SOCIAL SECURITY ADMINISTRATION
Retirement, Survivors and Disability Insurance
|Name of Program Service Center
|City, State, ZIP
|Date: July 8, 1991
|Claim Number: XXX-XX-XXXX B
We have considered your application for wife's benefits on Beneficiary Name's Social
Security record. You are not entitled to benefits now because you do not meet the
Why We Cannot Pay You
You cannot get benefits because your marriage does not meet the requirements of the
law. You can only qualify for benefits as a spouse if one of the following is true:
Your marriage to Beneficiary Name is valid under State or federal law, or
Your marriage to Beneficiary Name is not valid, but you went through a marriage ceremony
in good faith.
Other Social Security Benefits
You are not entitled to any other Social Security benefit based on the application
you filed. In the future, if you think you may be entitled to benefits, you will need
to apply again.
SSA Pub. No. 05-10058
See Next Page
If You Disagree With The Decision
If you disagree with the decision, you have the right to appeal. We will review your
case again and 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.
The 60 days start the day after you receive 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
You must have a good reason if you wait more than 60 days to ask for an appeal.
You will have to ask for an appeal in writing. We will ask you to sign a form called
“Request For Reconsideration.” The form number is SSA-561-U2. To get this form, contact one of our offices. We can
help you fill out the form.
Please read the enclosed pamphlet, “Your Right to Question the Decision Made on your Social Security Claim.” It contains more information about the appeal.
You have the right to file a new application at any time, but filing a new application
is not the same as appealing this decision. If you disagree with this decision and
you file a new application instead of appealing:
you might lose some benefits, or not qualify for any benefits, and
we could deny the new application using this decision, if the facts and issues are
So, if you disagree with this decision, you should file an appeal within 60 days.
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. Your 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. And if you hire a lawyer, we will
withhold up to 25 percent of any past due benefits to pay toward the fee.
If You Have Any Questions
If you have any questions, you may call us toll-free at 1-800-772-1213, or call your
local Social Security Office at 1-xxx-xxx-xxxx. 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:
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
Assistant Regional Commissioner,