Form Ssa-561-U2 Social Security Administration - Request For Reconsideration (Page 4 of 4) in pdf

HOW TO APPEAL YOUR SUPPLEMENTAL SECURITY INCOME (SSI)

OR SPECIAL VETERANS BENEFIT (SVB) DECISION

There are three different ways to appeal. You can pick the appeal that fits your case. You can have a lawyer, friend, or someone else

help you with your appeal.

Here are the three ways to appeal:

1. CASE REVIEW:

You can give us more facts to add to your file. Then we'll decide your case again. You don't meet with the person who decides your

case.

You can pick this kind of appeal in all cases.

2. INFORMAL CONFERENCE:

You'll meet with the person who will decide your case. You can tell that person why you

think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

You can pick this kind of appeal in all SSI cases except two. You can't have it if we turned down your SSI application for medical

reasons or because you're not blind. Also you can't have it if we're giving you SSI but you disagree with the date we said you

became blind or disabled. In SVB cases, you can pick this kind of appeal only if we're stopping or lowering your SVB payment.

3. FORMAL CONFERENCE:

This is a meeting like an informal conference. Plus, we can make people come to help prove you're right. We can do this even if

they don't want to help you. You can question these people at your meeting.

You can pick this kind of appeal only if we're stopping or lowering your SSI or SVB payment. You can't get it in any other case.

Now you know the three kinds of appeals. You can pick the one that fits your case. Then fill out this form. We'll help you fill it out.

There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you the names of these groups.

NOTE: DON'T FILL OUT THIS FORM IF WE SAID WE'LL STOP YOUR DISABILITY CHECK FOR MEDICAL REASONS OR

BECAUSE YOU'RE NO LONGER BLIND. WE'LL GIVE YOU THE RIGHT FORM (SSA-789-U4) FOR YOUR APPEAL.

The information on this form is authorized by regulation (20 CFR 404.907 - 404.921 and 416.1407 - 416.1421) and Public Law

106-169 (section 809(a)(1) of section 251(a)). While your response to these questions is voluntary, the Social Security Administration

cannot reconsider the decision on this claim unless the information is furnished.

Privacy Act Statement

Collection and Use of Personal Information

Section 205(a), of the Social Security Act as amended, [42 U.S.C. 405(a)] and Title 20 C.F.R. 404.907 - 404.922 and 416.1407–416.1422 authorize us to collect this

information. We will use this information to help us determine your entitlement to benefits. Providing this information is voluntary. However, failing to procide us with

all or part of the requested information may affect our ability to re-evaluate the decision on your claim.

We rarely use the information you provide on this form for any purpose other than for determining problems in Social Security programs. However, we may use it for

the administration and integrity of Social Security programs. We may also disclose information to another person or to another agency in accordance with approved

routine uses, which include but are not limited to the following:

1. To enable a third party or an agency to assist Social Security in establishing rights to Social Security benefits and/or coverage;

2. To comply with Federal laws requiring the release of information from Social Security records (e.g., to the Government Accountability Office and the

Department of Veterans Affairs);

3. To make determinations for eligibility in similar health and income maintenance programs at the Federal, State, and local level; and

4. To facilitate statistical research, audit or investigative activities necessary to assure the integrity of Social Security programs.

We may also use the information you provide in computer matching programs. Matching programs compare our records with records kept by other Federal, State or

local government agencies. Information from these matching agencies can be used to establish or verify a person’s eligibility for Federally-funded or administered

benefit programs and for repayment of payments or delinquent debts under these programs.

A complete list of routine uses for this information is available in our System of Records Notice entitled Claims Folder System 60-0089, and 60-0103, Supplemental

Security Income Record and Special Veterans Benefits. These notices, additional information regarding this form, and information regarding our programs and

systems, are available on-line at or at any local Social Security office.

Paperwork Reduction Act Statement / This information collection meets the requirements of 44 U.S.C. § 3507, as amended by Section 2 of the

Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control

number. We estimate that it will take about 8 minutes to read the instructions, gather the facts, and answer the questions. SEND THE

COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U.S. Government agencies in your

telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate

above to : SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the

completed form.

Form SSA-561-U2 (06-2012) ef (06-2012)

Form Ssa-561-U2 Social Security Administration - Request For Reconsideration Page 4

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