Situation 4 — Notice to Use Underpayment to Reduce Overpayment of Survivor (Cont.)
Social Security Administration
Supplemental Security Income
Telephone Number: (XXX) XXX-XXXX
Social Security Number: XXX-XX-XXXX
Date: October 5, 1993
City, State, ZIP
We are writing to tell you that we can pay you the Supplemental Security Income (SSI) that was due your child, Sally Long, for August 1993. She was not paid for this month. We show the amount she should have received in the table below.
As we told you before in another letter, you have an overpayment of $205 on your own record. We will use the $434 due you on Sally Long's record to pay off your overpayment. As a result, your overpayment will be paid in full. We will send you the remaining $229. You should receive the payment about October 19, 1993.
Information About Your Payment
||Amount Due for Each Month
|Total SSI Due on Sally Long's Record
|Amount Applied to Your Overpayment
|You are due............
Your Payment Is Based On These Facts
• Sally Long filed an application for SSI March 1, 1993.
• Sally Long was living in your household for March 1, 1993, through September 18, 1993.
Do You Disagree With The Decision?
If you disagree with the decision, you have the right to appeal. We will review your case and consider any new facts you have.
• You have 60 days to ask for a 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.
• To appeal, you must fill out a form call "Request for Reconsideration." The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out the form.
How to Appeal
There are two ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide your case.
• Case Review. You have a right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case. This is the only kind of appeal you can have to appeal a medical decision.
• Informal Conference. You'll meet with the person who decides your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.
If You Want Help With Your Appeal
You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. You local Social Security office has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.
If You Have Any Questions
If you have any questions, you may call, write, or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for . The telephone number is shown on page 1 of this letter.
Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.