Ssa-l8551-u3

SOCIAL SECURITY ADMINISTRATION
OFFICE OF QUALITY PERFORMANCE

Form Approved
OMB No. 0960-0189

Date:

Claim Number:

Dear
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 visit you at your
home or another convenient location on
.
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.

··
·
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What Will Happen When I Visit You
I will identify myself with my Social Security Administration Photo ID.
I will ask you some questions about your benefits.
The Privacy Act Statement that allows this review is enclosed.

How You Can Get Ready For My Visit
I have enclosed a form with the items checked that you should have available.
Please review the enclosed copy of the Earnings Record for the account on
which you are receiving benefits.
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
My telephone number is

and
. Thank you.

.

Sincerely,
Quality Reviewer
Enclosures:

Form SSA-L8551 (11-2011)
Destroy Prior Editions

Privacy Act Statement

We are removing the 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-L8551 (11-2011)