Questionnaire About Special Veterans Benefits

Social Security Administration
Important Information about Your Special Veterans Benefits
Return the attached form to:

WHY WE ARE SENDING YOU THE ENCLOSED FORM
We must regularly review your claim for Special Veterans Benefits (SVB) to determine your
continuing entitlement and correct payment amount.

WHAT YOU MUST DO
You must complete the enclosed form “Statement for Determining Continuing Entitlement for
Special Veterans Benefits (SVB)” and return it to us. If you are the beneficiary’s representative
payee, please answer according to how the questions pertain to the beneficiary.

What Your Representative Payee Must Do
If you have a representative payee, the payee must complete the enclosed form SSA-2010
Statement for Determining Continuing entitlement for Special Veterans Benefits (SVB), on your
behalf. The payee must answer according to how the questions apply to you and return the form
to SSA.
NOTE: A representative payee is the person, agency, organization, or institution selected by
SSA to receive and manage benefits on behalf of an incapable beneficiary.

HOW TO COMPLETE THE ENCLOSED FORM
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Check the name and address above. If the information is not correct, write the correct
information at the end of the form in the spaces labeled:
o Signature (Please print your name above your signature),
o Mailing Address,
o City, State, Country, and
o Postal Code
Answer all questions on the form.
Sign your name in the space marked “Signature of Beneficiary or Representative Payee.”

WHEN TO RETURN THE FORM
You must complete the form, sign it, and send it with any evidence to us within 30 days from the
date you receive this form. We have enclosed an envelope for your convenience.

WHERE TO RETURN THE FORM
Return the completed and signed and any evidence to the Social Security office listed in the box
labeled “Return the attached form to:” on the front page of this letter.

WHAT WILL HAPPEN IF WE DO NOT HEAR FROM YOU
If we do not hear from you, your benefits will stop. We will send you a letter to notify you that
we are suspending your benefits. The letter will explain our action and what you need to do if
you disagree with our action.

WHAT YOU NEED TO REPORT
You must report to us any change that affects your Special Veterans Benefits. The following is a
list of changes that must be reported:
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You change your mailing address or residence.
You return to or visit the United States for a calendar month or longer.
You become unable to manage your benefits.
You have been deported or removed from the United States.
You have an unsatisfied warrant for your arrest for a felony crime in the United States, or in
U.S. jurisdictions that do not define crimes as felonies, for a crime that is punishable by death
or imprisonment for a term exceeding one year.
You are in violation of a condition of probation or parole.
You receive an increase or decrease in a pension, annuity or other recurring payment. Some
examples of payments are retirement, worker’s compensation, veteran’s benefits, or
disability benefits.
You move to another country.
Your family, representative payee or other knowledgeable person must notify us if you die.

You need to report a change the month in which the change occurred in order to prevent a
possible overpayment or penalty.

HOW TO CONTACT US IF YOU HAVE QUESTIONS OR IF YOU HAVE CHANGES TO
REPORT
If you are outside the United States and have questions or have changes to report, you may
contact one of the offices shown below.

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If you live in the Philippines, please call the SSA Division of the Veterans Affairs
Regional Office at 632-301-2000, extensions 6302, 6319, or 5085 from 8 a.m. to 3 p.m.,
Monday through Friday. You may write or visit the SSA Division, U.S. Department of
Veterans Affairs, 1131 Roxas Boulevard, Ermita 0930 Manila. You also may E-mail the
Veterans Affairs Regional Office at [email protected].
If you live in American Samoa, Canada, Guam, Puerto Rico, Samoa or the Virgin
Islands, contact the nearest U.S. Social Security office.
If you live in Mexico, contact the nearest U.S. Social Security office or the nearest U.S.
Embassy or consulate.

If you live in any other country, contact the nearest U.S. Embassy or consulate. Visit
www.socialsecurity.gov/foreign for a complete list of these offices.
If you are in the United States and have questions, you may visit our website at
www.socialsecurity.gov or call us toll-free at 1-800-772-1213. We can answer specific questions
from 7 a.m. to 7 p.m., Monday through Friday. We can provide information by automated phone
service 24 hours a day.