Effective Dates: 01/04/2024 - Present Previous | Next

TN 15 (01-24)

SI 00510.021 Use of the SSA- L8051-U3 to Refer Individuals to File for Social Security Benefits

A. Policy

1. When to Use Form SSA-L8051-U3

Use form SSA-L8051-U3 (SSI Referral Notice for Social Security Benefits) to:

  1. a. 

    Notify an individual that they may be entitled to receive Social Security Benefits. It explains the requirements and consequences of not filing for Title II benefits by the date indicated (30 days after notice is given to an individual, 35 days if the SSA-L8051-U3 is mailed); and

  2. b. 

    Prepare an FO diary of the referral.

NOTE: See SI 00510.031 for an exhibit of SSA-L8051-U3.

2. Specific Situations

a. Deferred Claims

See SI 00510.025B. for use of the SSA-L8051-U3 in deferred claims situations.

b. Title II Claims - Not Deferred

Issue the SSA-L8051-U3 whenever a separate Title II application is required. See SI 00601.035.B.2 for exceptions to taking a separate Title II application.

B. Procedure - Completing Form SSA-L8051-U3

1. First Page - Referral Notice

  1. a. 

    In the first blank, enter the “Respond by Date.” The time period for filing for other benefits is 30 calendar days from the date of the notice or, if the notice is mailed, 35 days.

EXAMPLE: If you are mailing the notice on 6/1/07, you will enter a “Respond by Date” of 7/6/07.

  1. b. 

    In the second blank after “You will have to pay back any SSI you may have received beginning...,” enter the month and year which represents the first month an overpayment begins if an individual does not comply with the filing requirement.

NOTE: The entry is different when the notice is mailed during the last 5 days of the month.

EXAMPLE: The date on the notice is 11/30/07, assumed receipt of the notice is 5 days after it is mailed or 12/5/07. The individual will have to repay any payments received beginning with the month of December 2007. (See SI 00510.001.B.)

2. Second Page - Field Office Control Copy

Use the second page as a control copy for follow-up purposes.

3. Third Page - Field Office Title II Adjudicator Copy

Complete the third page after removing carbons (if not MSSICS generated). The Title II adjudicator will use this copy to furnish information about the status of the Title II claim.

C. Procedure - Routing the SSA-L8051-U3

  1. 1. 

    Give or send the first page of the SSA-L8051-U3 to the Title XVI claimant/recipient.

  2. 2. 

    Keep the FO copy for control purposes.

  3. 3. 

    The Title II adjudicator will complete Page 3 of the form and return it to the Title XVI adjudicator when Title II status is obtained.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500510021
SI 00510.021 - Use of the SSA- L8051-U3 to Refer Individuals to File for Social Security Benefits - 01/04/2024
Batch run: 01/04/2024
Rev:01/04/2024