Current iAppeals Internet Screens

iAppeals Screens for the final PSA (May 24)

If You Do Not Want To Use This Online
Appeal Process

Other Ways to Request an Appeal or Complete a Disability Report
If you prefer not to complete a Request for Reconsideration or a Disability
Report on the Internet, you can use any of the following ways:
Call our toll-free number, 1-800-772-1213. Explain that you don't
want to use the online appeal process but do want to appeal the
decision made in your case. Representatives are available Monday
through Friday from 7 AM to 7 PM. If you are deaf or hard of
hearing, call our toll-free 'TTY' number, 1-800-325-0778.
Contact your local Social Security Office and tell our representative
that you want to appeal the decision made on your case.
Refer to your denial notice to find out the kind of appeal you need to
request. You can print the form you need from our Forms Page. In
addition to the Request for Reconsideration form, you will need to
print and complete a paper Appeal Disability Report (SSA-3441)
and an Authorization to Disclose Information to SSA (SSA-827).
After you print out and complete all three forms, you should mail or
take them to your local Social Security Office. We will be able to
take action more quickly if we receive all three forms at the same
time.
NOTE: You must have Adobe Reader on your computer to read and print
the forms. If you do not have a current version of Adobe Reader, use this
link to get a free copy of Adobe Reader.
If you live outside the United States, see Service Around the World.

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Last edited 4/6/2007 6:11 PM

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iAppeals Screens for the final PSA (May 24)

Privacy Information

The Social Security Act (sections 205(a), 702, 1631(e)(1)(a) and (b), and
1869(b)(1) and (c), and Public Law 106-169 (Section 809(a)(1) of Sections
251(a)) and Section 1839(i) of the Act (P.L. 108-173) as appropriate)
authorizes the collection of information on this form. We need the
information to continue processing your claim. You do not have to give it,
but if you do not you may not receive benefits under the Social Security
Act. We may give out the information on this form without your written
consent if we need to get more information to decide if you are eligible for
benefits or if a Federal law requires us to do so. Specifically, we may
provide information to another Federal, State, or local government agency
which is deciding your eligibility for a government benefit or program; to
the President or Congressman inquiring on your behalf; to an independent
party who needs statistical information for a research paper or audit report
on a Social Security program; or to the Department of Justice to represent
the Federal Government in a court suit related to a program administered
by the Social Security Administration. We explain, in the Federal Register,
these and other reasons why we may use or give out information about
you. If you would like more information, get in touch with any Social
Security office, the Veterans Affairs Regional Office in Manila, or any U.S.
Foreign Service post.
We may also use the information you give us when we match records by
computer. Matching programs compare our records with those of other
Federal, State, or local government agencies. Many agencies may use
matching programs to find or prove that a person qualifies for benefits paid
by the Federal government. The law allows us to do this even if you do
not agree to it.
Explanations about these and other reasons why information about you
may be used or given out are available in Social Security offices. If you
want to learn more about this, contact any Social Security office, the
Veterans Affairs Regional Office in Manila, or any U.S. Foreign Service
post.

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Last edited 4/6/2007 6:11 PM

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iAppeals Screens for the final PSA (May 24)

Paperwork Reduction Act

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. The OMB Control Number for the
Internet Appeal Disability Report is 0960-0144. The expiration date for this
OMB Control Number is 8/31/2009. We estimate that it will take you an
average of 120 minutes to respond, but total time required will depend upon
the number of questions you need to answer for the Internet Appeal
Disability Report.
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.

If You Have Questions
Call our toll-free number, 1-800-772-1213. If you are deaf or hard of
hearing, call our toll-free 'TTY' number, 1-800-325-0778. Representatives
are available Monday through Friday from 7 AM to 7 PM.

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Last edited 4/13/2007 4:46 PM

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iAppeals Screens for the final PSA (May 24)

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iAppeals Screens for the final PSA (May 24)

Your Right To Representation

You can handle your own Social Security appeal with free help from Social
Security, or you can choose a lawyer, a friend or someone else to help
you. Someone you appoint to help you is called your “representative”.
You cannot choose someone who has been suspended or disqualified
from representing others before the Social Security Administration or who
may not, by law, act as a representative. You may contact your local
Social Security office for a list of legal referral and service organizations.
We will work with your representative, just as we would work with you.
If you want to appoint someone as your representative, you or your
representative must first complete Form SSA-1696 (Appointment of
Representative) or send a written statement naming your representative.
If your representative is not an attorney, he or she must sign the statement
or SSA-1696 or state in writing that he or she accepts the appointment,
before you send it to us.
Your representative cannot charge or collect a fee from you without first
getting written approval from Social Security. However, your
representative may accept money from you in advance as long as it is held
in a trust or escrow account.
Both you and your representative are responsible for providing us with
accurate information. It is illegal to furnish false information knowingly and
willfully. If you do, you may face criminal prosecution.
You can get more information about having a representative by selecting
the link Your Right to Representation.

If You Have Questions
Call our toll-free number, 1-800-772-1213. If you are deaf or hard of
hearing, call our toll-free 'TTY' number, 1-800-325-0778. Representatives
are available Monday through Friday from 7 AM to 7 PM.

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Last edited 5/16/2007 9:31 AM

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iAppeals Screens for the final PSA (May 24)

Who Is The Wage Earner?

The Wage Earner is a person who earns Social Security credits while
working for wages or self-employment income. He or she is sometimes
referred to as the "Number Holder" or "Worker."
If the Claim Number is not your own Social Security Number, then the
Wage Earner is the spouse or parent on whose record you filed for
disability. You should enter his or her name in the space provided.
You may continue without providing this information.

If You Have Questions
Call our toll-free number, 1-800-772-1213. If you are deaf or hard of
hearing, call our toll-free 'TTY' number, 1-800-325-0778. Representatives
are available Monday through Friday from 7 AM to 7 PM.

Close this window to return to the appeal process.
Last edited 5/16/2007 9:31 AM

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iAppeals Screens for the final PSA (May 24)

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About Your Notice and Claim Numbers

Your notice has information that can help you complete the appeal
request.
This example is just to show you where to look. In order to continue, your
notice title should be one of the following:
Notice of Disapproved Claim
Notice of Reconsideration
Notice of Federal Reviewing Official Decision

This is
your
Notice
title.

SOCIAL SECURITY ADMINISTRATION
Retirement, Survivors, and Disability Insurance
Supplement Security Income
Notice of Reconsideration
Date: [Month, Day, Year}
Claim Number: 000-00-0000 A
[Your Name]
[Your Address]

This is your
claim number,
including any
letter(s) at the
end.

You asked us to take another look at your claim for
Social Security disability benefits. Someone who did not
make the first decision reviewed your case, including any
new facts we received, and found that the first decision
was correct.

If You Have Questions
Call our toll-free number, 1-800-772-1213. If you are deaf or hard of
hearing, call our toll-free 'TTY' number, 1-800-325-0778. Representatives
are available Monday through Friday from 7 AM to 7 PM.

Close this window to return to the appeal process.
Last edited 4/6/2007 6:12 PM

iAppeals Screens for the final PSA (May 24)

Name: John Public
SSN: xxx-xx-1234

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You Cannot Use the Internet to
Complete Your Appeal Request

You do not meet one or more of the qualifications to file your request for
appeal using the Internet. To request an appeal, you should contact
Social Security immediately as explained below and tell them that you
received this message.
To contact Social Security:
Call our toll-free number, 1-800-772-1213. Explain that you are unable
to use the online appeal process but do want to appeal the decision
made in your case. If you are deaf or hard of hearing, call our toll-free
"TTY" number, 1-800-325-0778. Representatives are available
Monday through Friday from 7 AM to 7 PM.
Visit your local Social Security Office and tell the representative that
you want to appeal the decision made on your case.
Select the Exit button to leave this report. You will be taken to the Social
Security home page.
Exit

Last edited 5/16/2007 9:32 AM