We are completing our work on your application for Social Security benefits. This
letter is about how we will pay you if we decide that you can receive benefits. We
will send you another letter when we finish our work on your application.
How We Plan To Pay You
The information we have shows that you need help managing your money and meeting your
daily needs. Because of this information, we plan to send your benefits to (1) . We will call this (2) your representative payee.
Your Representative Payee's Duties
It is your representative payee's duty to manage your Social Security money. The representative
payee must report changes that can affect your benefits and act in your best interest.
We will ask your representative payee to show us how the money was used for you.
If You Disagree With This Decision
If you think you should get your own benefits or that someone else should help you
manage your benefits, you have the right to appeal. You have the right to review the
facts in your file. You can give us more facts to add to your file. We will review
your case and consider any new facts you have. Then, a person who didn't make the
first decision will decide your case.
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You have 60 days to ask for an appeal. However, unless we hear from you within 10
days, we will select the representative payee named above.
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The 10 days and 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.
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You must have a good reason for waiting more than 60 days to ask for an appeal.
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You have to ask for an appeal in writing. We will ask you to fill out Form SSA-561-U2,
called “Request for Reconsideration.” To get this form, contact one of our offices. We can help you fill out the form.
If You Want Help With Your Appeal
3215E
If You Have Any Questions
3763A
OR
3901C