If the inquirer calls the FO to request a reconsideration on behalf of a claimant
and the caller is other than an appointed representative or representative payee:
Explain the requirements regarding disclosure and representation of claimants.
Give him or her a form SSA-1696-U4 and a form SSA-561-U2, a copy of the pamphlet “Your
Right to Representation.”
Fill in only the claimant’s name on the first two forms.
Instruct the inquirer to contact the claimant or recipient and have the forms completed
and returned to the FO within 15 working days.
If the appeal is being established in MSSICS, complete the ANCR screen and RPOC screen
describing the contact.
Follow up in 15 days with the claimant or recipient, not the inquirer.
Manually prepare a notice that states the following:
"We are writing to tell you that we learned from (1) that you want to appeal your
Supplemental Security Income (SSI) case.
"What We Will Need
"We gave you (2) two forms for you to fill out, and return to us. These
“SSA-561-U2, Request for Reconsideration (a signature is not required), and
“SSA-1696-U4, Appointment of Representative (a signature is required).
"We haven't received the completed forms.
"What You Should Do
"You should fill out and send us the SSA-561-U2 if you want to appeal. If you want
(3) or someone else to help you with your appeal, fill out and send us the SSA-1696-U4
"Please read the enclosed pamphlet and fact sheet, "Your Right to
Question the Decision Made On Your SSI Claim' and "Social Security and Your Right
"If we don't receive the completed SSA-561-U2 or hear from you by (4), we will assume
you do not want to appeal our decision.
"If You Have Any Questions
"If you have any questions or need help filling out these forms, you may call, write
or visit any Social Security office. If you visit our office, please have this letter
with you and ask for (5) . The telephone number is (6) .
" (7) .
name of the person who contacted the FO, in format: "John Doe"
last name of the person who contacted the FO, in format: "Mr. Doe"
date (the expiration of the 60-day period in which to request the appeal), e.g., December
name of FO contact, in format: "Marie Dole"
FO contact's phone number
Optional: Also, if you plan to visit an office, you may call ahead to make an appointment.
This will help us serve you more quickly when you arrive at the office.
Include the factsheet “Your Right to Representation." If there is no response within
15 workdays, close out the file. If the claimant responds, follow procedures appropriate
to the response.