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SOCIAL SECURITY ADMINISTRATION _____________________________________________________________ | |
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Refer to: TAHB [SSN] [XSSN] |
Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255] | |
Last Update: 9/1/05 (Transmittal II-6-13)
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SOCIAL SECURITY ADMINISTRATION _____________________________________________________________ | |
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Refer to: TAHB [SSN] [XSSN] |
Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255] | |
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MEMORANDUM TO: |
Social Security Office [Insert mailing address] |
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FROM: |
Office of Appellate Operations Branch[#] |
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SUBJECT : |
Request for Assistance in Pending Request for Review - ACTION Claimant: [Insert Claimant's Name](Deceased) Social Security Number: [Insert SSN] Last Known Address: [Insert Claimant's Address] Last Known Phone No.: [Insert Claimant's Phone No.] |
On [insert date], the claimant filed a request for review which is pending before the Appeals Council. We have been notified that the claimant died on [insert date].
[If proof of death needed insert]:
[Please provide the Appeals Council with proof of the claimant's death.]
In order to proceed with the case, the Appeals Council [also] needs information as to whether there is a qualified individual who wishes to continue the action (See 20 CFR 416.1471(b)).
If a person potentially eligible for supplemental security income dies, any underpayment may be paid to:
A surviving eligible spouse.
Any surviving spouse who was living in the same household as the deceased in the month he or she died or within 6 months immediately preceding the month of death.
The parents of the deceased, if the deceased was a disabled or blind child who was living with his parent or parents at the time of death or within the 6 months immediately preceding the month of death.
The State, if the claimant was receiving interim assistance under an interim assistance reimbursement agreement.
Repayment to the State takes precedence over any other underpayment due. Therefore, please advise the Appeals Council if the deceased authorized interim assistance reimbursement and provide supporting documentation.
If there is no interim assistance reimbursement agreement with the State, please have any qualified individual who desires to continue the action complete the attached form, “Request for Designation as a Qualified Individual in a Proceeding Before the Appeals Council.”
If a qualified individual indicates that he or she does not wish to continue the action, please obtain a signed statement to this effect.
Please return all material directly to the Appeals Council within 30 days from the date of this memorandum.
Our address and FAX number are:
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ADDRESS: |
Appeals Council Office of Hearings and Appeals ATTN: Branch [#], Suite [#] 5107 Leesburg Pike Falls Church, VA 22041-3255 |
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FAX: |
[FAX #], Attn: Branch [#]. |
Please include the claimant's Social Security Number on all correspondence.
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[Name] [Hearings and Appeals Analyst] OR [Branch Chief] |
Attachment:
Request for Designation as a Qualified Individual