SSA-8553 Phone Letter

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SOCIAL SECURITY ADMINISTRATION
OFFICE OF QUALITY PERFORMANCE 


SUITE 40099 HIGH STBOSTON, MA 02110-2320

Date: June 21, 2011
Claim Number: XXX-XX-5371  
xxxxxxxxxxxxxxxxxxxxx 
xxx
 MARENGO STCLEBURNE, TX  76033-4327

Dear MS XXXX,

Each month the Social Security Administration (SSA) asks a few people, who get benefit payments, to help us make sure we pay everyone the correct amount of money.  We picked you this month by chance, not for any other reason.  

To make sure you receive the correct amount, I would like to telephone you at your home on Monday, July 18, 2011 at 09:00 a.m. (Central Time).

I am with the Office of Quality Performance, which is a special reviewing section in SSA, and is separate from the office that processed your claim.  If you would like to verify that this is a legitimate letter, you can call SSA.  The national toll-free number is (800) 772-1213.

What Will Happen When I Call You

    • I will identify myself as shown on the bottom of this letter.
    • I will ask you questions about your benefits. 
    • The Privacy Act Statement that allows this review is enclosed.

How You Can Get Ready for My Call

    • I have enclosed a form with the items checked that you should have available when I call. 
    • You may have a friend or relative present to help you during my call.

Please Return the Enclosed Form to Me

Please complete and sign forms SSA 8552 and SSA 2935-U3, and mail them to me in the enclosed envelope.  You do not need a stamp.  

If you have any questions, you may call me between 08:00 a.m. and 3:00 p.m.  My telephone number is (866) 755-5346  Ext. 14910.  Thank you.

								Sincerely,




								
								Quality Reviewer

Enclosures:
Interview Confirmation Form (SSA 8552)
Information Needed Form
Authorization Form (SSA 2935-U3)
Privacy Act Statement
Return Envelope
							













Form Approved
Social Security Administration

OMB No. 0960-0189


Claim Number: XXX-XX- 5371  

1.	I / We will be available for your interview as scheduled.


YES



NO



If NO, please phone me as soon as possible to set a better time.


2.	My telephone number is:  (            )                                                 .


3.	My address is:  

			    

			    

			    



4.	Signature:  

	Date:  








Form SSA-8552








INFORMATION NEEDED TO REVIEW YOUR SOCIAL SECURITY CLAIM


Claim Number: XXX-XX-5371  

Please have documents or proof of the ITEMS CHECKED below available for your interview if you have them in your possession. This will help us complete the review of your claim more quickly.  Information regarding any items that are not checked but may pertain to you should also be mentioned during the interview. 



Social Security or Medicare Card for       



Birth or baptismal certificate recorded before you were age 5 – otherwise, at least two of the following documents are needed : school records, census records, delayed birth certificate, children’s birth certificates, family Bible, naturalization certificate, etc.



Records of age will also be needed for       



Marriage Certificates for you and      



Divorce or annulment decrees for all prior marriages



Death Certificates for      



Social Security numbers for all former spouses



Proof of military service



Pay Slips or W-2 Forms for       



Self-employment tax returns for       



A copy of the earnings record for the account on which you are receiving benefits is enclosed.  Please review the earnings and compare them with your records.  I have highlighted some specific years that I would like to discuss with you.

If you disagree with any of these earnings, please have your records available at the time of the interview.  W2 forms are the best evidence of wages.  Tax returns and proof of filing are the best evidence of self employment wages.



Other:       






Form SSA-85





Form Approved
Social Security Administration

OMB No. 0960-0189
AUTHORIZATION TO THE SOCIAL SECURITY ADMINISTRATION TO OBTAIN PERSONAL

INFORMATION




BENEFICIARY'S NAME:   xxxxxxxxxxxxxxxx
SOCIAL SECURITY NUMBER:   XXX-XX-5371
STREET ADDRESS:   xxxxxxxxxxxxxxxxxxxx
                                    

CITY:   CLEBURNE
STATE:   TX
ZIP CODE:   76033

I authorize the Individual, Organization, or Agency listed below to disclose to the Social Security Administration information about  me relating to a claim for Social Security  benefits.  I understand that this information will be kept confidential as required by the  Social Security Act and the Privacy Act of 1974.  This authorization shall remain in effect for no longer than 12 months from the  date of my signature.

Name of Individual, Organization, or Agency:   
Address:  
                
City:   
State:   
Zip Code:   


Signature of Beneficiary (First name, middle initial, last name)
Date (Month, day, year)
(Write in ink)


SIGN


HERE





Signature of Representative Payee or Guardian
(First name, middle initial, last name)
Date (Month, day, year)
(Write in ink)


SIGN


HERE



Witnesses are required ONLY if this authorization has been signed by mark (X) above.  If signed by mark (X), two witnesses to the  signing who know the applicant must sign below, giving their full addresses.

Signature of Witness
(First name, middle initial, last name)
Date (Month, day, year)

(Write in ink)







SIGN HERE



ADDRESS







Signature of Witness
(First name, middle initial, last name)
Date (Month, day, year)

(Write in ink)








SIGN HERE  ADDRESS

Form SSA-2935-U3 (06-2008) 

PRIVACY ACT STATEMENT


Privacy Act Statement

Collection and Use of Personal Information

Section 205 of the Social Security Act, as amended, authorizes us to collect this information.  We will use the information you provide on this form to obtain information from another individual, organization, or agency regarding your Social Security benefits.

Completion of this form is voluntary; however, failure to provide all or part of the information could prevent us from correctly reviewing your Social Security benefits.
 
We rarely use this information you supply for any purpose other than for reviewing your claim for Social Security benefits.  However, we may use it for the administration and integrity of Social Security programs.  We may also disclose information to another person or to another agency in accordance with approved routine uses, which include but are not limited to the following: 

    1. To enable a third party or an agency to assist Social Security in establishing rights to Social Security benefits and/or coverage;

    2. To comply with Federal laws requiring the release of information from Social Security records (e.g., to the Government Accountability Office and Department of Veterans’ Affairs);

    3. To make determinations for eligibility in similar health and income maintenance programs at the Federal, State, and local level; and,

    4. To facilitate statistical research, audit, or investigative activities necessary to assure the integrity and improvement of Social Security programs.

We may also use the information you provide in computer matching programs.  Matching programs compare our records with records kept by other Federal, State, or local government agencies.  Information from these matching programs can be used to establish or verify a person’s eligibility for Federally-funded or administered benefit programs and for repayment of payments or delinquent debts under these programs.

Additional information regarding this form, routine uses of information, and our programs and systems is available on-line at www.socialsecurity.gov or at your local Social Security office.

Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paper Reduction Act of 1995.  You do not need to answer these questions unless we display a valid Office of Management and Budget control number.  We estimate that it will take about 40-50 minutes to read the instructions, gather the facts, and answer the questions.  You may send comments on our time estimate about to :  SSA,  6401 Security Blvd., Baltimore, MD 21235-6401.  Send only comments relating to our time estimate to this address, not the complete form.

FORM: SSA L8553-U3