NL: Notices, Letters and Paragraphs
BASIC (07-90)
Social Security Administration
Retirement, Survivors, and Disability Insurance
Notice of Award
Miscellaneous Program Service Center
225 E. Oak Street
Central City, ST 00000
Date:
Claim Number: 123-45-6789A
JOHN G. BENEFICIARY
101 MAIN STREET
ANYTOWN, ST 00001
You are entitled to monthly retirement benefits beginning February 1989.
What We Will Pay And When
You will receive $286 for February 1989 around March 3, 1989.
After that you will receive $286 each month.
Other Social Security Benefits
The benefits described in this letter is the only one you can receive 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.
Do You Think We Are Wrong?
If you think we are wrong, you have the right to appeal. We will correct any mistakes and will look at any new facts you have. A person who did not make the first decision will decide your case.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter.
You must have a good reason if you wait more than 60 days to ask for an appeal.
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
If you have any questions, you may call us at 1-800-2345-SSA. We can answer most questions over the phone. You can also write any Social Security office. The office that serves your area is located at:
Street address
City, State Zip
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 at the office. This will help us serve you more quickly when you arrive at the office.
Gwendolyn S. King
Commissioner
of Social Security
Enclosure(s):
Pub 05-10077