BASIC (03-01)

A. Procedure - Exhibit 1

Use Exhibit 1 to inform the individual that SSA has processed the voluntary termination of SVB per VB 01505.011C. Provide the following language:

Based on your request, we ___(1)___ ___(2)___ entitlement to Special Veterans Benefit payments beginning ___(3)___.

Paragraph Fill-ins:

1. (have terminated) or (will terminate)

2. (your), (veteran's name, possessive)

3. (Month/Year)

B. Procedure - Other Required Exhibit 1 Paragraphs

1. Appeal Paragraph

Include the appeal paragraph and enclose a Pub. 05-10058, “Your Right to Question the Decision Made on Your Social Security Claim”

2. Whom To Contact Paragraph

Insert one of the following paragraphs under the heading “If You Have Questions or Need Help” on the Exhibit 1 depending upon whether the mailing address is inside or outside the U.S.

Domestic Paragraph

If you have any questions, you may call, write or visit our office or any U.S. Social Security office. You may also write to us at the address shown at the top of this letter. If you call or visit an office, please have this letter with you. 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.

Foreign Paragraph

If you have questions, you should contact one of the offices shown below. You may also write to us at the address shown at the top of this letter. However, if you call or visit an office, please have this letter with you.

• If you live in Canada, contact any U.S. Social Security office.

• If you live in Guam, Puerto Rico, Samoa or the U.S. Virgin Islands, you should contact the nearest U.S. Social Security office.

• If you live in Mexico, contact any U.S. Social Security office or the nearest United States Embassy or consulate.

Exhibit 1

Social Security Administration
Special Veterans Benefits                                                   Address:

                                                                                                  Phone:
                                                                                                  FAX:
                                                                                              Office Hours:

                                                                                              Date:


Dear:

We are writing to you about your Special Veterans Benefits (SVB).


If You Disagree With The Decision


If you disagree with our decision, you have the right to appeal. A person who did not make the first decision will decide your case. We will review those parts of the decision with which you disagree and will look at any new facts you have.

• You have 60 days to ask for an appeal.

• You must put the request for an appeal in writing.

• 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.

• You may make your request through any U.S. Social Security office, United States Embassy or consulate, or the U.S. Veterans Affairs Regional Office in Manila, Philippines. Or you may write to us at the address shown at the top of this letter.
  
  Enclosure: Pub. 05-100582
  
  If You Have Questions or Need Help