Effective Dates: 06/28/2024 - Present Previous | Next

TN 116 (02-25)

NL 00703.005 Exhibit/Dictated Notices

A. Introduction

This subchapter contains exhibit notices currently in use by the program service centers, ODIO, and where noted, the FO's.

B. Policy

1. General

The beneficiary has the right to be notified when the adjudicator (claims authorizer, benefit authorizer, recovery reviewer, etc.) takes an action on the claim. Exhibit letters are provided for situations that occur fairly frequently but contain variable or optional information. They are produced through M/TEXT or the Document Processing System (DPS) and are used when:

  • •

    a computer notice is not available and

  • •

    a form notice does not adequately explain the action taken.

2. Notice Preparation

See NL 00610.000 for established guidelines.

C. Procedure

1. Requesting Exhibit Notices — All Claims

  1. a. 

    Make requests on Form SSA-573 or SSA-559.

  2. b. 

    Specify the letter to be typed by showing the Document Identifier, when it is available, or the POMS section number of the letter.

  3. c. 

    Show fill-ins in the order in which they are to appear in the notice.

  4. d. 

    For all adult claimants/beneficiaries 18 years or older, use the full name in the first fill-in. Thereafter, use the third person pronouns of they, them, or their.

  5. e. 

    For children, under 18, use the full name in the first fill-in and the first name in all subsequent fill-ins unless the pronoun is indicated.

2. Requesting Exhibit Notices — Foreign Claims

Letters being sent outside the United States require some changes.

a. Overpayment Notices

Use paragraph 3100FC when requesting refunds.

b. Referral Paragraph

Use paragraph 3901D (see Label E for text and fill-ins).

3. Typing Exhibit Notices

a. Forms

  • •

    Use SSA-L2000-C2 (Universal Notice) for Title II Exhibit Letters to claimants, beneficiaries and representative payees.

  • •

    Use SSA Letterhead for all other notices.

b. “Enclosure” Paragraphs

  • •

    When the letter has more than one page, start the word “Enclosure:” or “Enclosures:” at the left margin two lines below the text on the first page.

  • •

    When the letter, including name and title, can fit on one page, start the word “Enclosure:” or “Enclosures:” at the left margin two lines below the title.

  • •

    Type each enclosure on a separate line below “Enclosures:” starting at the left margin.

D. Exhibit — Sample Exhibit Notice

SOCIAL SECURITY ADMINISTRATION

Retirement, Survivors and Disability Insurance

​ Name of Program Service Center
​ Street Address
​ City, State, ZIP
​ Date: July 8, 1991
​ Claim Number: XXX-XX-XXXX B

 

Beneficiary Name

Street Address

City/State/Zip Code

 

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 marriage requirement.

 

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.

 

Enclosure:

SSA Pub. No. 05-10058

 

See Next Page

 

​ Page 2 of 3

XXX-XX-XXXXB

 

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 5-day period.

  • •

    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.

 

New Application

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 the same.

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.

 

See Next Page

​ Page 3 of 3
XXX-XX-XXXXB PAGE 3 OF 3

 

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before they 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:

Street Address

City, State

ZIP Code

 

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.

Name

Assistant Regional Commissioner,

Processing Center

 

E. Exhibit — Referral Paragraphs

Foreign Referral Paragraph; 3901D

 

If You Have Any Questions

If you have any questions, you should contact (1) . You may also write to (2) . Please be sure to include your claim number if you do write. However, if you visit an office, please take this letter. It will help the people there answer your questions.

Fill-ins:

(1)

If ..... Then substitute....
Consular code is: ​
600 or 601 the U.S. Veterans Affairs Regional Office, SSA

Division, 1131 Roxas Boulevard, Manila.
704, 714, 734, 744, 754, 773, 774, 783, 793 or 899 any Social Security office or the nearest United States Embassy or consulate.
815, 816, or 953 any Social Security office.
Geographic code is: ​
10120A, 50160A or 33020E any Social Security office or the nearest United States Embassy or consulate.
05480A any Social Security office or the nearest United States Embassy or consulate. Or, if you live in the Philippines, you may contact the U.S. Veterans Affairs Regional Office, SSA Division, 1131 Roxas Boulevard, Manila.
Consular or geographic code is

other than shown above. 		the nearest United States Embassy or consulate.

(2) use the Social Security Administration, P.O. Box 17049, Baltimore, Maryland        21235-7049, U.S.A. for totalization modules, otherwise use Social Security

      Administration, P.O. Box 17769, Baltimore, Maryland 21235-7769, U.S.A.

 

Domestic Referral Paragraph; CTDO

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:

 

Field Office Address

City, St ZIP

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.

 

Default Referral Paragraph; 3901X

(Use this paragraph when an FO address is not available from the TRIDE)

 

If You Have Any Questions

If you have any questions, call us 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. Also, if you plan to visit an office, you may call ahead to make an appointment. Please have this letter with you if you call or visit an office. It will help us answer your questions.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900703005
NL 00703.005 - Exhibit/Dictated Notices - 06/28/2024
Batch run: 03/24/2025
Rev:06/28/2024