TN 1 (12-12)

A. Exhibit: Clark Court Order Informational Notice

This section exhibits the Clark Court Order Informational Notice we are mailing to title II and title XVI class members. A copy of this letter is available for viewing in the Online Retrieval System (ORS), in the MASS MAIL file off the ORS Main Menu titled Clark Informational Notice.

Social Security Administration

Important Information

Processing Center (title II) or Social Security Administration (title XVI)

Office Address:

Claim Number: [SSN]

[Date of Mailing]

Payee Name and address

IMPORTANT - READ CAREFULLY

You may be a class member in a court case called Clark v. Astrue. The case affects Social Security and Supplemental Security Income (SSI) payments. Because of the court case, we no longer suspend or deny payments based solely on the existence of a warrant for a probation or parole violation. Class members, whose payments were suspended, denied, or who had an overpayment determination made October 24, 2006, or later, may get back payments. Class members with appeals of suspensions, denials, or overpayments that were pending on October 24, 2006 or later also may get back payments.

We are sending this letter to alert potential Clark class members about this court case. We will tell you in another letter if you qualify for back payments or if we need to talk to you before we restart any payments. You do not need to contact us about this letter.

If You Have Questions

If you have any questions, please:

• Visit our website at www.socialsecurity.gov/clark_relief_order for information about the Clark court case and visit www.socialsecurity.gov for general information about Social Security and SSI;

• Call us at 1-800-772-1213 or call your local Social Security office. We can answer most questions over the phone. If you are deaf or hard of hearing, our toll-free TTY number, 1-800-325-0778; or

• Write or visit any Social Security office. If you plan to visit an office, you may call ahead to make an appointment.

The office that serves your area is located at:

[SSA field office address]

Please have this letter with you if you call or visit an office. If you write, please include a copy of the first page of this letter. It will help us answer your questions.

SI USTED HABLA ESPANOL

Le estamos enviando esta carta para informarle que es posible que usted sea un miembro de este caso de corte llamado Clark v. Astrue. Debido a este caso de corte, ya no suspendemos ni negamos pagos basados solamente en la existencia de una orden judicial por una violación de una libertad condicional o vigilada. Es posible que también tenga derecho a pagos retroactivos. Le diremos en otra carta si tiene derecho a pagos retroactivos o si necesitamos hablar con usted antes de reiniciar algún pago. No necesita comunicarse con nosotros acerca de este aviso.

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, Clark v. Astrue.

Social Security Administration

B. Title II Clark Court Order individualized notice paragraphs

After processing Title II class relief, send the class member an individualized notice, incorporating one of the paragraphs in this section, explaining the Clark relief that we did or did not provide. Title II Redesign (T2R) and MACADE/MADCAP systems automatically utilize the appropriate language in this section.

1. Caption for Clark Court Order relief notices

2. Clark Court Order relief resumption and reinstatement paragraph

a. T2R UTI

b. MADCAP and AURORA UTI

For MADCAP notices, request the UTI and add MADCAP enclosed notice block (e.g., C*FUG118). The fill-ins are automatically generated. For AURORA notices, request the UTI and manually add the fill-ins for the paragraph.

NOTE: If we recover an overpayment at the same time we are resuming or reinstating benefits because of Clark, use paragraph OPT127 to explain the overpayment removal or reduction instead of the ROAR overpayment paragraph.

3. Clark Court Order relief overpayment removal or reduction paragraph

For instructions on using paragraphs in MADCAP and AURORA notices, see instruction in GN 02615.160B.2.b. in this section.

4. Clark Court Order relief applied paragraph – continuing suspension or beneficiary terminated (non-payment before termination)

For instructions on using paragraphs in MADCAP and AURORA notices, see instruction in GN 02615.160B.2.b. in this section.

C. Title XVI Clark Court Order individualized notice paragraphs and exhibits

We require a redetermination (RZ) prior to providing Title XVI Clark relief. In this section, we provide the Clark paragraphs and notices used in the title XVI RZ process. After processing class relief, the System sends the class member an individualized notice, using existing language, explaining the Clark relief that we did or did not provide.

1. Clark Court Order RZ appointment paragraphs

Use the paragraphs in the chart when sending a title XVI RZ appointment notice to potential class members for determining title XVI eligibility factors for the Clark period. The paragraphs are included in Starz and Stripes, The Next Generation (SSTNG) as an option to use in the appointment notice and as a complete notice in the Document Processing System (DPS).

2. Exhibit: Clark Court Order RZ Appointment Notice – SSTNG and DPS

This exhibit illustrates how an individualized Clark Court Order RZ appointment notice could appear in SSTNG and DPS. You can locate the Clark RZ Appointment Notice is in the post-entitlement folder in DPS.

Social Security Administration

Supplemental Security Income

[Date of mailing]

Claim Number: [SSN]

Payee name and address

Salutation:

In a previous letter, we informed you of the court case called Clark v. Astrue. This is a very important letter about your potential eligibility for Supplemental Security Income (SSI) under the terms of the court case. Please read this letter carefully. If there is anything you do not understand, please get in touch with us right away.

You Have An Appointment

We must regularly review the cases of people who get SSI. We need information from you to make sure you are still eligible.

We want to talk to you on [date and time of appointment]. On that date:

• Call us at (XXX) XXX-XXXX and ask for [claim representative’s name].

If you can't keep your appointment, please call us. We will make another appointment for you.

When you call or come in, please have this letter with you.

Things We Need

When you talk with us, please try to have all of the items shown below from (month/day/year) to present. Even if you don't have all of the information, we need to hear from you. We will help you get anything you do not have.

We must see the original document(s) or a certified copy of these item(s). We cannot accept photocopies. We will return these items to you.

• Bank statements: savings and checking accounts, and any other bank statements for (bank name) (month/day/year) to present.

• Pay stubs from work or, self-employed, last year's income tax return for (employer name). (If tax return is not available, we need all records that show last year's business income and expenses).

• Life insurance policies and/or burial contract agreement.

If We Do Not Hear From You

You must contact us within 60 days from the date of this letter. If you do not, you may lose eligibility to relief provided under the Clark court case.

If You Have Any Questions

If you have any questions or need help, please call us at (XXX) XXX-XXXX ext. XXXX and ask for [claims representative’s name]. The office hours are 9:00 AM to 3:00 PM.

Social Security Administration

3. Clark Court Order RZ close-out paragraph

Use the paragraph in the chart when sending a title XVI Clark close-out notice to potential class members whose records are in terminated status and who did not respond to the Clark RZ appointment notice. The paragraph is included as a complete notice in the Document Processing System (DPS).

4. Exhibit: Clark Court Order RZ Appointment Close-out Notice

This exhibit illustrates how the individualized Clark Court Order RZ appointment close-out notice containing the Clark close-out paragraph could appear. You can locate the T-16 Clark Closeout Notice in the post-entitlement folder in DPS.

Social Security Administration

Supplemental Security Income

Important Information

[Date of mailing]

Claim Number: [SSN]

Payee name and address

Salutation:

We recently sent you a letter explaining that you may be eligible for Supplemental Security Income (SSI) under the Clark v. Astrue court case. We set up an appointment for [date of appointment]. You did not keep this appointment and we were unable to reach you to set up a new appointment. We have made an informal decision that you are not eligible for SSI.

Why You Are Not Eligible

We believe you are not eligible for SSI for the reason(s) shown below.

• You did not file an application for SSI. If you want to file, please contact us to set up a new appointment.

Why You May Want To File A Claim

You may want to file a claim for SSI if:

• You want a formal decision about your eligibility, or

• You disagree with our informal decision, or

• You want to give us more information about your case.

If you decide to file, you should do so right away. The sooner we get your signed application, the sooner we can decide if you are eligible. If we decide you are eligible, you could lose benefits if we receive your signed application after [60 days after appointment date].

Things To Remember

This informal decision is only about your eligibility for SSI. This decision is not about your eligibility for Social Security benefits or Medicare.

If You Have Questions

For general information about SSI, visit our website at www.socialsecurity.gov on the Internet. You will find the law and regulations about SSI eligibility and SSI payment amounts at www.socialsecurity.gov/SSIrules/.

For general questions about SSI or specific questions about your case, you may call us toll-free at 1-800-772-1213 or call your local Social Security office at XXX-XXX-XXXX. If you call or visit our office, please bring this letter with you and ask for [claims representative’s name].

Social Security Administration

D. Clark Court Order Notice of Inquiry paragraph

Use the Clark Court Order Notice of Inquiry to reply to an inquiry about Clark relief from a current or former beneficiary or recipient who does not meet the class definition in GN 02615.100A.2. You can locate the title II and title XVI Clark Court Order Notice of Inquiry in the general folder in DPS. In AURORA, the notice identifier for the Clark Court Order Notice of Inquiry is E4015.

1. Exhibit: Title II Clark Court Order Notice of Inquiry – DPS and AURORA

Social Security Administration

Retirement, Survivors, and Disability Insurance

Important Information

[Date of mailing]

Claim Number: [SSN]

Payee name and address

Salutation:

We are writing to you because you contacted us about the Clark v. Astrue court case. You can learn more about the Clark court case by visiting our website at www.socialsecurity.gov/clark_relief_order.

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 (XXX) XXX-XXXX. 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:

[SSA field office address]

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

2. Exhibit: Title XVI Clark Court Order Notice of Inquiry – DPS

Social Security Administration

Supplemental Security Income

Important Information

[Date of mailing]

Claim Number: [SSN]

Representative name and address

Salutation:

We are writing to you because you contacted us about the Clark v. Astrue court case. You can learn more about the Clark court case by visiting our website at www.socialsecurity.gov/clark_relief_order.

If You Have Any Questions

For general information about SSI, visit our website at www.socialsecurity.gov on the Internet. You will find the law and regulations about SSI eligibility and SSI payment amounts at www.socialsecurity.gov/SSIrules/.
For general questions about SSI or specific questions about your case, you may call us toll-free at 1-800-772-1213 or call your local Social Security office at XXX-XXX-XXXX. If you call or visit our office, please bring this letter with you.

Social Security Administration