We have decided that it is best for (1) to have (2) (3) checks paid directly to (4) .
Check Information
3828A |
(1) sending (2) regular monthly check of $ (3) to (4) about (5) .
|
OR 3828B
|
We (1) $ (2) to (3) around (4) . We (5) sending (6) regular monthly check of $ (7) to (8) around (9) .
|
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. (5) 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 get 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.1
-
•
You will have to have a good reason for waiting more than 60 days to ask for an appeal.
-
•
To appeal, you must fill out 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.
3828C
|
We are enclosing a copy of a letter that we sent to (1) . Please be sure to read it. If we are wrong about anything in that letter, you can
ask for an appeal.
|
(Optional) 3826D
|
How To Appeal
|
|
There are two ways to appeal. You can pick the one you want. If you meet with us in
person, it may help us decide (1) case.
|
|
-
•
Case
Review. You have a right to review the facts in (2) file. You can give us more facts to add to (3) file. Then we will decide (4) case again. You will not meet with the person who decides (5) case.
|
|
-
•
Informal
Conference. You will meet with the person who decides (6) case. You can tell that person why you think you are right. You can give us more
facts to help prove you are right. You can bring other people to help explain (7) case.
|
(Optional)
If You Want Help With Your Appeal
3215E
If You Have Any Questions
3901C - Domestic
3901D - Foreign
Enclosure:
Pamphlet No. SSA-05-10058
1 Delete this sentence for foreign claims.