Specify type of claim; e.g., RSI benefits, DI benefits, SSI payments, Special Veterans
Benefits, HI/SMI entitlement, lump-sum death payment, disability freeze, deductions,
earnings record revision.
NOTE: When reconsideration is requested on nonmedical concurrent Title II and Title XVI
common issues, the request is deemed to apply to both claims, if the time limit for
appealing either claim has not expired.