thinks the amount of fee is too low.  (5) 

If we do not hear from you or the  (6)  , we will assume you both agree with the amount of the fee shown.


Fill-ins:
(1) Beneficiary name
(2) “lawyer”/“representative”
(3) “lawyer”/“representative”
(4) “lawyer”/“representative”
(5) “If we withheld past-due benefits to pay your lawyer's fee, we will not pay the fee until 15 days pass and no one asks us to review the amount of the fee.”/null
(6) “lawyer”/“representative”

ATY816 Attorney Responsibilities – Fee Agreement Disapproved

If your lawyer wants us to pay the fee from your withheld benefits, he or she must ask us to approve the fee within 60 days of the date of this letter.

If your lawyer:

Is finished working on this case and wants to charge a fee, he or she should ask us to approve the amount of the fee right away.

Is not finished working on this case and wants to charge a fee, he or she must tell us within 60 days of the date of this letter that he or she will ask for a fee.

Does not want to charge a fee or does not want us to pay the fee from the benefits we withheld, he or she should tell us right away.

ATY817 Review of Determination on Fee Agreement

You or the  (1)  can ask us to review the determination on the fee agreement. If you decide to ask us for a review, write us within 15 days from the day you get this letter. Tell us that you disagree and give your reasons. Send your request to this address:

Social Security Administration
Office of Hearings Operations
Attorney Fee Branch
5107 Leesburg Pike
Falls Church, Virginia 22041-3255

The  (2)  also has 15 days to write us if he or she does not agree with the determination on the fee agreement.


Fill-ins:
(1) “lawyer”/“representative”
(2) “lawyer”/“representative”

ATY825 Fee Agreement Amount – Concurrent Title II/Title XVI – Additional Fee for Title XVI Claim – Number Holders Only

If we approve your claim for SSI, the  (1)  may be able to charge an additional amount for his or her work. We will send you another letter about SSI telling you the additional amount of the fee, if any, he or she can charge.


Fill-ins:
(1) “lawyer”/“representative”

ATY834 Fee Agreement Amount – Number Holder and Family

 (1)  past-due benefits are  (2)  for  (3)  .  (4)  family's past-due benefits are  (5)  for  (6)  . Under the fee agreement, the  (7)  cannot charge  (8)  and  (9)  family more than  (10)  for his or her work. The amount of the fee does not include any out-of-pocket expenses (for example, costs to get copies of doctors' or hospitals' reports). This is a matter between you and the  (11)  .


Fill-ins:
(1) “Your”/FN possessive
(2) money amount
(3) month and year/month and year through month and year
(4) “your”/“her”/“his”
(5) money amount
(6) month and year/month and year through month and year
(7) “lawyer”/“representative”
(8) “you”/SN
(9) “your”/“her”/“his”
(10) the total fee amount
(11) “lawyer”/“representative”

ATY836 Explanation to the Beneficiary About the Withholding of Representative Fees from Past-Due Benefits

Based on the law, we must withhold part of past-due benefits to pay an appointed representative. We cannot withhold more than 25 percent of past-due benefits to pay an authorized fee. We withheld  (1)  from  (2)  past-due benefits to pay  (3)  representative.


Fill-ins:
(1) money amount
(2) “Mr.” plus BLN possessive/“Ms.” plus BLN possessive/null plus BGN possessive/null plus FN possessive/“your”
(3) “the”

ATY838 Explanation of Withholding – Fee Agreement – Amount Withheld Greater than Fee Amount – SSI Pending – Number Holder's Family

Because of the law, we usually withhold 25 percent of the total past-due benefits to pay an approved lawyer's fee. We withheld  (1)  from  (2)  past-due benefits to pay  (3)  lawyer. We also withheld  (4)  from  (5)  family's past-due benefits. We base the amount of the fee  (6)  lawyer can charge on the total past-due benefits due  (7)  and  (8)  family.


Fill-ins:
(1) money amount
(2) “your”/name, possessive
(3) “the”
(4) money amount
(5) “your”/“her”/“his”
(6) “the”
(7) “you”/name
(8) “your”/“her”/“his”

NL 00725.160 “CLO” UTIs – Closeout

CLOC01 Caption

Other Social Security Benefits

CLOC06 Caption

Others Who May Be Eligible For Benefits

CLO001 General Closeout for Disallowances

 (1)  not due any other Social Security benefits. In the future, if you think  (2)  may qualify for benefits from us,  (3)  will need to apply again.


Fill-ins:
(1) “You are”/'He is”/”She is”
(2) “you”/“he”/“she”
(3) “you”/“he”/“she”

CLO002 General Closeout for Awards

 (1)   (2)  can receive from us at this time. In the future, if you think  (3)  might qualify for another benefit from us,  (4)  will need to apply again.


Fill-ins:
(1) “This benefit is the only benefit”/“These benefits are the only benefits”
(2) “you”/“he”/“she”
(3) “you”/“he”/“she”
(4) “you”/“he”/“she”

CLO003 Closeout for Lump Sum Awards

We checked to see if  (1)  for any other Social Security benefit on  (2)  record. We found that this is the only one  (3)  can receive from us at this time. In the future, if you think  (4)  might qualify for another benefit from us,  (5)  will need to apply again.


Fill-ins:
(1) “you qualify”/“he qualifies”/ “she qualifies”
(2) NH's FN
(3) “you”/“he”/ “she”
(4) “you”/“he”/“she”
(5) “you”/“he”/“she”

CLO036  

 (1)   (2)  may now be eligible for benefits on  (3)  record.  (4)  named the following  (5)  when  (6)  applied for benefits:


Fill-ins:
(1) “Your”/Beneficiary's name (possessive)/
(2) “child”/ “children”
(3) “your”/“his”/ “her”
(4) “You”/“He”/“She”
(5) “child”/“children”
(6) “you”/“he”/ “she”

CLO037

  •  (1) 

  •  (2) 

  •  (3) 

  •  (4) 

  •  (5) 

  •  (6) 

  •  (7) 

  •  (8) 

  •  (9) 

  •  (10) 


Fill-ins:
(1) First child named on DEPC screen
(2) Second child named on DEPC screen
(3) Third child named on DEPC screen
(4) Fourth child named on DEPC screen
(5) Fifth child named on DEPC screen
(6) Sixth child named on DEPC screen
(7) Seventh child named on DEPC screen
(8) Eighth child named on DEPC screen
(9) Ninth child named on DEPC screen
(10) Tenth child named on DEPC screen

CLO038

If  (1)  not filed an application for benefits for the  (2)  , please contact us.


(1) “you have”/“he has”/”she has”
(2) “child”/ “children”

CLOR05 Award Closeout When Second Claim Pending

This  (1)  benefit is the only benefit we can pay  (2)  at this time. We will let you know if  (3)  eligible for  (4)  benefits.  (5)  cannot receive any other type of benefits based on the application  (6)  filed.


Fill-ins:
(1)"retirement"/"wife's"/"husband's"/"widow's"/"widower's"/"mother's"/"father's"/"parent's"/"disabled widow's"/"disabled widower's"/"disabled divorced widow's"/"disabled divorced widower's"/"child's"/"lump sum death payment" *
(2) “you”/“him”/“her”
(3) “you are”/“he is”/“she is”
(4)"retirement"/"wife's"/"husband's"/"widow's"/"widower's"/"mother's"/"father's"/"parent's"/"disabled widow's"/"disabled widower's"/"disabled divorced widow's"/"disabled divorced widower's"/"child's"/"lump sum death payment" *
(5) “You”/“He”/“She”
(6) “you”/“he”/“she”
(*) indicates that the fill-ins are manual

CLOR06 Award Closeout When DIB Pending

The  (1)  benefit is the only one to which  (2)   (3)  entitled, with the possible exception of a disability benefit. We will let you know as soon as we decide whether  (4)   (5)  disabled. We will send you another letter to tell you what we decide about  (6)  disability claim.


Fill-ins:
(1) type of benefit currently being awarded *
(2) “you”/SN
(3) “are”/“is”
(4) “you”/“she”/“he”
(5) “are”/“is”
(6) “your”/“her”/“his”
(*) indicates that the fill-ins are manual

CLOR07 Closeout – Other Benefit Possible

We are still looking to see if  (1)  can receive  (2)  benefits.  (3)  cannot receive any other type of benefits based on the application  (4)  filed.


Fill-ins:
(1) “you”/“he”/“she”
(2) type of benefit, e.g., retirement benefit *
(3) “You”/“He”/“She”
(4) “you”/“he”/“she”
(*) indicates that the fill-ins are manual

CLOR11 Closeout of Potential Benefit

The  (1)  benefit is the only kind of benefit  (2)   (3)  entitled to receive, with the possible exception of  (4)  benefits. You told us when you applied for  (5)  benefits  (6)   (7)  that you did not wish to apply for  (8)  benefits  (9)  at that time.

If you change your mind, you need to apply for these benefits. The application date can make a difference in the amount we pay. If you apply within 6 months of the date of this letter, we may be able to use the date of your application for  (10)  benefits as the date of your application for  (11)  benefits.


Fill-ins:
(1) type of benefit*
(2) “you”/FN
(3) “are”/“is”
(4) type of benefit *
(5) type of benefit*
(6) “for”/null
(7) SN/null
(8) type of benefit *
(9) “for him”/“for her”/null
(10) type of benefit*
(11) type of benefit *
(*) indicates that the fill-ins are manual

CLOR12 Closeout – Family Benefits Involved

The  (1)  benefit is the only kind of benefit  (2)   (3)  family are entitled to receive, with the possible exception of  (4)  benefits. You told us when you applied for  (5)  benefits  (6)   (7)  that  (8)  did not wish to apply for  (9)  benefits at that time.

If  (10)  mind,  (11)  to apply for these benefits. The application date can make a difference in the amount we pay. If  (12)  within 6 months of the date of this letter, we may be able to use the date of the application for  (13)  benefits  (14)   (15)  as the date of application for  (16)  benefits.


Fill-ins:
(1) “retirement”/“disability”
(2) “you and your family”/NHFN
(3) “and his”/“and her”/null
(4) “wife's”/“husbands”/“child's” *
(5) “retirement”/“disability”
(6) “for”/null
(7) NHSN/null
(8) “you/your wife”/“your husband”/ “your child” *
(9) “wife's”/“husband's”/“child's” *
(10) “you change your”/“your wife changes her”/“your husband changes his”/“your child changes his/her” *
(11) “you need”/“she needs”/“he needs” *
(12) “you apply”/“your wife applies”/“your husband applies”/“your child applies” *
(13) “retirement”/“disability”
(14) “for”/null
(15) NHSN/null
(16) “wife's”/“husband's”/“child's” *
(*) indicates that the fill-ins are manual

CLOR13 Lump-Sum – Closeout to Other Benefits

The lump-sum death payment is the only kind of payment  (1)   (2)  entitled to receive, with the possible exception of  (3)  benefits. You told us when you applied for the lump-sum death payment  (4)   (5)  that you did not wish to apply for  (6)  benefits  (7)  at that time.

If you change your mind, you need to apply for these benefits. The application date can make a difference in the amount we pay. If you apply within 6 months of the date of this letter, we may be able to use the date of the application for  (8)  benefits.


Fill-ins:
(1) “you”/FN
(2) “are”/“is”
(3) type of benefit *
(4) “for”/null
(5) SN/null
(6) type of benefit *
(7) “for him”/“for her”/null
(8) type of benefit *
(*) indicates that the fill-ins are manual

CLOR20 Auxiliary Claimant Not Insured On Own Record

Benefits are not payable on your own record because you have not worked long enough under Social Security. To qualify, you need credit for  (1)  calendar quarters of work. You now have  (2)  . If you earn the additional quarters, please contact any Social Security office.


Fill-ins:
(1) required QCs *
(2) acquired QCs *
(*) indicates that the fill-in is manual

NL 00725.375 REF UTIs – Referral

REFC01 Caption

If You Have Any Questions

REF001 Referral – Domestic Address

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. However, if you have any specific  (1)  questions, you can call us at 1-800-772-1213. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

 (2) 

If you do call or visit an office, please have this letter with you. It will help us answer your questions.


Fill-ins:
(1) null
(2) Field office address

REF185 Referral – Foreign Address

Visit our website at  (1)  to find general information about Social Security. If you are in the United States, American Samoa, Guam, Northern Mariana Islands, Puerto Rico, or the U.S. Virgin Islands:

  • Call us toll-free at 800-772-1213 (TTY 800-325-0778).

  • Contact your nearest Social Security office.

If you are outside the United States or its territories:

  • If you are in Canada, visit  (2) to find the office that services your area.

  • Contact your nearest Federal Benefits Unit (FBU). Visit  (3)  for a list of FBUs.

  • Write to the Social Security Administration at:

P.O. Box 17769,

Baltimore, Maryland, 21235-7769

USA

Please be sure to include  (4)  Social Security claim number if you do write. If you visit an office, please take this letter with you. It will help us answer your questions.

If you have questions about Medicare, please visit  (5)  for information.


REF003 Referral – Domestic Address

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll free at 1-800-772-1213, or call your local Social Security office at  (1)  .

We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

 (2) 

If you do call or visit an office, please have this letter with you. It will help us answer your questions. 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.


Fill-ins:
(1) Local field office telephone number in the format 1-XXX-XXX-XXXX
(2) Field Office Address

REF008 Field Office Referral - Default

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific  (1)  questions, call us toll-free at 1-800-772-1213. We can answer most questions over the phone. If you prefer to visit one of our offices, please check the local telephone directory for the office nearest you. Or call us and we can give you the office address. Please have this letter with you if you call or visit an office. It will help us answer your questions.


Fill-in:
(1) null

REF011 Referral (Award Notice Only) 10 Digit Title II Public Contact Number other than National Number) and LAF = E

If you have any questions about your Social Security benefits, call us toll free at1-800-772-1213, or call the local Social Security office at  (1)  . 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 located at:

 (2) 

If you do call or visit an office, please have this letter with you. It will help us answer your questions. 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.

If you have any questions about railroad annuities or about your monthly check, please contact your local Railroad District office or the Railroad Retirement Board.

The address is:

U.S. Railroad Retirement Board
844 Rush Street
Chicago, Illinois 60611-2092

Fill-ins:
(1) Local DO telephone number on TRIDE in format 1-xxx-xxx-xxxx
(2) Street address, City, State and Zip Code corresponding to DOC

REF012 Referral (Award Notice Only) - Default

If you have any questions about your Social Security benefits, call us toll free at 1-800-772-1213. We can answer most questions over the phone. You can also write or visit any Social Security Administration office. If you prefer to visit one of our offices, call the 800 number and we can give you the local office address and telephone number.

If you do call or visit an office, please have this letter with you. It will help us answer your questions. 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.

If you have any questions about railroad annuities or about your monthly check, please contact your local Railroad District office or the Railroad Retirement Board.

The address is:

U.S. Railroad Retirement Board
844 Rush Street
Chicago, Illinois 60611-2092

REF013 Referral Without Field Office Phone Number (Award Notice Only)

If you have any questions about your Social Security benefits, call us toll free at 1-800-772-1213. 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 located at:

 (1) 

If you do call or visit an office, please have this letter with you. It will help us answer your questions. 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.

If you have any questions about railroad annuities or about your monthly check, please contact your local Railroad District office or the Railroad Retirement Board.

The address is:

U.S. Railroad Retirement Board
844 Rush Street
Chicago, Illinois 60611-2092

Fill-in:
(1) (1)

REF050 English Translation for Spanish Cover Letter – Awards – Domestic/Foreign Address

The attached sheet explains your right to question the decision on your claim. If you have any questions, contact any Social Security office. Most of your questions can be answered by telephone or mail. If you visit an office, please have this notice with you.


NL 00725 TN 32 - Modernized Claims System (MCS) Notices - 12/08/2020