DPS
FUG056
AURORA
FUG056
|
Beginning January 2005, the law prohibits us from paying Social Security benefits
to individuals who have an outstanding arrest warrant for a crime which is a felony
(or, in jurisdictions that do not define crimes as felonies, a crime that is punishable
by death or imprisonment for a term exceeding 1 year), or who have violated a condition
of probation or parole under Federal or State law. We have information that *F1 *F2
into one of these categories.
Fill-Ins:
*F1-1 Pronoun (you/they/Client/Beneficiary Name) *F2-1 fall *F2-2 falls
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DPS
SUS210
AURORA
SUS210
|
Based on the information we have, we should have stopped the Social Security benefits
beginning *F1.
Fill-Ins:
*F1-1 MM/CCYY
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AURORA
FUG048
|
We are writing to tell you that we plan to stop *F1 Social Security benefits. Beginning
January 2005, the law prohibits us from paying Social Security benefits to individuals
who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions
that do not define crimes as felonies, a crime that is punishable by death or imprisonment
for a term exceeding 1 year), or who have violated a condition of probation or parole
under Federal or State law. We have information that *F2 into one of these categories.
Based on the information we have, we should have stopped the Social Security benefits
beginning *F3.
Fill-Ins:
*F1-1 beneficiary’s name (possessive) *F1-2 your *F2-1 they fall *F2-2 you fall *F3-1 MM/CCYY (Date of suspension)
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DPS
INFC01
AURORA
INFC01
|
The Information We Have
|
DPS
FUG029
AURORA
FUG029
|
Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest
for a *F5 crime on *F6. The warrant information we have is: Warrant number: *F7 Originating case number: *F8 National Crime Information Center number: *F9 Social Security cannot provide further information about the warrant. Please contact
the *F10 directly.
Fill-Ins:
*F1-1 Warrant Issuing Agency Name *F2-1 Warrant Issuing Agency address *F3-1 Warrant Issuing Agency telephone number *F4-1 Pronoun (your/Client/Beneficiary Name Possessive) *F5-1 nonviolent and non drug-related *F5-2 violent *F5-3 drug related *F5-4 probation/parole violation that was a nonviolent and non drug-related) *F5-5 probation or parole violation that was a violent *F5-6 probation or parole violation that was drug related) *F5-7 NULL
*F6-1 MM/CCYY(date of the warrant) *F7-1 Warrant number *F8-1 Originating case number *F9-1 National Crime Information Center number *F10-1 Warrant Issuing Agency Name
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DPS
PAYC27
AURORA
PAYC27
|
How *F1 Benefits Can Be Paid
Fill-Ins:
*F1-1 Pronoun (Your/Client/Beneficiary Name Possessive)
|
DPS
FUG030
AURORA
FUG030
|
We will pay *F1 if you contact us at any time*F2 and can show us within 90 days from
the date that you contact us that any of the following apply:
The warrant was issued incorrectly in *F3 name because someone stole *F4 identity.
To prove this submit a copy of the police report *F5 filed as a victim of identity
theft or another official document from the court or the warrant issuing agency stating
that the warrant was erroneously issued in *F6 name.
*F7 found not guilty of the criminal offense. To prove this submit a copy of the court
docket indicating *F8 found not guilty of the criminal charges or a copy of the court
decision showing that *F9 found not guilty of the criminal charges.
The underlying charges relating to the criminal offense were dismissed. To prove this,
submit a copy of the court docket indicating charges were dismissed or another official
court or law enforcement agency document stating that it dismissed the criminal charges.
The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this,
submit a copy of the court docket or another official document from the warrant issuing
agency indicating the warrant in question was withdrawn.
*F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the
court docket or other court document indicating *F12 cleared of the criminal charges.
Fill-Ins:
*F1-1 Pronoun (you/Client/Beneficiary Name) *F2-1 , meet all of the SSI eligibility requirements, *F2-2 Null (if Title II benefits) *F3-1 Pronoun (your/their/Client/Beneficiary Name Possessive) *F4-1 Pronoun (your/their/Client/Beneficiary Name Possessive) *F5-1 Pronoun (you/they/Client/Beneficiary Name) *F6-1 Pronoun (your/their/Client/Beneficiary Name Possessive) *F7-1 Pronoun (You were/They were/Client/Beneficiary Name was) *F8-1 Pronoun (you were/they were/Client/Beneficiary Name was) *F9-1 Pronoun (you were/they were/Client/Beneficiary Name was) *F10-1 Pronoun (your/their/Client/Beneficiary Name Possessive) *F11-1 Pronoun (You were/They were/Client/Beneficiary Name was) *F12-1 Pronoun (you were/they were/Client/Beneficiary Name was)
|
DPS
FUG031
AURORA
FUG031
|
If none of the above apply, we also may pay *F1 if you contact us within 12 months
from the date of this letter *F2 and can show us that:
The crime for which the warrant was issued or the probation or parole violation was
both nonviolent and not drug related and, if a probation or parole violation is involved,
the original crime(s) for which *F3 paroled or put on probation was both nonviolent
and not drug related.
And
*F4 neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
The law enforcement agency that issued the warrant reports that it will not extradite
*F5 for the charges on the warrant or that it will not take action on the warrant
for *F6 arrest.
OR
The crime for which the warrant was issued or the probation or parole violation was
both nonviolent and not drug related and, if probation or parole violation is involved,
the original crime(s) for which *F7 paroled or put on probation was both nonviolent
and not drug related.
And
*F8 neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
The only existing warrant was issued 10 or more years ago.
And
*F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11
incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security
has appointed a representative payee to handle *F14 benefits or *F15 residing in a
long-term care facility, such as a nursing home or mental treatment/care facility.
Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F2-1 , meet all of the SSI eligibility requirements, *F2-2 Null (if Title II benefits) *F3-1 Pronoun (you were/they were/Client/Beneficiary Name was) *F4-1 Pronoun (You have/They have/Client/Beneficiary Name has) *F5-1 Pronoun (you/them/Client/Beneficiary Name) *F6-1 Pronoun (your/their/Client/Beneficiary Name Possessive) *F7-1 Pronoun (you were/they were/Client/Beneficiary Name was) *F8-1 Pronoun (You have/They have/Client/Beneficiary Name has) *F9-1 Pronoun (Your/Their/Client/Beneficiary Name Possessive) *F10-1 Pronoun (your/their/Client/Beneficiary Name Possessive) *F11-1 Pronoun (you are/they are/Client/Beneficiary Name is) *F12-1 Pronoun (your/their/Client/Beneficiary Name Possessive))
*F13-1 Pronoun (you are/they are/Client/Beneficiary Name is) *F14-1 Pronoun (your/their/Client/Beneficiary Name Possessive) *F15-1 Pronoun (you are/they are/Client/Beneficiary Name is)
|
DPS
MESC02
AURORA
MESC02
|
What You Can Do
|
DPS
PAY157
AURORA
PAY157
|
Our records show that *F1 already *F2 the following requirement(s) for *F3 benefits
to be paid:
Fill-Ins:
*F1-1 Pronoun (you/Client/Beneficiary Name) *F2-1 meet *F2-2 meets
*F3-1 Pronoun (your/their/Client/Beneficiary Name Possessive)
|
DPS
FUG032
AURORA
FUG032
|
The crime for which the warrant was issued was both nonviolent and not drug related.
NOTE: Do not use this paragraph for offense codes 5011 or 5012.
|
DPS
FUG033
AURORA
FUG033
|
The original crime(s) for which *F1 paroled or put on probation was both nonviolent
and not drug related.
Fill-Ins:
*F1-1 Pronoun (you were/Client/Beneficiary Name was)
NOTE: Use this paragraph for offense codes 5011 or 5012.
|
DPS
FUG034
AURORA
FUG034
|
*F1 neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
Fill-Ins:
*F1-1 Pronoun (You have/They have/Client/Beneficiary Name has)
|
DPS
FUG035
AURORA
FUG035
|
The law enforcement agency that issued the warrant reports that it will not extradite
*F1 for the charges on the warrant or that it will not take action on the warrant
for *F2 arrest.
Fill-Ins:
*F1-1 Pronoun (you/them/Client/Beneficiary Name) *F2-1 Pronoun (your/their/Client/Beneficiary Name Possessive)
|
DPS
FUG036
AURORA
FUG036
|
The only existing warrant was issued 10 or more years ago.
|
DPS
FUG037
AURORA
FUG037
|
*F1 medical condition impairs *F2 mental capacity to resolve the warrant.
Fill-Ins:
*F1-1 Pronoun (Your/Their/Client/Beneficiary Name Possessive) *F2-1 Pronoun (your/their/Client/Beneficiary Name Possessive)
|
DPS
FUG038
AURORA
FUG038
|
Social Security has appointed a representative payee to handle *F1 benefits.
Fill-Ins:
*F1-1 Pronoun (your/their/Client/Beneficiary Name Possessive)
|
DOC
FUG039
AURORA
FUG039
|
*F1 residing in a long-term care facility, such as a nursing home or mental treatment/care
facility.
Fill-Ins:
*F1-1 Pronoun (You are/Client/Beneficiary Name is)
|
DPS
PAY158
AURORA
PAY158
|
However, we do not have all the information we need to pay benefits. If you contact
us within 12 months from the date of this letter, we will pay *F1 benefits if you
can show us within 90 days from the date you contact us that:
Fill-Ins:
*F1-1 Pronoun (your/their/Client/Beneficiary Name Possessive)
|
DPS
FUG042
AURORA
FUG042
|
The probation or parole violation was both nonviolent and not drug related and, the
original crime(s) for which *F1 paroled or put on probation was both nonviolent and
not drug related. To prove this, submit an official court document that explains the
criminal charges on which *F2 originally convicted. Such documents include, but are
not limited to a docket, a conviction notice, or a plea agreement.
Fill-Ins:
*F1-1 Pronoun (you were/they were/Client/Beneficiary Name was) *F2-1 Pronoun (you were/they were/Client/Beneficiary Name was)
|
DPS
FUG040
AURORA
FUG040
|
The crime for which the warrant was issued is both nonviolent and not drug related.
To prove this, submit an official copy of the arrest warrant. Such documents include,
but are not limited to a docket, a conviction notice or a plea agreement.
|
DPS
FUG041
AURORA
FUG041
|
The original crime for which *F1 paroled or put on probation was both nonviolent and
not drug related. To prove this, submit an official court document that explains the
criminal charges on which *F2 originally convicted. Such documents include but are
not limited to a docket, a conviction notice, or a plea agreement.
Fill-Ins:
*F1-1 Pronoun (you were/Client/Beneficiary Name was) *F2-1 Pronoun (you were/they were/Client/Beneficiary Name was)
|
DPS
FUG043
AURORA
FUG043
|
*F1 neither been convicted of nor pled guilty to any other felony crime since the
warrant was issued on *F2. To prove this, give us a statement as to whether *F3 been
convicted of or pled guilty to any such crimes since *F4.
Fill-Ins:
*F1-1 Pronoun (You have/They have/Client/Beneficiary Name has) *F2-1 MM/CCYY *F3-1 Pronoun (you have/they have/Client/Beneficiary Name has) *F4-1 MM/CCYY (date of suspension)
|
DPS
FUG044
AURORA
FUG044
|
The law enforcement agency that issued the warrant is unwilling to act on it. To prove
this, submit an official document from the law enforcement agency that issued the
warrant stating that it will not extradite *F1 for the charges on the warrant or that
it will not take action on the warrant for *F2 arrest.
Fill-Ins:
*F1-1 Pronoun (you/them/Client/Beneficiary Name) *F2-1 Pronoun (your/their/Client/Beneficiary Name Possessive)
|
DPS
FUG045
AURORA
FUG045
|
*F1 incapable of managing *F2 benefits or *F3 legally incompetent. To prove this,
submit a copy of the court order that appointed a conservator or guardian to handle
*F4 affairs or that declared *F5 legally incompetent.
Fill-Ins:
*F1-1 Pronoun (You are/They are/Client/Beneficiary Name is) *F2-1 Pronoun (your/their/Client/Beneficiary Name Possessive) *F3-1 Pronoun (you are/they are/Client/Beneficiary Name is)) *F4-1 Pronoun (your/their/Client/Beneficiary Name Possessive)
*F5-1 Pronoun (you are/they are/Client/Beneficiary Name is)
|
DPS
FUG046
AURORA
FUG046
|
Or
*F1 residing in a long-term care facility, such as a nursing home or mental treatment
/care facility. To prove this, submit a statement that *F2 residing in such a facility.
Fill-Ins:
*F1-1 Pronoun (You are/Client Name/Beneficiary is) *F2-1 Pronoun (you are/they are/Client/Beneficiary Name is)
|
DPS
CAPC40
AURORA
CAPC40
|
If We Don't Hear From You
|
DPS
ALS039
|
If we do not hear from you within *F1 days from the date of this letter, we will assume
the information in this letter is correct and will stop *F2 Social Security benefits.
We will send another letter at that time. It will explain the change in *F3 benefits,
the amount of any overpayment, and how to appeal our decision.
You will have 60 days to ask for an appeal.
The 60 days will start the day after you receive the next letter.
Fill-Ins:
*F1-1 30
*F1 2 10
*F2-1 Pronoun (your/their/Client Name Possessive) *F3-1 Pronoun (your/their/Client
Name Possessive)
|
AURORA
BRR029
|
If we do not hear from you within *F1 days from the date of this letter, we will assume
the information in this letter is correct and will stop *F2 Social Security benefits.
We will send another letter at that time. It will explain the change in *F3 benefits,
the amount of any overpayment, and how to appeal our decision.
You will have 60 days to ask for an appeal.
The 60 days will start the day after you receive the next letter.
Fill-Ins:
*F1-1 30 (due process period)
*F1-2 10 (due process period) *F2-1 Pronoun (your/their/Beneficiary Name Possessive) *F3-1 Pronoun (your/their/Beneficiary Name Possessive)
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DPS
INFC08
AURORA
INFC08
|
Things To Remember
|
DPS
PRI023
AURORA
CLO022
|
Even though *F1 benefits will stop, we can pay other members of the family if they
are entitled on *F2 record.
Fill-Ins:
*F1-1 Pronoun (your/Client/Beneficiary Name Possessive) *F2-1 Pronoun (your/their/Client/Beneficiary Name Possessive)
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DPS
REFC01
AURORA
REFC01
|
If You Have Any Questions
|
DPS
REF003
AURORA
REF003
|
We invite you to visit our website at www.socialsecurity.gov on
the Internet to find general information about Social Security.
If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at *F01. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:
*F2 *F3 *F4 *F5
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.
Fill-Ins:
*F1-1 FO Phone Number *F2-1 FO street address *F2-2 city, state and zip code *F3-1 FO Address *F4-1 FO Address *F5-1 FO Address
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