2. What is your e-mail address? 

3. Have you requested copies of the specific legal authorities with respect to any SSI financial determinations?

Yes    No    If not, why not?
 
 

The decisions made in this letter are based on the law. You have a right to review and get copies of the information in our records that we used to make the decisions explained in this letter. You also have a right to review and copy the laws, regulations and policy statements used in deciding your case. To do so, please contact us. Our telephone number and address are shown under the heading 'If You Have Any Questions."

Yes    No

If so, would you be willing to send us a copy of the notice?

Yes    No

(check all that apply)

by telephone call to:   SSA's toll-free number (1-800-772-1213)
 
        SSA local field office

by letter

in-person request

Yes    No     If not, please describe the problems you encountered by telephone.
 

Yes    No     If so, please describe the problems.
 

• Did SSA staff ask you about the SSI notice for which you wanted the legal authorities?     Yes    No

• If so, did SSA staff ask you to: bring the notice to an SSA office?

(check all that apply)              fax the notice to an SSA office?

        read the SSI notice over the telephone?

• Were you asked to identify the specific sections of laws, regulations and/or POMS of which you wanted copies?    Yes    No

• If you have not received the requested copies of the specific legal authorities, please tell us what happened.

 




• If you have received the requested copies of the specific legal authorities:

Were the copies provided free of charge?    Yes    No

• How did you get the copies?    SSA mailed them to me.

(check all that apply)              SSA faxed them to me.
 
                  I had to pick them up at an SSA office.

        I chose to pick them up at an SSA office.

• How many days did it take from the date of your request to the date you received the copies?     Days

• Were you satisfied with the copies of the legal authorities you received?    Yes    No

• If not, what was wrong with the copies of the legal authorities you received?

• The legal authorities were:
 
(check all that apply)

not relevant to the SSI financial determination under review;

not specific enough in relation to the SSI financial determination under review;

did not cover all aspects of the SSI financial determination under review;

• The legal authorities did not include:
 
(check all that apply)

any laws (e.g., sections of the Social Security Act );

any regulations (e.g., sections of 20 C.F.R. Part 416);

any policy materials (e.g., sections of POMS).

• If so, what stage of appeal was pending:    Reconsideration.

    Hearing before an Administrative Law Judge.

    Review by the Appeals Counsel.

• If not, were you waiting to review the legal authorities before deciding whether to request an appeal?    Yes    No