NL 00703: Exhibit and Dictated Letters
TN 30 (03-96)
Document Identifier for Word Processor: E3216
A. EXHIBIT LETTER
You asked us to review our decision to make your (1) payments to (2) as your representative payee. We have finished our review which we call a reconsideration. We find that our decision to make your payments to (3) is correct. Someone who did not make the first decision reviewed the facts in your file and made this new decision. The rest of this letter explains our decision.
Why We Selected Your Representative Payee
We selected (4) as your representative payee for the following reason(s):
(5) .
After considering all possible payees to help you manage your money to meet your needs, we found that (6) is the best choice.
B. EQUESTING INSTRUCTIONS
Send this notice to a beneficiary when the reconsideration determination affirms the selection of the payee.
Fill-ins:
| (1) | Choice 1 - | Social Security |
| Choice 2 - | Supplemental Security Income | |
| Choice 3 - | Black Lung | |
| (2) | Choice 1 - | Payee's full name, e.g., “John P. Smith” |
| Choice 2 - | Name of institution, e.g., “the Haven Nursing Home” | |
| (3) | Choice 1 - | Payee's title and last name, e.g., “Mr. Smith” |
| Choice 2 - | Name of institution, e.g., “the Haven Nursing Home” | |
| (4) | Choice 1 - | Payee's title and last name, e.g., “Mr. Smith” |
| Choice 2 - | Name of institution, e.g., “the Haven Nursing Home” | |
| (5) | Choice 1 - | You are living with (him/her) |
| Choice 2 - | (He has/She has/They have) shown that (he/she/they) can help you manage your money to meet your needs. | |
| Choice 3 - | (He/She) is your (parent/spouse/friend/relative). | |
| Choice 4 - | You are in the care of (nursing home/institution, etc.) and the (director/manager) is responsible for seeing that your needs are met. | |
| Choice 5 - | Other reason - dictated language. For SSI cases, give the authority for the reconsideration determination | |
| Choice 6 - | Other information that concerns case. | |
| NOTE: FOs will select all that apply. Use bullets. | ||
| (6) | Choice 1 - | Payee's full name, e.g., “John P. Smith” |
| Choice 2 - | Nursing home or institution, e.g., “the Haven Nursing Home.” |