Effective Dates: 12/12/2011 - Present Previous | Next

TN 18 (12-11)

GN 00304.090 Form Letter SSA-L4159 for Law Enforcement Authority

A. Policy for form letter SSA-L4159

You may use a statement from a law enforcement official to document the noninvolvement of a claimant in a homicide.

The statement may be a report of contact or a letter and may be in the law enforcement official's own words or composed by the field office (FO).

To view the SSA-L4159, see OS 15010.747˙.

B. Procedure for completing form letter SSA-L4159

1. Preparing the SSA-L4159

To prepare and forward the form letter

  1. a. 

    Enter the originating office's address and telephone number in the upper right hand corner;

  2. b. 

    Enter the name and address of the law enforcement agency or official in the normal letterhead address space;

  3. c. 

    Enter the name of the deceased, the date and place of death, the decedent's Social Security number and the claimant's name in the space provided; and

  4. d. 

    Sign the name of the originating claims representative.

2. Mailing form letter SSA-L4159

Take the following actions to mail the form letter SSA-L4159:

  1. a. 

    Complete identifying information on the form and send it by SSA-562 U3 (Request for Assistance/Certification of Document(s) or Record(s)) to the parallel FO if the law enforcement official is outside the service area; and

  2. b. 

    Mail the form in a window envelope directly to the law enforcement official. Enclose a postage-paid self-addressed return envelope.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200304090
GN 00304.090 - Form Letter SSA-L4159 for Law Enforcement Authority - 12/12/2011
Batch run: 12/12/2011
Rev:12/12/2011