Onestops.info

About us | Contact us | Press | Site Map

Home : Customized Employment : Benefits planning and counseling :

Dealing with Social Security

Tips for One-Stop Customers and Staff

The following is a Sample form letter to obtain benefit information from social security. It is suggested that this be mailed to the local office along with a self-addressed stamped envelope.

Date: ___________________

Dear Social Security Representative:

The Any County or Town One-Stop Career Center is providing employment services for the individual listed below. We are requesting that you provide us with the following information concerning the benefits for this individual. Attached is an authorization for release of the information from the individual and payee.

Please complete and return in the enclosed addressed and stamped envelope. Thank you for your cooperation.

Carlos Smith
Employment Counselor Any County or Town One-Stop Career Center
(617) 555-1234

Beneficiary's Name:

Address:

Social Security #:

Under which program is this beneficiary currently receiving benefits?

______ Social Security Disability Insurance (SSDI) ---- Monthly Benefit Amt. $ _____
______ Supplemental Security Insurance (SSI) -------- Monthly Benefit Amt. $ _____

Form Completed By: _________________________ Date: ________________
Title: ___________________________ Office: ____________________
_________________________________________________________

AUTHORIZATION FOR RELEASE OF INFORMATION

I give permission for the Social Security Administration to disclose to Any County or Town One-Stop Career Center the information listed above.

Beneficiary's Name:
SS#:

Beneficiary's
Signature: _______________________________ Date: ___________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Payee's Name:

Payee's
Signature: _________________________________________ Date: ___________

Written by:

Institute for Community Inclusion

Printable version

Rate Article