Transcription of Request for Reconsideration - SSA-561-U2
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Request for Reconsideration - SSA-561-U2
SUPPLEMENTAL SECURITY INCOME (SSI) ORSPECIAL VETERANS BENEFITS (SVB) CLAIMNUMBERNAME OF WAGE EARNER OR SELF-EMPLOYEDPERSON(If different from claimant .)SPOUSE'S NAME(Complete ONLY in SSI cases)CLAIM FOR(Specify type, , retirement, disability, hospital /medical, SSI, SVB, etc.)SOCIAL SECURITYADMINISTRATIONTOE 710 TELEPHONE NUMBER(Include area code)TELEPHONE NUMBER(Include area code)( ) - ( ) - ODO, BALTIMOREOIO, BALTIMOREPROGRAM SERVICE CENTEROEO, BALTIMOREForm ApprovedOMB No. 0960-0622(Donotwriteinthisspace)SOCIAL SECURITY OFFICE ADDRESSNOTE:Take or mail thesigned originalto your local Social Security office, the Veterans Affairs Regional Office in Manila or Foreign Service post and keep a copy for your claimant INSISTSON FILING1.
SUPPLEMENTAL SECURITY INCOME (SSI) OR SPECIAL VETERANS BENEFITS (SVB) CLAIM NUMBER NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON (If different from claimant.) SPOUSE'S NAME (Complete ONLY in SSI cases)
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