TN 5 (07-07)

A. Field Office (FO) and Payment Service Center (PSC) Suggested Fowlkes Acquiescence Ruling (AR) Notice Language

The Title II Redesign (T2R) Notice system will create and generate an automatic resumption notice because of the coding entries that were annotated to the Fugitive Felon Suspension and Reinstatement (FFEL) screen in Post-entitlement Suspensions and Reinstatement System (POS) to resume the Title II benefits to the beneficiary. Because the coding entries used to resume benefits on the FFEL screen are not totally unique or specific to Fowlkes AR case processing, the T2R notice produced by the FFEL resumption action will not provide the beneficiary with complete and accurate information as to why his/her benefits were resumed from fugitive felon suspension status. The Social Security Administration (SSA) will need to send the beneficiary an additional dictated notice that will explain in more detail and with clarity, why his/her benefits were really resumed from fugitive felon status, i.e., because of the Fowlkes AR, not because the beneficiary took action to satisfy his/her warrant or that he/she provided SSA good cause for not satisfying his/her outstanding warrant.

1. SSA Approval of Request for Relief Under the Fowlkes AR

The following approved language should be used on SSA notices for informing the beneficiary about SSA’s determination regarding the request for relief (i.e., either partially favorable or fully favorable relief) under the Fowlkes AR:

“You asked us to look at the earlier decision we made on ( 1 ) case to see if the Fowlkes v. Adamec acquiescence ruling (AR) could change that decision. We decided that applying this ruling does change our earlier decision.

a. Fully Favorable Relief Granted Under the Fowlkes AR

Use the language in GN 02613.856A.1. when SSA grants fully favorable relief under the Fowlkes AR to the beneficiary. Also add the following additional paragraphs to the notice as necessary:

“You asked us to look at the earlier decision we made on    1    case to see if the Fowlkes v. Adamec acquiescence ruling (AR) could change that decision. We decided that applying this ruling does change our earlier decision.

Applying the AR, we should not have stopped ­   2    benefits     3    lived in Connecticut, New York, or Vermont and had an outstanding felony arrest warrant. We did not have evidence that    4    knew that there was an outstanding warrant for   5    arrest, that     6    evading arrest, and that the warrant was issued because    7    fleeing from justice.

We will send you a separate letter that explains the amounts of    8    payments and when you will receive them.

The Fowlkes v. Adamec AR applies only to persons who live in the States of Connecticut, New York, and Vermont. We may make a different decision about    9    benefits if    10    to another State.”

See GN 02613.856C.1. for an exhibit of the fully favorable relief letter in DPS.

b. Partially Favorable Relief Granted Under the Fowlkes AR

NOTE: Partially favorable relief cases will be processed by the PSC. See GN 02613.856D.4. for PSC instructions on creating partially favorable relief notices. Notice language for partially favorable relief cases, however, is available on DPS for FO use, if warranted.

Use the following suggested paragraph to explain the situation when SSA grants partially favorable relief under the Fowlkes AR to the beneficiary.

“You asked us to look at the earlier decision we made on     1    case to see if the Fowlkes v. Adamec acquiescence ruling (AR) could change that decision. We decided that applying this ruling does change our earlier decision.

Applying the AR, we should not have stopped ­   2    benefits    3   .    4    lived in Connecticut, New York, or Vermont and had an outstanding felony arrest warrant. We did not have evidence that    5    knew that there was an outstanding warrant for    6    arrest, that    7    evading arrest, and that the warrant was issued because    8    fleeing from justice.

We will send you a separate letter that explains the amounts of    9    payments and when you will receive them.

We cannot pay benefits to   12    beginning    13   , because    14    an outstanding arrest warrant for a felony crime and    15    no longer    16    in Connecticut, New York, or Vermont.”

See Exhibit 3 in GN 02613.856C.3. for an illustration of the notice to send in partially favorable relief situations.

2. SSA Denies Request for Relief Under the Fowlkes AR

For Title II cases, if the prior determination remains unchanged and SSA is denying the request for Fowlkes AR relief because the beneficiary could not meet the requirements for Fowlkes AR relief as explained in GN 02613.810B., include the following language in the notice:

a. Approved Denial Paragraph

“You asked us to look at the earlier decision we made on    1    Social Security case to see if the Fowlkes v. Adamec acquiescence ruling (AR) could change that decision. We have decided that applying this AR could not change our earlier decision.    2   . Our earlier decision remains the final decision of the Agency in    3    case. “

NOTE: The language and information for fill-in 2 of this paragraph is located in GN 02613.856.A.2.b. The fill-ins explain the reason that SSA is denying the request for Fowlkes AR relief.

b. SuggestedLanguage for Explaining the Insert in the Denial Decision Paragraph

Fill-ins 2:

(1) Choice 1 – your

Choice 2 – Beneficiary’s name (possessive)

(2) Choice 1 – Our earlier decision was made before the United States Court of Appeals for the Second Circuit issued its decision in Fowlkes v. Adamec on December 6, 2005

Choice 2 – [You/He/She] did not live in any of the States in the Second Circuit (Connecticut, New York, or Vermont) at the time of our earlier decision

Choice 3 - Our earlier decision was made before the United States Court of Appeals for the Second Circuit issued its decision in Fowlkes v. Adamec on December 6, 2005, and [you/he/she] did not live in any of the States in the Second Circuit (Connecticut, New York, or Vermont) at the time of our earlier decision

Choice 4 – [Your/His/Her] arrest warrant was for a parole or probation violation. The Fowlkes decision does not apply to parole or probation violations.

c. Fowlkes AR Denial Language

Add the following language to a Fowlkes AR denial notice:

You asked us to look at the earlier decision we made on    1    Social Security case to see if the Fowlkes v. Adamec acquiescence ruling (AR) could change that decision. We have decided that applying this AR could not change our earlier decision     2   . Our earlier decision remains the final decision of the Agency in    3    case.

For the Fowlkes v. Adamec AR to apply to    4   case,    5    had to meet these three requirements:

• 6    lived in the State of Connecticut, New York, or Vermont when we made the earlier decision to stop    7    benefits, and

• We stopped    8    benefits because    9    had an outstanding felony arrest warrant, and

• We made our earlier decision on or after December 6, 2005.

See GN 02613.856C.2. for an exhibit that illustrates the Fowlkes AR Denial notice.

NOTE: Appeal rights are not needed on this notice.

3. SSA Determines Prior Fugitive Felon Suspension Determination is Correct

For Title II cases if the prior determination remains unchanged because the beneficiary’s request for relief under Fowlkes has nothing to do with the Fowlkes AR (e.g., beneficiary is requesting information about his/her Medicare claim for benefits and how his/her premiums will be paid when his/her benefits are currently suspended because of the fugitive felon provisions), answer the inquiry from the beneficiary. SSA will not send a notice.

B. FO Process - Creating a Fowlkes AR Notice in DPS

The Fowlkes AR reinstatement notice and the Fowlkes AR Denial notice are on DPS.

1. Instructions for Creating the Appropriate Fowlkes AR Notice on DPS—

Use the following instructions to create the appropriate Fowlkes AR beneficiary notice in DPS:

• Go to DPS

• Go to the Folder in DPS titled “GENERAL”

• Select Notice:

  • Fowlkes Reinstatement Notice

  • Fowlkes Readjudication Denial Notice

2. Preparing Notice in DPS for Fowlkes AR Cases

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

• For preparing a notice to the beneficiary granting fully favorable relief under the Fowlkes AR, select the Fowlkes Reinstatement Notice in DPS and use the information in GN 02613.856.A.1.a. to complete the notice

• For preparing a notice to the beneficiary granting partially favorable relief under the Fowlkes AR, select the Fowlkes Reinstatement Notice in DPS and use the information in GN 02613.856A.1.b. to complete the notice.

  NOTE: Partially favorable relief cases will be processed by the PSC. Notice language for partially favorable relief cases, however, is available on DPS for FO use, if warranted.

• For preparing a notice to the beneficiary denying Fowlkes AR relief, select the Fowlkes Readjudication Denial Notice in DPS, and use the information in GN 02613.856A.2. to complete the notice. Do not add appeals language to the denial notice.

C. Procedure - Title II Fowlkes Relief Suggested Notice Exhibits

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

1. Exhibit 1 – Title II Fowlkes AR Relief Fully Favorable Relief Granted Letter Shell

Social Security Administration

Retirement, Survivors, and Disability Insurance

Important Information

                                                                            Date:

                                                                            Claim Number: XXX-XX-XXXXA

JOHN G. BENEFICIARY

101 MAIN STREET

ANYTOWN, ST 00001

You asked us to look at the earlier decision we made on your case to see if the Fowlkes v. Adamec acquiescence ruling (AR) could change that decision. We decided that applying this ruling does change our earlier decision.

Applying the AR, we should not have stopped ­your benefits. You lived in Connecticut, New York, or Vermont and had an outstanding felony arrest warrant. We did not have evidence that you knew that there was an outstanding warrant for your arrest, that you were evading arrest, and that the warrant was issued because you were fleeing from justice.

We will send you a separate letter that explains the amounts of your payments and when you will receive them.

The Fowlkes v. Adamec AR applies only to persons who live in the States of Connecticut, New York, and Vermont. We may make a different decision about your benefits if you move to another State.

Other Social Security Benefits

The benefits described in this letter are the only ones to which you are entitled from Social Security. If you think you might qualify for another kind of Social Security benefit in the future, you will have to file another application.

If You Disagree With The Decision

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision which you believe are wrong and will look at any new facts you have. We may also review those parts which you believe are correct and may make them unfavorable or less favorable to you.

• You have 60 days to ask for an appeal.

• The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

• You must have a good reason for waiting more than 60 days to ask for an appeal.

• You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2, called "Request for Reconsideration." Contact one of our offices if you want help.

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your Social Security Claim." It contains more information about the appeal.

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 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.

Your Responsibilities

Your benefits are based on the information you gave us. If this information changes, it could affect your benefits. For this reason, it is important that you report changes to us right away.

We have enclosed a pamphlet, “Your Social Security Rights and Responsibilities.” It tells you what you must be reported and how to report. Please be sure to read the part of the pamphlet which explains how work could changes your payments.

If You Have Any Questions

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 1-610-433-3237. 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:

SOCIAL SECURITY

41 N 4TH ST

ALLENTOWN, NY 18102

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.  

2. Exhibit 2 – T2 Fowlkes AR Relief Denial Letter Shell

Social Security Administration

Retirement, Survivors, and Disability Insurance

Important Information

                                                                            Date:

                                                                            Claim Number: XXX-XX-XXXXA

JOHN G. BENEFICIARY

101 MAIN STREET

ANYTOWN, ST 00001

You asked us to look at the earlier decision we made on your Social Security case to see if the Fowlkes v. Adamec acquiescence ruling (AR) could change that decision. We have decided that applying this AR could not change our earlier decision. Your arrest warrant was for a parole or probation violation. The Fowlkes decision does not apply to parole or probation violations.. Our earlier decision remains the final decision of the Agency in your case.

For the Fowlkes v. Adamec AR to apply to your case, you had to meet these three requirements:

• You lived in the State of Connecticut, New York, or Vermont when we made the earlier decision to stop your benefits, and

• We stopped your benefits because you had an outstanding felony arrest warrant, and

• We made our earlier decision on or after December 6, 2005.

If You Have Any Questions

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 1-610-433-3237. 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:

SOCIAL SECURITY
41 N 4TH ST
ALLENTOWN, NY 18102

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.  

NOTE: Appeal rights are not needed on this notice.

3. Exhibit 3 – T2 Fowlkes AR Suggested Partially Favorable Relief Letter

Social Security Administration

Retirement, Survivors, and Disability Insurance

Important Information

                                                                            Date:

                                                                            Claim Number: XXX-XX-XXXXA

JOHN G. BENEFICIARY

101 MAIN STREET

ANYTOWN, ST 00001

You asked us to look at the earlier decision we made on your case to see if the Fowlkes v. Adamec acquiescence ruling (AR) could change that decision. We decided that applying this ruling does change our earlier decision.

Applying the AR, we should not have stopped ­your benefits 01/2006 through 08/2006. You lived in Connecticut, New York, or Vermont and had an outstanding felony arrest warrant. We did not have evidence that you knew that there was an outstanding warrant for your arrest, that you were evading arrest, and that the warrant was issued because you were fleeing from justice.

We will send you a separate letter that explains the amounts of your payments and when you will receive them.

We cannot pay benefits to you beginning 09/2006, because you have an outstanding arrest warrant for a felony crime and you no longer live in Connecticut, New York, or Vermont.

The Information We Have

Our records show that the XYZ Sheriffs Dept., 123 Cypress Lane, Baltimore MD 12345, PHONE: 800-923-4567, issued a warrant for your arrest for a felony crime or a violation of Federal or State probation or parole on 1/12/2005.

The warrant information we have is:

Warrant number: MD123456

Originating case number: 2345768

National Crime Information Center number: 3456789

Social Security cannot provide further information about the warrant. Please contact the XYZ Sheriffs Dept directly.

Other Social Security Benefits

The benefits described in this letter are the only ones to which you are entitled from Social Security. If you think you might qualify for another kind of Social Security benefit in the future, you will have to file another application.

If You Disagree With The Decision

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision which you believe are wrong and will look at any new facts you have. We may also review those parts which you believe are correct and may make them unfavorable or less favorable to you.

• You have 60 days to ask for an appeal.

• The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

• You must have a good reason for waiting more than 60 days to ask for an appeal.

• You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2, called "Request for Reconsideration." Contact one of our offices if you want help.

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your Social Security Claim." It contains more information about the appeal.

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 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.

Your Responsibilities

Your benefits are based on the information you gave us. If this information changes, it could affect your benefits. For this reason, it is important that you report changes to us right away.

We have enclosed a pamphlet, “Your Social Security Rights and Responsibilities.” It tells you what you must be reported and how to report. Please be sure to read the part of the pamphlet which explains how work could changes your payments.

If You Have Any Questions

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 1-610-433-3237. 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:

SOCIAL SECURITY

41 N 4TH ST

ALLENTOWN, NY 18102

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.  

4. Exhibit – Advance Notice of Proposed Suspension – Reimposing Fugitive Felon Suspension-- Due Process

Social Security Administration

Retirement, Survivors and Disability Insurance

Important Information

                                                                                SOCIAL SECURITY

                                                                                3722 ANNEX BLDG

                                                                                BALTIMORE, MD 21235

    Claim Number: XXX-XX-XXXXA

                                                                                April 30, 2007

EMILY K BREINHOLT

11504 CHERRY HILL DR

SANDY UT 84094-5621

We are writing to tell you that we plan to stop your 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 you fall into one of these categories.

Based on the information we have, we should have stopped the Social Security benefits beginning 12/2006.

The Information We Have

You no longer live in Connecticut, New York or Vermont beginning 12/2006, so the Fowlkes Acquiescence Ruling (AR) no longer applies to your case. Based on this AR, when you lived in Connecticut, New York, or Vermont, we paid your benefits even though you had an outstanding warrant for a crime which was a felony. The Fowlkes AR does not apply in the State where you now live.

Our records show that the ABC Sheriffs Dept., 6401 Security Blvd. Baltimore, MD 21234-6401, 410-123-5678 issued a warrant for your arrest for a non-violent crime on 1/13/2005.

The warrant information we have is:

Warrant number: MD1234567

Originating case number: MA12345790

National Crime Information Center number: NCI123456

Social Security cannot provide further information about the warrant. Please contact the ABC Sheriffs Dept directly.

How Your Benefits Can Be Paid

We will pay you if you contact us at any time 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 your name because someone stole your identity. To prove this, submit a copy of the police report court or the warrant issuing agency stating that the warrant was erroneously issued in your name.

• You were found not guilty of the criminal offense. To prove this, submit a copy of the court docket indicating you were found not guilty of the criminal charges or a copy of the court decision showing that you were 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 your 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.

• You were otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating you were cleared of the criminal charges.

If none of the above applies, we also may pay you benefits if you contact us within 12 months from the date of this letter 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 you were paroled or put on probation was both nonviolent and not drug related.

And

• You have 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 you for the charges on the warrant or that it will not take action on the warrant for your 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 a probation or parole violation is involved, the original crime(s) for which you were paroled or put on probation was both nonviolent and not drug related.

And

• You have 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

• Your medical condition impairs your mental capability to resolve the warrant; or you are incapable of managing your benefits; or you are legally incompetent; or Social Security has appointed a representative payee to handle your benefits or you are residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

What You Can Do

Our records show that you already meet the following requirement(s) for your benefits to be paid:

• The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related.

• You have neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

• The law enforcement agency that issued the warrant reports that it will not extradite you for the charges on the warrant or that it will not take action on the warrant for your arrest.

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 you benefits if you can show us within 90 days from the date that you contact us that:

• 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.

And

• You have neither been convicted of nor pled guilty to any other felony crime since the warrant was issued on 1/13/2005. To prove this, give us a statement as to whether you have been convicted of or pled guilty to any such crimes since 1/13/2005.

And

• 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 you for the charges on the warrant or that it will not take action on the warrant for your arrest.

If We Do Not Hear From You

If we do not hear from you within 30 days from the date of this letter, we will assume the information in this letter is correct and will stop your Social Security benefits.

We will send another letter at that time. It will explain the change in your benefits, the amount of any overpayment and how to appeal our decision. Also, you will have 60 days to ask for an appeal.

The 60 days will start the day after you receive the next letter.

Things To Remember

Even though your benefits will stop, we can pay other members of your family if they are entitled on your record.

If You Have Any Questions

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 1-123-456-7890. 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:

Social Security Office

1111 Main Street

City, State 00000

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.

NOTE: The signature for this letter will be determined based on normal sign-out requirements for adverse action letters that are appropriate for the technician that prepares this notice.

5. Exhibit – Re-Suspension Notice – Reimposing Fugitive Felon Suspension When Beneficiary Moves Out of the Second Circuit

Social Security Administration

Retirement, Survivors, and Disability Insurance

Important Information

                                                                             Claim Number: XXX-XX-XXXXA

                                                                             Date:

JOHN G. BENEFICIARY

101 MAIN STREET

ANYTOWN, ST 00001

We cannot pay benefits to you beginning 12/2006 because you have an outstanding arrest warrant for a felony crime.

Information About Your 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 you fall into one of these categories.

The Information We Have

You no longer live in Connecticut, New York or Vermont beginning 12/2006, so the Fowlkes Acquiescence Ruling (AR) no longer applies to your case. Based on this AR, when you lived in Connecticut, New York, or Vermont, we paid your benefits even though you had an outstanding warrant for a crime which was a felony. The Fowlkes AR does not apply in the State where you now live.

Our records show that the XYZ Sheriffs Dept., 123 Cypress Lane, New York, NY 12345, PHONE: 800-923-4567, issued a warrant for your arrest for a violent or drug-related crime on 1/5/2005.

The warrant information we have is:

Warrant number: NY123456

Originating case number: 2345678

National Crime Information Center number: 3456789

Social Security cannot provide further information about the warrant. Please contact the XYZ Sheriffs Dept. directly.

How Your Benefits Can Be Paid

We will pay you if you contact us at any time and can show us that any of the following apply:

• The warrant was issued incorrectly in your name because someone stole your identity. To prove this, submit a copy of the police report that you 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 your name.

• You were found not guilty of the criminal offense. To prove this, submit a copy of the court docket indicating you were found not guilty of the criminal charges or a copy of the court decision showing that you were 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 your arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the issuing agency, indicating the warrant in question was withdrawn.

• You were otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating you were cleared of the criminal charges.

If none of the above applies, we also may pay you benefits if you contact us within 12 months from 04/30/2007 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 you were paroled or put on probation was both nonviolent and not drug related.

And

• You have 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 you for the charges on the warrant or that it will not take action on the warrant for your arrest.

Or

• The crime for which the warrant was issued is based on 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 you were paroled or put on probation was both nonviolent and not drug related.

And

• You have 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

• Your medical condition impairs your mental capability to resolve the warrant; or you are incapable of managing your benefits; or you are legally incompetent; or Social Security has appointed a representative payee to handle your benefits or you are residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Overpayment Information

Since we did not stop your payments until 06/2007, you were paid $1,500 too much in benefits.

Do You Think We Are Wrong About The Overpayment?

You have certain rights with respect to this overpayment and its recovery.

1. Right to Appeal: If you disagree in any way with this overpayment determination, you have the right, within 60 days of the date you receive this notice, to request that the determination be reconsidered. If you request this independent review of the overpayment determination, please submit any additional information you have which pertains to the overpayment.

2. Right to Request Waiver: You also have the right to request a determination concerning the need to recover the overpayment. An overpayment must be refunded or withheld from benefits unless both of the following are true:

   • The overpayment was not your fault in any way, and

   • You could not meet your necessary living expenses if we recovered the overpayment, or recovery would be unfair for some other reason.

If you request waiver, we may need a statement of your assets and monthly income and expenses.

If you request reconsideration and/or waiver within 30 days, the overpayment will not have to be recovered until the case is reviewed. This review is described in more detail on the attached form SSA-3105, Important Information About Your Appeal and Waiver Rights. The people in any Social Security office will be glad to help you complete the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration) and/or waiver (SSA-632-13K, Overpayment Recovery Questionnaire).

Even if you do not want to request reconsideration or waiver, please call, write or visit any Social Security office if you have questions or need more information. Please take this letter with you if you do visit an office.

How To Pay Us Back

You should refund this overpayment within 30 days. Please make your check or money order payable to "Social Security Administration." and send it to us in the enclosed envelope. Always include your claim number (as indicated above) on the check or money order. If you cannot refund the full overpayment now, you should submit:

1. partial payment,

2. an explanation of your financial circumstances, and

3. a definite plan for repaying the balance.

If You Disagree With The Decision

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision which you believe are wrong and will look at any new facts you have. We may also review those parts which you believe are correct and may make them unfavorable or less favorable to him.

• You have 60 days to ask for an appeal.

• The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

• You must have a good reason for waiting more than 60 days to ask for an appeal.

• You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2, called "Request for Reconsideration." Contact one of our offices if you want help.

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your Social Security Claim." It contains more information about the appeal.

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 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.

If You Have Any Questions

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 1-610-433-3237. 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:

SOCIAL SECURITY

41 N 4TH ST

City, ST 00000

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.

Enclosure

SSA-3105, Important Information About Your Appeal and Waiver Rights

6. Exhibit – One-Time Fowlkes AR Readjudication Notice

Social Security Administration

Important Information

                                                                            OFFICE ADDRESS:

PHONE: (XXX) XXX-XXXX

JOHN G. BENEFICIARY                                        DOC: XXX  DATE:        July 23, 2007

101 MAIN STREET                                               FW             SOCIAL SECURITY NUMBER:

ANYTOWN, CT 00001-0000                                                     XXX-XX-XXXX

                                                                                               KEY CODE: XXXXXXXX

                                                                                               CLAIM NUMBER(S):

                                                                                               XXX-XX-XXXXXX

IMPORTANT - READ CAREFULLY

We may be able to pay you Social Security benefits because of a recent court decision. The decision was made by the United States Court of Appeals for the Second Circuit in a case called Fowlkes v. Adamec.

The law does not allow us to pay Social Security benefits to persons who are fleeing to avoid prosecution, custody, or a jail term for a felony crime.

In the Fowlkes v. Adamec case, the court found that the Social Security Administration cannot stop paying benefits just because someone has an outstanding arrest warrant for a felony. The court found that the person must also know that he or she is wanted by law enforcement, the person is evading arrest, and the warrant was issued because the person was fleeing from justice.

We issued the Fowlkes v. Adamec acquiescence ruling (AR) to explain how we will decide other cases in the States of Connecticut, New York, and Vermont for persons who have outstanding felony arrest warrants. Based on this AR, beginning December 6, 2005, we will not stop the payments of these persons unless the person knows there is an outstanding felony warrant for his or her arrest, he or she does not resolve the warrant, and the warrant was issued because he or she is fleeing from justice.

This ruling does not apply to persons whose benefits were stopped for a parole or probation violation.

You Must Ask Us To Review Our Earlier Decision

You must contact your local Social Security office and request a review of your case if you would like us to make a new decision about your Social Security benefits.

If you contact Social Security, you need to provide us with the name of the court case, Fowlkes v. Adamec, or the name of the AR, which is the Fowlkes v. Adamec AR. We may also ask you for other information to help us decide whether applying this ruling to your case could change our prior decision.

When We Will Make A New Decision About Your Benefits

We will make a new decision about the payment of your Social Security benefits only if you request a review and we then determine that the Fowlkes v. Adamec AR could change our prior decision.

Legal Representation

If you have an attorney or someone else helping you with your case, you should contact him or her. You should also give him or her a copy of this notice.

If You Have Any Questions

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. For specific questions about your case, you may contact your local Social Security office. The address and telephone number are printed at the top of this letter.

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  

SI USTED HABLA ESPANOL

Si usted habla español y no entiende esta carta, por favor llame o visite su oficina local de Seguro Social. Un representante de la oficina de Seguro Social le explicará esta carta. Debe informarle que usted está respondiendo al aviso, Fowlkes v. Adamec.

D. Procedure - PSC Processing Instructions for Suggested Fowlkes AR Notices

See GN 02613.856A for suggested language to use for Fowlkes AR notices. Manually dictated paragraphs will be necessary and they should be patterned after the language suggested in GN 02613.856A until approved Fowlkes AR language is made available for PSC use in AURORA.

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

1. PSC Processing Instructions for Suggested Fowlkes AR Denial Notices

Send a denial notice to the claimant. Do not provide appeal rights. Use the following approved language from the language in GN 02613.856A.2.b. for denial notices. Remember to send a copy of the notice to ORS.

2. PSC Processing for Cases Where SSA Cannot Change its Prior Determination—Beneficiary Inquiry Unrelated to Fowlkes AR

See GN 02613.856A.3. for instructions regarding this action.

3. PSC Processing for Cases Where SSA Grants Fully Favorable Relief Under the Fowlkes AR

a. MACDAP/MACADE Transactions

See the following instructions for notices to use on MADCAP/MACADE transactions:

• Generate an incomplete notice using MADCAP/MACADE. See instructions in GN 02613.856A.1. for language to add to the incomplete notice for fully favorable relief situations. See the exhibit in GN 02613.856C.1. for an example of the notice.

NOTE: Information about the language that must be included for partially favorable relief cases is located in GN 02613.856A.1.b. and in GN 02613.856D.4.

• Remember to send a copy of the notice to ORS.

b. POS (FFEL) Transactions

FFEL will create inaccurate T2R notices. These notices provide incorrect information to the beneficiary regarding the reason the beneficiary’s benefits are being resumed for fully favorable Fowlkes AR relief situations and/or suspended because of the partially favorable relief determination made by SSA. POS (FFEL) will not be used to resume or suspend benefits when granting partially favorable relief under the Fowlkes AR or for re-suspending benefits because the beneficiary moved out of the Second Circuit. SSA will use MADCAP/MACADE to process partially favorable Fowlkes AR relief cases in order to avoid sending out confusing notices to the beneficiary. See GN 02613.840C.3. for FO instructions for actions required on partially favorable relief cases. SSA will also used MADCAP/MACADE to process re-suspension actions when the beneficiary has been granted fully favorable Fowlkes AR relief and then he/she moves out of the Second Circuit. See GN 02613.856D.5. for additional instructions for re-suspension of Title II benefits when the beneficiary moves out of the Second Circuit.

4. Notice Actions for Partially Favorable Relief under the Fowlkes AR

Notices for partially favorable relief determinations made by SSA, will be also be created by MADCAP/MACADE and generated as incomplete notices. See GN 02613.856A.1.b. for the additional notice language that must added to the MADCAP/MACADE notices to explain the partially favorable relief determination. Remember to send a copy of the notice to ORS.

a. FO Processing of Notices for Partially Favorable Relief Under the Fowlkes AR

The FO will not process fully favorable relief determinations under the Fowlkes AR. The notice action will be processed by the PSC through MADCAP/MACADE. See GN 02613.840C.3. for a sample of the notice to be used in this situation.

b. PSC Processing of Notices for Partially Favorable Relief Under the Fowlkes AR

The PSC will process the partially favorable relief notice (i.e., closed period payment notice) action as indicated in the following:

• Send a one-time payment notice. See instructions in GN 02613.840C.3.c. for language to use for partially favorable relief situations. See an example of the notice to send the beneficiary in partially favorable relief situations in GN 02613.856C.3. The beneficiary will remain in fugitive felon suspension until the outstanding warrant issue is resolved because the beneficiary no longer resides in the Second Circuit.

• Remember to send a copy of the notice to ORS.

5. PSC Processing for Cases Where SSA Grants Fully Favorable Relief Under the Fowlkes AR, Then Beneficiary Moves Out of the Second Circuit

The FO will not process cases where SSA must re-suspend Title II benefits because the beneficiary moves out of the Second Circuit.

Before SSA can re-suspend the Title II benefits, Advance Notice of Proposed Suspension must be given to the beneficiary, if appropriate. See GN 02613.940 to determine if an Advance Notice of Proposed Suspension is necessary. See GN 02613.850C.3. for instructions on processing these cases. See GN 02613.856C.4. for a sample of the Advance Notice of Proposed Suspension to use in the re-suspension situation.

After the due process period has expired, and the re-suspension action is taken, the PSC will send the beneficiary a re-suspension notice. The notice action will be processed by the PSC through MADCAP/MACADE. See GN 02613.840C.3.c. for the paragraph to add to the incomplete notice for this situation. See GN 02613.856C.5. for a sample notice displaying re-suspension of Title II benefits after the beneficiary moves out of the Second Circuit.

If a person receives Fowlkes relief and subsequently takes up residence in a State outside of the Second Circuit, benefits will be suspended beginning the month residence in another State begins.

See GN 02613.840C.3.c. for the paragraph language to use when SSA must re-suspend the Title II benefits again for fugitive felon suspension because the beneficiary left the Second Circuit.

See GN 02613.856.C.5. for the exhibit showing a sample notice and the language that should be used in the re-suspension notice when the beneficiary moves out of the Second Circuit after being granted Fowlkes AR relief.