Ssa-l8554-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. This month, we picked
(for whom you are
representative payee). We made this selection by chance, not for any other reason.
To make sure you receive the correct amount, I would like to telephone you and
on
at
.
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 Call You
I will identify myself as shown on the bottom of this letter.
I will ask you questions about

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.
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 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
and
My telephone number is
. Thank you.
Sincerely,
Quality Reviewer
Enclosures:

.

Form SSA-L8554 (12-2011)
Destroy Prior Editions

Privacy Act Statement

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
Collection and Use of Personal Information

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-L8554 (12-2011)