If you disagree with any of your statements, you should contact us within 10 days after the date of this notice to let us know.
Review the reporting responsibilities so you are aware of the changes or events that you need to report to us.
Provide the additional information that is listed below under "What We Need".Penalty of Perjury
You declared under penalty of perjury that you examined all the information on this form and it is true and correct to the best of your knowledge. You were told that you could be liable under law for providing false information.
We need the item(s) listed below to decide if you can receive benefits. We must see the original document(s) or a certified copy of the item(s) from the custodian of the original record(s). We cannot accept photocopies except for tax returns. We will return the item(s) to you.
Please bring or mail these items to us right away. The sooner we receive the item(s), the sooner we can decide if you are eligible.
Birth Certificate or religious record of age
Marriage Certification
Divorce or annulment Decree
Proof of death
Proof of tax/wage withholding
Evidence-citizenship/residence status
Proof needed with disability claim
Bank name, account number, and routing number for direct deposit
Request for pay stubs
Request for self-employment records
Request for workers’compensation award letter
SSA-827 Authorization
OTHER
OTHER
OTHER
OTHER
OTHER
If You Have Any Questions
If you have any questions, you should call, write or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for . The telephone number is shown above. We can answer most questions over the phone. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.
Enclosure (s):
Application Summary
Envelope
NL 00722.160 - T2 Application Cover Letter With Attestation Summary - 02/21/2007
Batch run: 02/21/2007
Rev: 02/21/2007
This website is produced and published at U.S. taxpayer expense.