TN 37 (12-21)
NL 00725.008 Notice of Disapproved Claim
EXAMPLE 1: NOTICE OF DISAPPROVAL
Social Security Administration
Retirement, Survivors, and Disability
Insurance
Notice of Disapproved Claim
Miscellaneous
Program Service Center
225
E. Oak Street
Central
City, ST 00000
Date:
BNC:
21MS123J45678-A
JOHN G. BENEFICIARY
101 MAIN STREET
ANYTOWN, ST 00001
We have considered your application and find that you are not entitled to any Social
Security benefits.
Why We Cannot Pay You
You do not qualify for retirement benefits now because, based on your correct date
of birth was, January 17, 1927, you are not yet age 62.
Your Date of Birth
Based on the evidence we have, we have decided that your correct date of birth was
January 17, 1927.
Do You Think We Are Wrong?
If you think we are wrong, you have the right to appeal. We will correct any mistakes
and will look at any new facts you have. A person who did not make the first decision
will decide your case.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day you get this letter.
-
•
You must have a good reason if you wait more than 60 days to ask for an appeal.
Other Social Security Benefits
You are not entitled to any other Social Security benefits based on the application
you filed. In the future, if you think you may be entitled to benefits, you will need
to apply again.
If You have Any Questions
If you have any questions, you may call us at 1-800-2345-SSA. We can answer most questions
over the phone. You can also write any Social Security office. The office that serves
your area is located at:
Street address
City, State Zip
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment at the office. This will help us serve you more quickly when
you arrive at the office.
Social
Security Administration
EXAMPLE 2: NOTICE OF DISALLOWANCE
Social Security Administration
Retirement, Survivors, and Disability
Insurance
Notice of Disapproved Claim
Mid-Atlantic
Program Service Center
300
Spring Garden Street
Philadelphia,
Pennsylvania 19123-2992
Date:
BNC:
21MS123J45678-A
JOHN G. BENEFICIARY
101 MAIN STREET
ANYTOWN, ST 00001
We are writing to tell you that you do not qualify for retirement benefits.
Why We Cannot Pay You
You did not work long enough under Social Security to receive benefits.
Work under Social Security if figured in credits. Please read the enclosed pamphlet,
"How You Earn Social Security Credits," which explains how the credits are earned
and how many a person needs to receive benefits.
To qualify for benefits, you need a total of 40 work credits. You have earned 36 credits,
and still need 4 credits more. These figures are based on your date of birth, September
13, 1932.
Other Social Security Benefits
You are not entitled to any other Social Security benefits based on the application
you filed. In the future, if you think you may be entitled to benefits, you will need
to apply again.
Enclosure(s):
Pub-05-10058
Pub-05-10072
Do You Disagree With The Decision?
If you think we are wrong, you have the right to appeal. We will correct any mistakes
and we will look at any new facts you have. A person who did not make the first decision
will decide your case.
• You have 60 days to ask for an appeal.
• The 60 days start the day after you receive this letter.
• You must have a good reason if you wait more than 60 days to ask for an appeal.
Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your
Social Security Claim". It contains more information about the appeal.
New Application
You have the right to file a new application at any time, but filing a new application
is not the same as appealing this decision. If you disagree with this decision and
you file a new application instead of appealing:
• you might lose some benefits, or not qualify for any benefits, and
• we could deny the new application using this decision, if the facts and issues are
the same.
• So, if you disagree with this decision, you should file an appeal within 60 days.
If You Want Help With Your Appeal
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it. And if you hire a lawyer, we will
withhold up to 25 percent of any past due benefits to pay toward the fee.
If You Have Any Questions
If you have any questions, you may call us toll-free at 1-800-772-1213, or call your
local Social Security office at 1-234-567-8900. We can answer most questions over
the phone. You can also write or visit any Social Security office. The office that
serves your area is located at:
DISTRICT OFFICE
3689 OFFUTT ROAD
RANDALLSTOWN, MARYLAND 21133
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. 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.
Social Security Administration