Ssa-l8552-u3

Form Approved
OMB NO. 0960-0189

Social Security Administration

SOCIAL SECURITY ADMINISTRATION
Office of Quality Performance

Date:

Claim Number:

For:

Beneficiary:

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. This
, (for whom you are representative payee). We made
month, we picked
this selection by chance, not for any other reason.

To make sure you receive the correct amount, I would like to visit you and
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
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 Visit You
•

I will identify myself with my Social Security Administration Photo ID.

•

I will ask you some questions about

•

The Privacy Act Statement that allows this review is enclosed.

benefits.

How You Can Get Ready For My Visit
•

I have enclosed a form and checked the papers for
have available.

•

Please review the enclosed copy of the Earnings Record for the account on which
is receiving benefits.

•

You may have a friend or relative present to help you during my visit.
Page 1

that you should

Form SSA-L8552 (03-2012)

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
Thank you.
My telephone number is

and

Sincerely,

Quality Reviewer
Enclosures:

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Form SSA-L8552 (03-2012)

THE EARNINGS RECORD
Benefits are computed by giving credit for any earnings, since 1937, that were covered
under the Social Security Act. As part of our review, we check the record for accuracy.
The earnings record shows yearly amounts for 1951 through recent years. In the years
not shown, no earnings were reported to Social Security. Earnings during 1937 — 1950
are shown as a separate total.
Please compare the earnings amounts to any records you have. Pay particular attention
to:
•

Years with no earnings

•

Years with earnings much higher than the ones before and after them

•

Years with earnings much lower than the ones before and after them

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 payment of the taxes are the best evidence of self-employment
earnings.

Page 3

Form SSA-L8552 (03-2012)

Privacy Act Statement
Collection And Use Of Information

We are removing the Privacy
Act Statement
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.
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Form SSA-L8552 (03-2012)