3769A |
We are writing to tell you that we have information that shows (1) needs help managing (2) money and meeting (3) needs. Because of this information, we plan to send (4) (5) money to (6) as representative payee.
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The Representative Payee's Duties
It is the representative payee's duty to manage (7) (8) money. The representative payee must report changes that can affect (9) benefits and act in (10) best interest. We will ask (11) to show us how the money was used.
If You Disagree With This Decision
If you think someone else should help manage these benefits, you have the right to
appeal. You have the right to review the facts in the file and to submit additional
evidence. We will review the case and consider any new facts you have. Then, a person
who didn't make the first decision will decide the 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.
How To Appeal
3769C |
There are two ways to appeal. You can pick the way you want. If you meet with us in
person, it may help us decide your case.
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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.
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Informal Conference - You'll meet with the person who decides your case. You can tell that person why
you think you're right. You have the right to review the facts in your file. You can
give us more facts to help prove you are right. You can bring other people to help
explain your case.
If You Want Help With Your Appeal
3215E
If You Have Any Questions
3765C
OR
3901C