You asked us to look again at our decision not to replace [1] check(s) dated [2] ,
totaling $[3] . We will need any new information that you have about the check(s).
You can use hospital or doctor bills, gasoline bills or statements from friends or
relatives to show that you were not at the address shown on the check(s) the day the
post office delivered [4].
If you have any questions, call us toll free at 1-800-772-1213 [5]. 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:
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District Office Address City, State Zip
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. If you plan to visit an office, you should call ahead to
make an appointment. This will help us serve you more quickly.
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Fill-ins:
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[1]
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Choice 1 -
Choice 2 -
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your
person's name, possessive, in format: John Smith's
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[2]
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Date of check(s), in format: May 3, 2011
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[3]
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Amount of check(s)
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[4]
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it or them
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[5]
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or call your local Social Security office at (field office phone number is taken from
the DOORS).
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