Social Security Administration
Supplemental Security Income
Notice of Planned Action
Social Security Number:
Your payments (or those of the individual named above) will be changed as follows:
Due Each Month
Why Your Payments Will Change
In the past, we did not count some of your income when we figured your SSI payments. We have changed the way we count your income. We have to start counting more of your income when we figure your SSI payments. This makes your income too high for you to get SSI. We used the following income:
If you think these facts are wrong, please let us know.
Why We Are Counting More of Your Income
We changed the rules we use to count your income:
• In the past, we used State rules to figure your SSI payment. The State rules said we did not have to count some of your income when we figured your payment. This made your income low enough so that you could get SSI.
• But when your SSI payment will include only money from your State for more than 6 months in a row, we have to change the way we figure your payment. We must use Federal rules to figure your payments beginning with the seventh month.
We will not change your check if you appeal within 10 days after getting this notice.
• Your SSI payment has included only State money since (date). We have to use the Federal rules to figure your payments beginning (date).
Under the Federal rules we have to count more of your income. This makes your income too high for you to get SSI payments.
(Optional) You Have Been Paid Too Much SSI
(Date) was the last month we could use State rules to figure your SSI. We should have used Federal rules beginning with (date). Because we did not make this change in time, we have paid you too much SSI.
We will send you another letter to tell you how we have paid you too much and what to do if you thing we are wrong.
What to Do If You Think You Can Get SSI
You may be able to get SSI again. Please let us know right away if these things change:
• Your income.
• If anyone moves in or out of your house.
If you tell us these things change, you need to show us proof. Then we will let you know if you can get any SSI.
If You Have Any Questions
If you have any questions, you may call, write or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (Claim Representative Name). (His/Her) telephone number is (XXX) XXX-XXXX.
Also, if you plan to visit an office, you may call ahead to make any appointment. This will help us serve you more quickly when you arrive at the office.
Field Office Manager
DO YOU THINK WE ARE WRONG?
If you think we are wrong, you have the right to appeal. We will correct mistakes. We will look at any new facts you have.
• You have 60 days to ask for an appeal.
• The 60 days start the day after you get this letter.
• You will have to have a good reason for waiting more than 60 days.
• To appeal, you must fill out a form call "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.
APPEAL IN 10 DAYS TO KEEP GETTING YOUR SAME CHECK
• We will not change your check if you appeal within 10 days.
• The 10 days start the day after you get this letter.
• If you lose your appeal, you might have to pay backs some or all of this money.
HOW TO APPEAL
There are three ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide your case.
• Case Review. You have a right to review the facts in your file. You can give us more facts to add to your file. Then we will decide your case again. You will not meet with the person who decides your case.
• Informal Conference. You will meet with the person who decides your file. You can give us more facts to add to your file. Then we will decide your case again. You will not meet with the person who decides your case.
• Formal Conference. This is a meeting like a an informal conference. The difference is we can make people come to help prove you are right. We can make them bring important papers about your case, even if they do not want to help you. You can question these people at your meeting.
IF YOU WANT HELP WITH YOUR APPEAL
You may want help from a friend, lawyer or someone else. There are groups that can find you a lawyer. Some can give you a free lawyer. We can give you the names of these groups.