DI 12095.160 Model Language SSI Notice of Decision - Attainment of Age 65, Change of Category
Supplemental Security Income
Notice of Decision
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From:
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Department of Health and Human Services
Social Security Administration
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Date:
Social Security Number:
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We are contacting you in connection with your eligibility for payments under the Supplemental
Security Income program.
We recently contacted you and explained the possible advantages to you of changing
from the SSI disability category to the SSI aged category. Since you elected to make
this change, you will no longer be required to go for treatment for (drug addiction)
(alcoholism). 1 In addition, you will receive your SSI check directly.
If you have any questions about this, please contact your social security office as
explained on the reverse of this notice.
This information is also being sent to (name of representative payee).
1Use term(s) that applies.
See other side for important information
Form SSA-L8165-U2 (9-84)
Prior editions may be used until supply is exhausted
GET IN TOUCH WITH SOCIAL SECURITY IF:
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You want more information about this case.
Call or write to our office if you have questions or need more information. If you
like, come to our office and someone will help you. Please bring this notice with
you if you come to a Social Security office.
Form SSA-L8165-U2 (9-84)