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.

Form SSA-561-U2 (9-2007) ef (9-2007) Title II Title VIII (See VB 02501.035) ADMINISTRATIVE ACTIONS THAT ARE INITIAL DETERMINATIONS (See GN03101.070, GN03101.080, and SI04010.010)

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