TN 2 (11-06)

NL 00755.330 Good Cause Denial Paragraphs and Notices

NOTE: On April 1, 2009, SSA changed its policy of not paying fleeing felons. Follow the instructions below only for felony warrants with offense codes 4901, 4902, or 4999. Follow the Martinez settlement instructions in GN 02613.860 through GN 02613.885 for all other felony warrant codes.

On March 18, 2011, upon remand from the Second Circuit, the District Court for the Southern District of New York certified a nationwide class in Clark v. Astrue that includes all individuals whose benefits or payments we suspended or denied after October 29, 2006. Given the pending litigation, including continuing litigation about the class certification, at this time we are not suspending or denying payments based solely on a report of a probation or parole violation warrant. Follow the instructions in EM-11032, dated May 9, 2011 for processing cases with probation or parole violation warrants with offense codes: 5011, 5012, 8101, 8102, or 9999 or “Blank” and an offense charge symbol of “probation or parole violation.”

We will make additional changes to this section, as necessary, in the future.

A. Introduction

1. Good Cause Denial--Evidence Presented by Beneficiary to Establish Good Cause is Insufficient/Incomplete for a Mandatory or Discretionary Good Cause Determination

a. Beneficiary Protest Suspension During Due Process Period and Tries to Prove Good Cause

The beneficiary is given an advance notice of proposed suspension that informs the beneficiary about his/her outstanding warrant and instructs the beneficiary what to do to prevent his/her future benefit suspension. The advance notice of proposed suspension instructs the beneficiary to contact SSA within 30 days of receipt of the notice to protest the suspension of future benefits and to also provide SSA with evidence or information to establish good cause for not satisfying his or her warrant.

If the beneficiary contacts SSA during the due process period to protest the future benefit suspension and to also request good cause for not satisfying his or her outstanding warrant, then he or she has 90 days from the date of contacting SSA to provide the necessary good cause evidence or information to SSA to establish claim for good cause.

If the beneficiary does not provide the required evidence as stated in GN 02613.025 to either establish mandatory good cause or discretionary good cause for not satisfying his or her outstanding warrant within the required 90 day timeframe, then good cause will be denied. The SSA technician will input the good cause denial code to the FFEL Warrant Due Process/Good Cause screen per the instructions in GN 02613.025C.6.b., bullet #1. This action will create an automated suspension action and post the good cause denial code. In addition, an automatically generated suspension/overpayment notice will be sent to the beneficiary to explain why benefits will be suspended and to also explain that reason why good cause will not be granted.

In instances where an automated notice cannot be computer generated (e.g., a processing systems exception occurs; an incorrectly generated notice error occurs; or SSA needs to send the final initial determination of fugitive felon/probation or parole violation suspension to the beneficiary (i.e., initial award plus suspension notice that was prepared in accordance with the instructions in NL 00755.100, etc.), a manual suspension/overpayment and good cause denial notice must be sent to the beneficiary. Instructions for preparing a manual suspension and good cause denial notice are found in NL 00755.330.

NOTE: The good cause denial code reasons for not granting good cause are found in GN 02613.930B. and the appropriate manual notice language to explain the good cause denial is found in NL 00755.330B.

b. Beneficiary Contacts SSA to Establish Good Cause After Due Process Period Expires (Beneficiary is in Suspension)

If the beneficiary asks SSA to find the beneficiary had good cause for not satisfying an outstanding warrants, as provided in section 202(x)(1)(B) of the Social Security Act, SSA will issue an initial determination based on the evidence furnished by the beneficiary and contained in the SSA record. Beneficiaries may assert mandatory good cause at any time and discretionary good cause within 12 months of certain events. These initial determinations about good cause are governed by the rules of reopening and administrative finality. (See GN 04001.100 for information on reopenings and changes in rulings or legation interpretations regarding change of position.)

See GN 02613.025B.3.a. for a description of mandatory good cause. See GN 02613.025B.3.b. for a description of discretionary good cause.

The beneficiary can contact SSA to try and establish good cause for not satisfying his/her outstanding warrant after the due process period has expired and the beneficiary is in fugitive felon or probation or parole violator suspension status.

If the beneficiary contacts SSA after the due process period has expired and the beneficiary is in suspension and he or she wants to establish good cause for not satisfying his/her outstanding warrant, then he or she has 90 days from the date of contacting SSA to provide the necessary good cause evidence or information to SSA to establish claim for good cause. SSA will not resume his/her benefits during this 90 day period while the beneficiary is trying to establish good cause.

If the beneficiary does not provide any of the required evidence as stated in GN 02613.025 to either establish mandatory good cause or discretionary good cause for not satisfying his/her outstanding warrant within the required 90 day timeframe, then the beneficiary’s request for trying to establish good cause will be closed-out. See the instructions in NL 00755.330A.3. for sending the close-out letter for a good cause contact request.

If the beneficiary does not provide SSA with the correct evidence to prove good cause or the evidence provided does not fully meet the mandatory or discretionary good cause standards established in GN 02613.025 that will allow SSA to make an initial determination of good cause, then the beneficiary’s request for proving good cause will be denied. The SSA technician will input the good cause denial code to the FFEL Warrant Due Process/Good Cause screen. (See GN 02613.025C.6.b., bullet #3. for instructions on processing a good cause denial action under these circumstances.) An automated POS FFEL suspension action will not be created but the good cause denial code will be annotated to the FFSCF. A manual notice must be sent to the beneficiary to notify him/her of SSA’s good cause denial determination. See NL 00755.330D. for the good cause denial language to be used in the notice.

2. Good Cause Denial Based on Other Factors

There are other additional factors that preclude SSA from granting good cause to a beneficiary when the beneficiary contacts SSA to establish good cause for not satisfying the warrant.

These factors include:

  • a request for discretionary good cause and the beneficiary’s warrant is for a crime that is a violent or drug-related felony crime or probation or parole violation was violent or drug related or the original offense upon which the probation or parole violation was based was violent or drug related, or

  • a request for discretionary good cause and the beneficiary has a subsequent felony crime on which he or she had been convicted or pled guilty.

3. Good Cause Request Close-Out Notice—Beneficiary Did not Provide Evidence of Good Cause to SSA Within 90 Days of Protest

After a beneficiary contacts SSA to request good cause for not satisfying his/her outstanding warrant, the beneficiary has 90 days to provide the good cause evidence or information to SSA.

If at the end of the 90-day period the beneficiary has not submitted any evidence to establish good cause for not satisfying his/her warrant, then the request to establish good cause will be closed-out and SSA will not make an initial good cause determination because the beneficiary did not provide SSA with any evidence to prove good cause.

SSA will send the beneficiary a close-out notice to tell him/her that SSA is closing out his/her request to establish good cause for not satisfying the outstanding warrant. SSA will send this notice after 90 days have elapsed from the date the beneficiary contacted SSA to request good cause.

Because SSA is neither making a new initial determination or reopening or revising an initial suspension determination that would allow payment again if good cause had been established, the notice does not provide the beneficiary reconsideration and hearing information per NL 00601.150B.1. The paragraph and fill-in to use to explain the reason SSA is closing out the request for good cause is located in NL 00755.330A.3. and NL 00755.330C.4. The exhibit notice illustrating the close-out of the request to prove good cause is found in NL 00755.330E.3.

B. Procedure – Good Cause Denial Paragraphs or Good Cause Request Close-Out Paragraph

1. PC/FO--FUG 502-- Fugitive Felon Good Cause Denial Paragraph

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

a. FO Notice Preparation (DPS) Fugitive Felon Good Cause Denial Paragraphs or Good Cause Request Close-Out Paragraph

UTI # on DPS

Description of
Paragraph

Use of Paragraph

FUG502

Fugitive Felon Good Cause Denial Paragraph (Multi-Use Paragraph)

(See NL 00755.900F.2. for the paragraph.)

Use this paragraph when the beneficiary is denied good cause for specific mandatory or discretionary good cause denial code reasons found in GN 02613.930B. Fill-ins for this paragraph are located in NL 00755.330B.1.c.).

FUG050

Fugitive Felon Good Cause Denial Paragraph (Other)

(See NL 00755.900F.3. for the paragraph.)

Use this paragraph when the beneficiary is denied discretionary good cause because of the following reasons:

--the beneficiary’s warrant is for a crime that is violent or drug-related or the probation or parole violation is violent or drug related and/or the original crime on which the probation/parole violation was based was violent or drug-related, or

--the beneficiary had been subsequently convicted or pled guilty to a felony crime, or

--the beneficiary did not contact SSA to provide any good cause evidence to substantiate his/her request for good cause within 90 days. (See NL 00755.330A.3. for additional information explaining this reason for denial.)

Fill-ins for this paragraph are located in NL 00755.330B.2.).

NOTE: This paragraph is currently available to the FOs in DPS. AURORA will be updated in the future with the revised FUG050.

b. AURORA (PC Notice Preparation) Fugitive Felon Denial Paragraph or Good Cause Request Close-Out Paragraph

UTI #

Description of
Paragraph

Use of Paragraph

FUG502

Fugitive Felon Good Cause Denial Paragraph

(See NL 00755.900F.2. for the paragraph.)

Use this paragraph when the beneficiary is denied good cause for specific mandatory or discretionary good cause denial code reasons found in GN 02613.930B. Fill-ins for this paragraph are located in NL 00755.330B.1.c.)

FUG050

Not available for PC Use

This paragraph is not available in Aurora. If a beneficiary’s good cause request is being denied because of the following:

--the beneficiary’s warrant is for a crime that is violent or drug-related or the probation or parole violation is violent or drug related and/or the original crime on which the probation/parole violation was based was violent or drug-related, or

--the beneficiary has been subsequently convicted or pled guilty to a felony crime, or

--the beneficiary did not contact SSA to provide any good cause evidence to substantiate his/her request for good cause within 90 days. (See NL 00755.330A.3. for additional information explaining this reason for denial.)

Refer the case to the FO having jurisdiction over the mailing address on the MBR to prepare the good cause denial notice for the reasons mentioned in NL 00755.330B.1.b., FUG 050 paragraph.

c. PC or FO--Good Cause Denial Paragraph Fill-ins

UTI # on DPS and AURORA

Language for Paragraph or Caption

FUG502

Based on the information __(*F1)__, we __(*F2)__ __(*F3)__ __(*F4)__ __(*F5)__ __(*F6)__ __(*F7)__ because _(*F8)_ __(*F9)__

Fill-Ins:

*F1-1 Pronoun (we have/you have provided us)
*F2-2 cannot (use for good cause denial or suspensions)
*F3-2 grant good cause for not satisfying the outstanding warrant
*F4-1 beginning
*F4-2 for
*F5-1 MM/CCYY
*F6-1 and

*F6-2 through

*F6-1 null

*F7-1 MM/CCYY

*F7-2 null

*F8-1-Pronoun (you were/he was/she was)(your/his/her) (you have/he has/she has) (you are)/he is/she is) (you do not have/he does no have/she does not have)

*F8-2- null

*F9 11 Pronoun (your/his/her) warrant was issued correctly

*F9 12 Pronoun (you were/he was/she was) found guilty of the criminal offense

*F9 13 Pronoun (your/his/her) criminal charges were not dismissed

*F9 14 Pronoun (your/his/her) warrant was not withdrawn

*F9 15 Pronoun (your/his/her) criminal charges were not otherwise cleared

*F9 16 (null) law enforcement is taking action on the warrant

*F9 17 Pronoun (you do not have/he does not have/she does not have) a mental condition impairing the capability to resolve the warrant

*F9 18 Pronoun (you do not have/he does not have/she does not have) a representative payee

*F9 19 Pronoun (you are/he is/she is) not residing in a long-term care facility

*F9 20 Pronoun (you were/he was/she was) incorrectly identified in connection with this warrant.

2. FO—Paragraph FUG050—Good Cause Denial or Good Cause Request Close-Out--Other (Violent/Drug Related Crimes; Subsequent Conviction or Non-responder to Providing Any Evidence of Good Cause)

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

UTI # on DPS

Language for Paragraph or Caption

DPS

FUG050

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/client/beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

*F4 –3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

*F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant.

*F5-1 null

*F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

*F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant.

3. Procedure – SSA Could Not Determine Mandatory or Discretionary Good Cause Based on Evidence Provided by the Beneficiary

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

a. Specific Paragraph FUG502 and FUG 050 fill-ins for good cause denial notices and good cause request close-out notice

a. FUG 502--Good Cause Denied—good cause evidence insufficient for SSA to make a mandatory or discretionary good cause determination

Based on the information __(*F1)__, we __(*F2)__ __(*F3)__ __(*F4)__ __(*F5)__ __(*F6)__ __(*F7)__ because _(*F8)_ __(*F9)__

Fill-ins:

*F1-1 Pronoun (you have provided us)
*F2-2 cannot
*F3-2 grant good cause for not satisfying the outstanding warrant
*F4-1 beginning
*F4-2 for
*F5-1 MM/CCYY
*F6-1 and

*F6-2 through

*F6-1 null

*F7-1 MM/CCYY

*F7-2 null

*F8-2 null

*F9-11 Pronoun (you/his/her) warrant was issued correctly

*F9-12 Pronoun (you were/he was/she was) found guilty of the criminal offense

*F9-13 Pronoun (your/his/her) criminal charges were not dismissed

*F9-14 Pronoun (your/his/her) warrant was not withdrawn

*F9-15 Pronoun(your/his/her) criminal charges were not otherwise cleared

*F9-16 {null} law enforcement is taking action on the warrant

*F9-17 Pronoun (you do not have/he does not have/she does not have) a mental condition impairing the capability to resolve the warrant

*F9-18 Pronoun (you do not have/he does not have/she does not have) a representative payee

*F9-19 Pronoun (you are/he is/she is) not residing in a long-term care facility

*F9-20 Pronoun (you were/he was/she was) incorrectly identified in connection with this warrant

.

b. FUG 050--Good Cause denied—warrant is for a violent or drug related crime or probation or parole violation or previous offense on which probation or parole violation is crime and/or beneficiary had a subsequent conviction

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/client/beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

*F4-3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

*F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was a violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant.

*F5-1 null

*F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

*F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant.

c. FUG 050--Good cause request close-out paragraph—beneficiary did not respond in the 90 day period

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/client/beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

*F4-3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was a violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant.

*F5-1 null

*F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

*F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant.

C. Examples of Good Cause Denial and Good-Cause Request Close-Out Paragraphs

1. Good cause denied—Specific Discretionary Good Cause Denial (Paragraph FUG502)

Our Decision

Based on the information you have provided us, we cannot grant good cause for not satisfying the outstanding warrant beginning 01/2005 because you are not residing in a long-term care facility.

2. Good cause denied—Specific Mandatory Good Cause Denial (Paragraph FUG502)

Our Decision

Based on the information you have provided us, we cannot grant good cause for not satisfying the outstanding warrant beginning 01/2005 because your criminal charges were not dismissed.

3. Good cause denied—Good Cause Denial Other Paragraph (FUG050)—Crime is Violent or Drug Related

Our Decision

We cannot pay benefits to you beginning 03/2005 because you have an outstanding arrest warrant for a violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

4. Good cause close-out paragraph—90 day Non-responder—Good Cause Evidence Not Presented to SSA

Our Decision

We cannot pay benefits to you beginning 04/2005 because you have an outstanding arrest warrant for a violation of probation or parole under Federal or State law and you did not provide evidence to SSA to establish good cause for not satisfying your outstanding warrant.

D. Procedure – Good Cause Denial Paragraphs

The following chart provides the reasons SSA will not grant good cause and the accompanying 3-position good cause denial codes that SSA uses to describe the good-cause denial reasons in an abbreviated format. (See GN 02613.930B. for the 3-position good-cause denial codes and their respective meanings.) The chart also provides the appropriate good cause denial paragraphs and the fill-ins for the paragraphs which should be included in the beneficiary notice

1. PC/FO--FUG502 Mandatory and Discretionary Good Cause Denial Paragraph Fill-ins

Good Cause Denial Reason Code

Good Cause Denial Reasons

Good Cause Denial Paragraph and Fill-In Reason

QNG

Fugitive felon found guilty of criminal offense

FUG502—Use –Fill-in F9-12 Pronoun (you were/he was/she was) found guilty of the criminal offense.

QCD

Charges are not dismissed

FUG502-- Use –Fill-in F9-13 Pronoun (your/his/her) criminal charges were not dismissed.

QWW

Warrant not withdrawn

FUG502-- Use –Fill-in F9-14 Pronoun (your/his/her) warrant was not withdrawn

QCC

Charges not cleared

FUG502-- Use –Fill-in F9-15 Pronoun (your/his/her) criminal charges were not otherwise cleared.

QNP

LEA is taking action on warrant

FUG502-- Use –Fill-in F9-16 law enforcement is taking action on the warrant.

QMC

No mental condition, fugitive felon capable of resolving warrant

FUG502-- Use –Fill-in F9-17 Pronoun (you do not have/he does not have/she does not have) a mental condition impairing the capability to resolve the warrant.

QRP

No rep payee, fugitive felon is capable or competent

FUG502-- Use –Fill-in F9-18 Pronoun (you do not have/he does not have/she does not have) a representative payee.

QNH

Fugitive felon is not residing in a long-term care nursing home or mental treatment/care facility and there is no rep payee

FUG502-- Use –Fill-in F9-19 Pronoun (you are/he is/she is) not residing in a long-term care facility.

2. FO--FUG050 Good Cause Denial Paragraph for Violent/Drug Related Crime, Subsequent Conviction and Non-responder to Provide Good Cause Evidence

NOTE: The good cause denial reason code of “QID” will be used as a multi-use good cause denial code category. QID will also represent several additional good cause denial factors that have not already been established in GN 02613.930B. The additional good cause denial reasons that will now apply to QID are illustrated in the following chart:

Good Cause Denial Reason Code

Good Cause Denial Reasons

Good Cause Denial Paragraph and Fill-In Reason

QID

Warrant issued correctly, no identity theft or other identity issue—Miscellaneous Denial Code—Use this code when no other good cause denial code is found in NL 00755.330D.1. or NL 00755.330D.2.

FUG502—Use fill-in F9-11-- Pronoun (your/his/her) warrant was issued correctly.

QID

Warrant issued correctly, no identity theft or other identity issue—beneficiary has a violent or drug-related felony crime, (or)

Beneficiary has a violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based.

FUG050—Use fill-in F4–3-- violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

(or)

FUG050—Use fill-in F4-4-- violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant

QID

Warrant issued correctly, no identity theft or other identity issue and beneficiary has another felony crime on which he or she has been convicted or pled guilty

FUG050—Use fill-in F5-2--and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

3. FO--FUG050 Good Cause Close-out Paragraph—Beneficiary Did Not Respond or Provide Any Good Cause Evidence

Beneficiary Did Not Provide Good Cause Evidence to SSA in 90-Day Time Period

If the warrant was issued correctly, and there is no identity theft or other identity issue and the beneficiary contacted SSA to establish good cause but he or she did not provide good cause evidence to SSA within the 90 day time period,

Then, use the following paragraph to explain the close-out of the request for good cause.:

FUG050—Use fill-in F5-2--and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

E. Exhibit – Examples of Good Cause Denial Notices

1. Good Cause Denial Notice—Good Cause Denial Reason QNH (Fugitive Felon Is Not Residing In A Long-Term Care Nursing Home or Mental Treatment/Care Facility and There Is No Rep Payee)

Social Security Administration

Retirement, Survivors, and Disability Insurance

Important Information

                                                                            

                                                                            Date:

                                                                            Claim Number: XXX-XX-XXXXA

                

JOHN G. BENEFICIARY

101 MAIN STREET

ANYTOWN, ST 00001

Our Decision

Based on the information you have provided us, we cannot grant good cause for not satisfying the outstanding warrant beginning 01/2005 because you are not residing in a long-term care facility.

Other Social Security Benefits

The benefits described in this letter are the only ones to which you are entitled from Social Security. If you think you might qualify for another kind of Social Security benefit in the future, you will have to file another application.

If You Disagree With The Decision

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision which you believe are wrong and will look at any new facts you have. We may also review those parts which you believe are correct and may make them unfavorable or less favorable to you.

You have 60 days to ask for an appeal.

The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

You must have a good reason for waiting more than 60 days to ask for an appeal.

You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2, called "Request for Reconsideration." Contact one of our offices if you want help.

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your Social Security Claim." It contains more information about the appeal.

If You Want Help With Your Appeal

You can have a friend, lawyer, or someone else can help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your Social Security office has a list of groups that can help you with your appeal. If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

Your Responsibilities

Your benefits are based on the information you gave us. If this information changes, it could affect your benefits. For this reason, it is important that you report changes to us right away.

We have enclosed a pamphlet, “Your Social Security Rights and Responsibilities.” It tells you what you must report and how to report. Please be sure to read the part of the pamphlet which explains how work could changes your payments.

If You Have Any Questions

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 1-610-433-3237. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

SOCIAL SECURITY
41 N 4TH ST
ALLENTOWN, PA 18102

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.  

NOTE: The general referral paragraph and the appropriate signature are also required for the notice. See NL 00601.040 for additional paragraphs required on post-entitlement notices; e.g., overpayment or underpayment paragraphs, etc. See NL 00601.003 for name and signature requirements on notices.

2. Good Cause Denial Notice—Crime is Violent or Drug Related

Social Security Administration

Retirement, Survivors, and Disability Insurance

Important Information

                                                                            

                                                                            Date:

                                                                            Claim Number: XXX-XX-XXXXA

JOHN G. BENEFICIARY

101 MAIN STREET

ANYTOWN, ST 00001

Our Decision

We cannot pay benefits to you beginning 03/2005 because you have an outstanding arrest warrant for a violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

Other Social Security Benefits

The benefits described in this letter are the only ones to which you are entitled from Social Security. If you think you might qualify for another kind of Social Security benefit in the future, you will have to file another application.

If You Disagree With The Decision

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision which you believe are wrong and will look at any new facts you have. We may also review those parts which you believe are correct and may make them unfavorable or less favorable to you.

You have 60 days to ask for an appeal.

The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

You must have a good reason for waiting more than 60 days to ask for an appeal.

You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2, called "Request for Reconsideration." Contact one of our offices if you want help.

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your Social Security Claim." It contains more information about the appeal.

If You Want Help With Your Appeal

You can have a friend, lawyer, or someone else can help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your Social Security office has a list of groups that can help you with your appeal. If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

Your Responsibilities

Your benefits are based on the information you gave us. If this information changes, it could affect your benefits. For this reason, it is important that you report changes to us right away.

We have enclosed a pamphlet, “Your Social Security Rights and Responsibilities.” It tells you what you must report and how to report. Please be sure to read the part of the pamphlet which explains how work could changes your payments.

If You Have Any Questions

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 1-610-433-3237. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

SOCIAL SECURITY
41 N 4TH ST
ALLENTOWN, PA 18102

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.  

NOTE: The general referral paragraph and the appropriate signature are also required for the notice. See NL 00601.040 for additional paragraphs required on post-entitlement notices; e.g., overpayment or underpayment paragraphs, etc. See NL 00601.003 for name and signature requirements on notices.

3. Exhibit - Request for Good Cause Close-Out Notice—Beneficiary Did Not Provide Any Good Cause Evidence Within 90 Days

This notice is sent to the beneficiary to notify him/her that SSA is closing out his/her request to prove good cause for not satisfying his/her outstanding warrant. SSA will send this notice after 90 days has lapsed from the date the beneficiary contacted SSA to state that he or /she wanted to try and prove good cause for not satisfying his/her outstanding warrant.

Social Security Administration

Retirement, Survivors, and Disability Insurance

Important Information

                                                                            

                                                                            Date:

                                                                            Claim Number: XXX-XX-XXXXA

                

JOHN G. BENEFICIARY

101 MAIN STREET

ANYTOWN, ST 00001

Our Decision

We cannot pay benefits to you beginning 04/2005 because you have an outstanding arrest warrant for a violation of probation or parole under Federal or State law and you did not provide evidence to SSA to establish good cause for not satisfying your outstanding warrant.

Other Social Security Benefits

The benefits described in this letter are the only ones to which you are entitled from Social Security. If you think you might qualify for another kind of Social Security benefit in the future, you will have to file another application.

Your Responsibilities

Your benefits are based on the information you gave us. If this information changes, it could affect your benefits. For this reason, it is important that you report changes to us right away.

We have enclosed a pamphlet, “Your Social Security Rights and Responsibilities.” It tells you what you must report and how to report. Please be sure to read the part of the pamphlet which explains how work could changes your payments.

If You Have Any Questions

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 1-610-433-3237. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

SOCIAL SECURITY
41 N 4TH ST
ALLENTOWN, PA 18102

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

NOTE: This notice does not get the reconsideration or appeals level paragraphs per NL 00601.150B.1. and NL 00755.330A.3. The general referral paragraph and the appropriate signature are also required for the notice. See NL 00601.040 for additional paragraphs required on post-entitlement notices; e.g., overpayment or underpayment paragraphs, etc.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900755330
NL 00755.330 - Good Cause Denial Paragraphs and Notices - 05/29/2012
Batch run: 12/04/2012
Rev:05/29/2012