Current SSA-L2937

SOCIAL SECURITY ADMINISTRATION
Office of Quality Performance

Date:
Applicant Name:
SSN:

The Social Security Administration is conducting a quality review on this account.
The following information is needed for our review for the above named applicant.

We have also included a signed authorization for release of the information and a selfaddressed stamped envelope for your convenience.
We appreciate your assistance with our review. If you have any questions, you may phone
me at my office between 8:00 a.m. and 4:00 p.m., Monday through Friday.
My toll-free telephone number is
Sincerely,

Social Insurance Specialist

Enclosures: Postage-paid envelope
Signed Authorization for Release of Information

Form SSA-L2937 (08-2011)

PAPER REDUCTION ACT NOTICE
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C section 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 number for this
collection is 0960-0066. We estimate that it will take about 15 minutes to read the
instructions, gather the facts, and answer the questions. Send only comments on our
time estimate above to: SSA, 1338 Annex Building, Baltimore, MD 21235-0001.

Form SSA-L2937 (08-2011)