Form SSA-3462 Record of Supplemental Security Income Inquiry--MSSICS S

LSEL - LEAD SELECTION
MSSICS
LEAD SELECTION
PAGE 1 OF LSEL
[1-D]
REQUESTED SSN: SSS-SS-SSSS
[2-O]
PLACE A Y NEXT TO EACH LEAD YOU WANT DISPLAYED
[3-D] [4-D]
[5-D]
[6-D]
[7-D] [8-D]
(Y) LEAD LEAD NH
CLAIMANT PROTECTIVE INFORMAL CLOSE
OUT
SSN
NAME
FILING DATE DENIAL REC DATE
X ALL SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
X SSS SSSSSSSSS SSSSS SSSSSSSSSS SSSSSS
S
SSSSSS
[9-O]
ENTER THE NUMBER OF THE LEAD YOU WANT PROPAGATED: 999
[10-D]
MORE (Y): S

LEAD - LEADS/PROTECTIVE FILING DATA
MSSICS
LEADS/PROTECTIVE FILING DATA
LEAD
[1-D]
NUMBER SSS
[2-D]
NAME: SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSS SSSS
[3-D]
[4-D] [5-D]
[6-D] [7-D]
SSN: SSSSSSSSS SEX: S BIRTHDATE: SSSSSSSS PROOF: S ONSET DATE:
SSSSSSSS
[8-D]
CALLER NAME: SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSS
SSSS
[9-D]
RELATIONSHIP TO CLAIMANT: SSSSSSSSSSSSSSSSSS
[10-D]
ADDRESS: SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS
[11-D]
[12-D]
[13-D]
CITY: SSSSSSSSSSSSSSSSSSSSSS STATE: SS ZIP: SSSSS
[14-D]
COUNTRY: SSSSSSSSSSSSSSSSSSSSSS
[16-D]
[17-D]
[18-D]
[15-D]
PHONE: SSS SSS SSSS INFO: SSSSSSSSSS PHONE: SSS SSS SSSS INFO:
SSSSSSSSS
[19-D]
CLAIM TYPE(S): SSSSSS SSSSSS SSSSSS
[20-D]
PROOFS REQ: S AGE
S MAR/DIV
S DIR DEP
S MILITARY
S MEDICAL EVIDENCE S DEATH
S SSI INC/RESOURCES W2/EARNINGS FOR 19SS 19SS 19SS
[22-D]
[23-D]
[21-D]
APPT DATE: SSSSSS APPT TIME: SSSS CONTACT TYPE: S (1-PHONE 2-IN
OFFICE)
[24-D] [25-D] [26-D] [27-D] [28-D] [29-D] [30-D]
ISSUE REQ F/UP F/UP TICKLE REC REMARKS
SSSSSS SSSSSS SSSSSS SSSSSS SSSSSS SSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSS SSSSSS SSSSSS SSSSSS SSSSSS SSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSS

SSSSSS SSSSSS SSSSSS SSSSSS SSSSSS SSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSS SSSSSS SSSSSS SSSSSS SSSSSS SSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSS
[31-O]
[32-O]
IS THIS THE LEAD YOU WANT (Y/N): X

REMARKS (Y): P

ACLM - SSI CLAIMS APPLICATION
MSSICS
SSI CLAIMS APPLICATION
ACLM
[1-O]
SSS-SS-SSSS SSSSS SSSSSSSSSS
TRANSFER TO: XXXX
[2-M]
APPLICATION TYPE: P 1=DEFERRED 2=FULL 3=ABBREVIATED
[3-C]
IF ABBREVIATED, TYPE: 9 1=EXCESS COUNTABLE INCOME
2=INELIGIBLE RESIDENT OF A PUBLIC INSTITUTION
3=ABSENCE FROM U.S.
4=EXCESS RESOURCES
5=NOT A CITIZEN or LAWFULLY ADMITTED ALIEN
6=NOT AGED 65, BLIND, OR DISABLED
7=FAILURE TO PURSUE CLAIM
8=INMATE OF A PENAL INSTITUTION
9=NOT A RESIDENT OF THE UNITED STATES
[4-O]
PROTECTIVE FILING DATE (MMDDYY): PPPPPP
[5-M]
EFFECTIVE FILING DATE (MMDDYY): 999999
[6-O]
PENDING FILE BEGIN DATE (MMYY): SSSS
[7-M]
TYPE OF APPLICANT: P 1=CLAIMANT 2=OTHER INDIVIDUAL 3=AGENCY
[8-O]
REMARKS (Y): X