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Content Overview

The SSA-561-U2 form is an essential document for individuals seeking to appeal a decision made by the Social Security Administration (SSA) regarding their benefits. This form serves as a formal request for reconsideration, allowing applicants to present their case and provide additional evidence that may support their claim. Completing the SSA-561-U2 accurately is crucial, as it initiates the appeals process and ensures that the SSA reviews the decision thoroughly. Individuals must include pertinent details about their original claim, the reasons for their disagreement, and any new information that could influence the outcome. Timeliness is key; the appeal must be filed within a specified period following the initial decision. Understanding the requirements and implications of the SSA-561-U2 form can significantly impact the chances of a successful appeal, making it imperative for applicants to approach this process with care and attention to detail.

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Form SSA-561 (08-2025) UF

 

Page 1 of 3

Discontinue Prior Editions

 

 

 

OMB No. 0960-0622

Social Security Administration

REQUEST FOR RECONSIDERATION

NAME OF CLAIMANT:

CLAIMANT SSN:

CLAIM NUMBER: (If different than SSN)

ISSUE BEING APPEALED: (Specify if retirement, disability, hospital or medical, SSI, SVB, overpayment, etc.) I do not agree with the Social Security Administration's (SSA) determination and request reconsideration.

My reasons are:

CONTACT INFORMATION

CLAIMANT SIGNATURE - OPTIONAL:

 

NAME OF CLAIMANT'S REPRESENTATIVE: (If any)

 

 

 

 

 

 

MAILING ADDRESS:

 

 

MAILING ADDRESS:

 

 

 

 

 

 

 

 

 

CITY:

STATE:

ZIP CODE:

CITY:

STATE:

ZIP CODE:

 

 

 

 

 

 

TELEPHONE NUMBER:

DATE:

 

TELEPHONE NUMBER:

DATE:

 

(Include area code)

 

 

(Include area code)

 

 

 

SUPPLEMENTAL SECURITY INCOME (SSI) OR SPECIAL VETERANS BENEFITS (SVB)

RECONSIDERATION ONLY

THREE WAYS TO APPEAL

I want to appeal your determination about my claim for SSI or SVB. I have read about the three ways to appeal. I have checked the box below:

CASE REVIEW - You can pick this kind of appeal in all cases. You can give us more facts to add to your file. Then we will decide your case again. You do not meet with the person who decides your case.

INFORMAL CONFERENCE - You can pick this kind of appeal in all SSI cases except for medical issues. In SVB cases, you can pick this kind of appeal only if we are stopping or lowering your SVB payment. You will meet with a person who will decide your case. You can tell that person why you think you are right. You can give us more facts to help prove you are right. You can bring other people to help explain your case.

FORMAL CONFERENCE - You can pick this kind of appeal only if we are stopping or lowering your SSI or SVB payment. This meeting is like an informal conference, but we can also get people to come in and help prove you are right. We can do this even if they do not want to help you. You can question these people at your meeting.

TO BE COMPLETED BY SOCIAL SECURITY ADMINISTRATION

1. HAS INITIAL DETERMINATION

Yes

No

FIELD OFFICE DEVELOPMENT (GN 03102.300)

BEEN MADE?

 

 

NO FURTHER DEVELOPMENT REQUIRED

2. IS THIS REQUEST FILED TIMELY?

Yes

No

REQUIRED DEVELOPMENT ATTACHED

(If "NO", attach claimant's explanation for delay.

 

 

REQUIRED DEVELOPMENT PENDING, WILL

Refer to GN 03101.020)

 

 

FORWARD OR ADVISE STATUS WITHIN 30 DAYS

SOCIAL SECURITY OFFICE ADDRESS AND DATE

 

SSI CASES ONLY - GOLDBERG KELLY (GK)

APPEAL RECEIVED:

 

 

(SI 02301.310) RECIPIENT APPEALED AN ADVERSE

 

 

 

ACTION:

 

 

 

WITHIN 10 DAYS AFTER RECEIVING THE

 

 

 

ADVANCE NOTICE;

 

 

 

AFTER THE 10-DAY PERIOD AND GOOD CAUSE

 

 

 

EXISTS FOR EXTENDING THE TIME LIMIT

 

 

 

PAYMENT CONTINUATION APPLIES AND INPUT

 

 

 

MADE TO SYSTEM

NOTE: Take or mail the completed original to your local Social Security office, the Veterans Affairs Regional Office in Manila, or any U.S. Foreign Service post and keep a copy for your records.

Form SSA-561 (08-2025) UF

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ADMINISTRATIVE ACTIONS THAT ARE INITIAL DETERMINATIONS

(See GN03101.070, GN03101.080, and SI04010.010)

NOTE: These lists cover the vast majority of administrative actions that are initial determinations. However, they are not all inclusive.

Title II

1.Entitlement or continuing entitlement to benefits;

2.Reentitlement to benefits;

3.The amount of benefit;

4.A recomputation of benefit;

5.A reduction in disability benefits because benefits under a worker's compensation law were also received;

6.A deduction from benefits on account of work;

7.A deduction from disability benefits because of claimant's refusal to accept rehabilitation services;

8.Termination of benefits;

9.Penalty deductions imposed because of failure to report certain events;

10.Any overpayment or underpayment of benefits;

11.Whether an overpayment of benefits must be repaid;

12.How an underpayment of benefits due a deceased person will be paid;

13.The establishment or termination of a period of disability;

14.A revision of an earnings record;

15.Whether the payment of benefits will be made, on the claimant's behalf to a representative payee, unless the claimant is under age 18 or legally incompetent;

16.Who will act as the payee if we determine that representative payment will be made;

17.An offset of benefits because the claimant previously received Supplemental Security Income payments for the same period;

18.Whether completion of or continuation for a specified period of time in an appropriate vocational rehabilitation program will significantly increase the likelihood that the claimant will not have to return to the disability benefit rolls and thus, whether the claimant's benefits may be continued even though the claimant is not disabled;

19.Nonpayment of benefits because of claimant's confinement for more than 30 continuous days in a jail, prison, or other correctional institution for conviction of a criminal offense;

20.Nonpayment of benefits because of claimant's confinement for more than 30 continuous days in a mental health institution or other medical facility because a court found the individual was not guilty for reason of insanity; a court found that he/she was incompetent to stand trial or was unable to stand trial for some other similar mental defect; or, a court found that he/she was sexually dangerous.

Title XVI

1.Eligibility for, or the amount of, Supplemental Security Income benefits;

2.Suspension, reduction, or termination of Supplemental Security Income benefits;

3.Whether an overpayment of benefits must be repaid;

4.Whether payments will be made, on claimant's behalf to a representative payee, unless the claimant is under age 18, legally incompetent, or determined to be a drug addict or alcoholic;

5.Who will act as payee if we determine that representative payment will be made;

6.Imposing penalties for failing to report important information;

7.Drug addiction or alcoholism;

8.Whether claimant is eligible for special SSI cash benefits;

9.Whether claimant is eligible for special SSI eligibility status;

10.Claimant's disability; and

11.Whether completion of or continuation for a specified period of time in an appropriate vocational rehabilitation program will significantly increase the likelihood that claimant will not have to return to the disability benefit rolls and thus, whether claimant's benefits may be continued even though he or she is not disabled.

NOTE: Every redetermination which gives an individual the right of further review constitutes an initial determination.

Title VIII (See VB 02501.035)

1.Meeting or failing to meet the qualifying and/or entitlement factors for special veterans benefits (SVB);

2.Reduction, suspension or termination of SVB payments;

3.Applicability of a disqualifying event prior to SVB entitlement;

4.Administrative actions in SVB cases similar to those listed under Title II-items 3, 4, 10, 11 & 16.

Title XVIII

1.Entitlement to hospital insurance benefits and to enrollment for supplementary medical insurance benefits;

2.Disallowance (including denial of application for HIB and denial of application for enrollment for SMIB);

3.Termination of benefits (including termination of entitlement to HI and SMI).

4.Initial determinations regarding Medicare Part B income-related premium subsidy reductions.

Form SSA-561 (08-2025) UF

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HOW TO APPEAL YOUR SUPPLEMENTAL SECURITY INCOME (SSI)

OR SPECIAL VETERANS BENEFIT (SVB) DECISION

Now that you picked the kind of appeal that fits your case, fill out this form or we'll help you fill it out. You can have a lawyer, friend, or someone else help you with your appeal. There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you the names of these groups.

NOTE: DON'T FILL OUT THIS FORM IF WE SAID WE'LL STOP YOUR DISABILITY CHECK FOR MEDICAL REASONS OR BECAUSE YOU'RE NO LONGER BLIND. WE'LL GIVE YOU THE RIGHT FORM (SSA-789) FOR YOUR APPEAL.

The information on this form is authorized by regulation (20 CFR 404.907 - 404.921 and 416.1407 - 416.1421) and Public Law 106-169 (section 809(a)(1) of section 251(a)). While your response to these questions is voluntary, the Social Security Administration cannot reconsider the decision on this claim unless the information is furnished.

Privacy Act Statement

Collection and Use of Personal Information

Sections 205, 702(a)(5), 809, 1631, 1633, and 1869(b) of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from re-evaluating the decision on your claim.

We will use the information to determine your eligibility for benefits and administer our programs. We may also share your information for the following purposes, called routine uses:

•To third party contacts in situations where the party to be contacted has, or is expected to have, information relating to the individual’s capability to manage his/her affairs or his/her eligibility for or entitlement to benefits under the Social Security program; and

•To the Center for Medicare & Medicaid Services (CMS), for the purpose of administering Medicare Part A, Part B, Medicare Advantage Part C, and Medicare Part D, including but not limited to: Medicare Part C enrollment and premium collection processes; Part D enrollment and premium collection processes; Medicare Part B premium reduction based on participation in a Part C plan; and Medicare Part B enrollment and income-related monthly adjustment amount determinations, appeals of determinations, and premium collections.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.

A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN) 60-0089, entitled Claims Folder System, as published in the Federal Register (FR) on April 1, 2003, at 68 FR 15784 and 60-0321, entitled Medicare Database File, as published in the FR on July 25, 2006, at 71 FR 42159. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy/.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 8 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA’s website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to

our time estimate to this address, not the completed form.

➤ PDF File

Form Specifications

Fact Name Details
Purpose The SSA-561-U2 form is used to appeal a Social Security Administration (SSA) decision regarding disability benefits or other entitlement determinations.
Eligibility Anyone who disagrees with an SSA decision can file this appeal, provided they do so within the specified time frame.
Filing Deadline The appeal must be filed within 60 days of receiving the notice of the decision you wish to appeal.
Submission Methods The form can be submitted online, by mail, or in person at a local SSA office.
Required Information Applicants must provide personal information, details about the decision being appealed, and any supporting documents.
State-Specific Forms Some states may have additional requirements or forms; for example, California follows the California Code of Regulations Title 20.
Legal Representation Individuals have the right to seek assistance from legal representatives or advocates during the appeals process.

SSA SSA-561-U2: Usage Guidelines

After completing the SSA-561-U2 form, you will submit it to the Social Security Administration (SSA) for review. The SSA will evaluate your request and notify you of their decision. Be sure to keep a copy of your completed form for your records.

  1. Obtain the SSA-561-U2 form. You can download it from the SSA website or request a paper form by calling your local SSA office.
  2. Start with the personal information section. Fill in your name, Social Security number, and date of birth accurately.
  3. Provide your contact information. Include your current address, phone number, and email address if applicable.
  4. In the section regarding the reason for your appeal, clearly state why you disagree with the SSA's decision. Be concise and specific.
  5. If applicable, include any additional information or evidence that supports your appeal. This may include medical records or other relevant documents.
  6. Review the completed form carefully. Check for any errors or missing information.
  7. Sign and date the form. Ensure that you are the one submitting the appeal.
  8. Make a copy of the completed form for your records before sending it.
  9. Submit the form to the appropriate SSA office. You can do this by mail or, in some cases, electronically.

Your Questions, Answered

What is the SSA SSA-561-U2 form used for?

The SSA SSA-561-U2 form is used to request a reconsideration of a decision made by the Social Security Administration (SSA). This form is typically submitted when an individual disagrees with the SSA's determination regarding their eligibility for Social Security benefits, such as disability or retirement benefits. By completing this form, individuals can formally ask the SSA to review their case and reconsider the initial decision.

Who should fill out the SSA SSA-561-U2 form?

The form should be filled out by individuals who have received a notice from the SSA regarding a decision they wish to contest. This includes those who have been denied benefits or have had their benefits reduced or terminated. It is important that the individual or their authorized representative completes the form accurately to ensure that the request for reconsideration is processed smoothly.

How do I submit the SSA SSA-561-U2 form?

The completed SSA SSA-561-U2 form can be submitted in several ways. Individuals can mail the form to their local Social Security office. Alternatively, the form may also be submitted online through the SSA's website, depending on the specific circumstances. It is advisable to keep a copy of the completed form for personal records. Ensure that the form is submitted within the specified time frame outlined in the SSA's notice.

What information do I need to provide on the SSA SSA-561-U2 form?

When filling out the SSA SSA-561-U2 form, individuals will need to provide personal information, including their name, Social Security number, and contact information. Additionally, it is essential to explain the reasons for the request for reconsideration clearly. Supporting documentation, such as medical records or other relevant information, may also be included to strengthen the case.

What happens after I submit the SSA SSA-561-U2 form?

After submission, the SSA will review the request for reconsideration. This process may take several weeks. During this time, the SSA may reach out for additional information or clarification. Once a decision is made, the individual will receive a notice in the mail explaining the outcome. If the reconsideration is denied, further appeals may be available, and individuals will be informed of their options in the notice.

Common mistakes

  1. Incomplete Information: Many individuals fail to provide all required information on the SSA-561-U2 form. Missing details can delay the review process or lead to a denial of the request.

  2. Incorrect Personal Information: Errors in personal details such as name, Social Security number, or date of birth can create confusion. It’s crucial to double-check this information before submission.

  3. Failure to Sign: Some people neglect to sign the form. A signature is essential as it confirms that the information provided is accurate and that the individual is requesting a reconsideration.

  4. Not Providing Sufficient Evidence: Supportive documentation is vital. Many applicants do not include enough evidence to back their claims, which can result in a lack of credibility for their case.

  5. Ignoring Deadlines: Each request has specific deadlines. Some individuals submit their forms late, which can lead to automatic denials. Staying aware of these timelines is essential.

  6. Not Keeping Copies: Failing to keep a copy of the completed form can be a mistake. Having a record is important for future reference and for tracking the status of the request.

Documents used along the form

The SSA SSA-561-U2 form is used to request reconsideration of a decision made by the Social Security Administration (SSA) regarding benefits. When filing this form, individuals may need to provide additional documentation to support their request. Below is a list of other forms and documents that are often used alongside the SSA SSA-561-U2 form.

  • SSA-827: This is the Authorization to Disclose Information to the Social Security Administration. It allows the SSA to obtain medical records and other relevant information needed to process a claim.
  • SSA-3368: The Adult Disability Report is a form that provides detailed information about a person's medical condition, work history, and daily activities. It is essential for evaluating disability claims.
  • SSA-8000: This is the Application for a Social Security Card. If a person needs to update or obtain a new Social Security card, this form is necessary.
  • SSA-501: This is the Request for Reconsideration form. It is specifically used to appeal a decision made on an initial claim for benefits.
  • SSA-827: The Authorization to Disclose Information is crucial for allowing the SSA to collect medical and other records that support the reconsideration request.
  • Form 1099: This form reports income received from Social Security benefits. It can be useful for verifying income when appealing a decision.
  • Medical Records: Documentation from healthcare providers detailing the medical condition of the applicant. These records are vital in supporting a claim for benefits.
  • Work History Report: A document outlining the applicant's employment history, including job duties and earnings. This helps establish work-related eligibility for benefits.
  • Personal Statement: A written account from the applicant explaining their situation and reasons for the reconsideration request. This can provide context and support for the appeal.
  • Power of Attorney: If someone is assisting the applicant, this document grants them the authority to act on the applicant's behalf during the reconsideration process.

Using these forms and documents can strengthen a reconsideration request. Each piece of information contributes to a clearer picture of the applicant's situation, helping the SSA make a more informed decision.

Similar forms

  • SSA-3441: This form is used to appeal a decision regarding Social Security disability benefits. Like the SSA-561-U2, it allows individuals to request a reconsideration of a prior decision.
  • SSA-827: The Authorization to Disclose Information to the Social Security Administration form permits the SSA to obtain medical records. It is similar in that it supports the appeal process by gathering necessary information.
  • SSA-501: The Request for Reconsideration form is used to appeal a decision made by the SSA. It is directly related to the SSA-561-U2, which also serves to challenge previous determinations.
  • SSA-16: This form is for applying for Social Security Disability Insurance (SSDI). It shares similarities with the SSA-561-U2 in that both are essential for individuals navigating the SSA's decision-making process.
  • SSA-827: This is the Authorization to Disclose Information form. It is similar to the SSA-561-U2 as it allows individuals to provide necessary information to support their claims.
  • SSA-7050: The Request for Earnings and Benefit Statement form helps individuals obtain their earnings records. This document can be used in conjunction with the SSA-561-U2 to clarify employment history during an appeal.

Dos and Don'ts

When filling out the SSA SSA-561-U2 form, attention to detail is crucial. Here’s a list of dos and don’ts to ensure your application is processed smoothly:

  • Do read the instructions carefully before starting the form.
  • Do provide accurate and complete information to avoid delays.
  • Do sign and date the form where required.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank unless instructed.
  • Don't use correction fluid or tape on the form.
  • Don't submit the form without reviewing it for errors.
  • Don't forget to check the submission deadline for your appeal.

Misconceptions

The SSA-561-U2 form, also known as the Request for Reconsideration, is an important document for individuals seeking to appeal a decision made by the Social Security Administration (SSA). However, several misconceptions surround this form. Here are four common misunderstandings:

  • It can only be used for denied claims. Many people believe that the SSA-561-U2 is only applicable if their initial claim for benefits was denied. In reality, this form can also be used to appeal decisions regarding the amount of benefits or other changes to existing benefits.
  • Filing the form guarantees a favorable outcome. Some individuals think that simply submitting the SSA-561-U2 will automatically lead to a reversal of the SSA's decision. However, the reconsideration process involves a thorough review, and there is no guarantee of success.
  • There is no deadline for submitting the form. A common misconception is that there is an open-ended timeframe for filing the SSA-561-U2. In fact, you typically have 60 days from the date you receive the notice of the decision you are appealing to submit the form.
  • Supporting documents are not necessary. Some people assume that the SSA-561-U2 can be submitted without any additional information. It is crucial to include any relevant documents or evidence that support your case to strengthen your appeal.

Understanding these misconceptions can help you navigate the appeals process more effectively and increase your chances of a successful outcome.

Key takeaways

The SSA-561-U2 form is an important document for individuals seeking to appeal a decision made by the Social Security Administration (SSA). Here are five key takeaways about filling out and using this form:

  • The SSA-561-U2 form is specifically designed for individuals who want to appeal a decision regarding their Social Security benefits.
  • Completing the form accurately and thoroughly is crucial. Any missing information can delay the appeal process.
  • It is important to submit the form within the designated time frame, typically 60 days from the date you receive the decision notice.
  • Individuals can provide additional evidence or documentation to support their appeal, which can strengthen their case.
  • After submitting the SSA-561-U2 form, applicants will receive a confirmation from the SSA, which is essential for tracking the status of the appeal.