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Blank SSA SSA-561-U2 Form

The SSA-561-U2 form is a request for reconsideration used by individuals who disagree with a decision made by the Social Security Administration (SSA) regarding their benefits. This form allows claimants to appeal the SSA's determination and seek a review of their case. Understanding how to properly complete and submit this form is crucial for anyone looking to challenge an SSA decision.

Outline

The SSA SSA-561-U2 form plays a crucial role for individuals who wish to appeal a decision made by the Social Security Administration (SSA) regarding their disability benefits. This form is specifically designed for those who have received a notice of denial for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). By completing the SSA-561-U2, individuals can formally request a reconsideration of the SSA's decision. The form requires personal information, details about the decision being appealed, and any additional evidence or documentation that may support the claim. It is essential to submit the SSA-561-U2 within the designated timeframe to ensure that the appeal is considered. Understanding the importance of this form can significantly impact one's ability to secure the benefits they may rightfully deserve.

Sample - SSA SSA-561-U2 Form

Form SSA-561 (08-2025) UF		Page 1 of 3
Discontinue Prior Editions		Page 1 of 3
		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	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 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

Page 2 of 3

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

Page 3 of 3

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.

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Form Information

Fact Name	Details
Purpose	The SSA-561-U2 form is used to request a reconsideration of a Social Security Administration (SSA) decision regarding disability benefits or other claims.
Eligibility	Individuals who disagree with an SSA decision can file this form. This includes those denied for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
Filing Deadline	Applicants must submit the SSA-561-U2 within 60 days of receiving the SSA's notice of the decision they wish to appeal.
Where to Submit	The completed form can be submitted online, by mail, or in person at a local SSA office.
State-Specific Forms	Some states may have additional forms or requirements. For example, California follows the California Code of Regulations Title 20, Section 5100.
Outcome	After reviewing the SSA-561-U2, the SSA will issue a new decision, which can either uphold or reverse the previous decision.

Detailed Guide for Filling Out SSA SSA-561-U2

After obtaining the SSA-561-U2 form, it is essential to fill it out accurately to ensure that your request is processed smoothly. This form is used for appealing a decision made by the Social Security Administration. Completing it correctly can help facilitate the next steps in your appeal process.

Begin by entering your personal information at the top of the form. This includes your name, Social Security number, and contact information.
Provide the date of the decision you are appealing. This is usually found in the notice you received from the Social Security Administration.
In the next section, explain why you disagree with the decision. Be clear and concise, focusing on specific points that support your appeal.
If you have any additional information or evidence that supports your case, list it in the designated section. Include any relevant documents or statements.
Sign and date the form at the bottom. Your signature indicates that the information you provided is accurate to the best of your knowledge.
Make a copy of the completed form for your records before submitting it.
Mail the form to the address specified in the instructions. Ensure it is sent to the correct location to avoid delays.

Obtain Answers on SSA SSA-561-U2

What is the SSA SSA-561-U2 form?

The SSA SSA-561-U2 form is a request for reconsideration for individuals who disagree with the Social Security Administration's (SSA) decision regarding their benefits. This form allows individuals to formally appeal a decision, such as the denial of Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. By submitting this form, individuals can provide additional information and evidence to support their claim.
Who should use the SSA SSA-561-U2 form?

This form is intended for individuals who have received a notice from the SSA regarding an unfavorable decision on their benefits. If you believe that the decision was incorrect or if new evidence has come to light that could change the outcome, you should consider using this form to initiate the reconsideration process.
How do I complete the SSA SSA-561-U2 form?

Completing the SSA SSA-561-U2 form involves several steps:
- Provide your personal information, including your name, Social Security number, and contact details.
- Clearly state the decision you are appealing and the reasons for your disagreement.
- Attach any supporting documents that may help strengthen your case, such as medical records or other relevant evidence.
- Sign and date the form before submitting it to the SSA.
Where do I send the completed SSA SSA-561-U2 form?

Once you have completed the form, it should be sent to the address specified in the notice you received from the SSA regarding the decision you are appealing. If you are unsure of where to send it, you can also check the SSA's official website or contact their office for guidance.
What happens after I submit the SSA SSA-561-U2 form?

After submitting the form, the SSA will review your request for reconsideration. This process may take several weeks. You will receive a notice informing you of the decision made on your appeal. If the decision remains unfavorable, you may have additional options to appeal further, such as requesting a hearing before an administrative law judge.
Is there a deadline for submitting the SSA SSA-561-U2 form?

Yes, there is a deadline for submitting the SSA SSA-561-U2 form. Generally, you must file your request for reconsideration within 60 days from the date you received the notice of the decision you are appealing. It is important to adhere to this timeline to ensure that your appeal is considered.

Common mistakes

Filling out the SSA-561-U2 form can be a critical step in the process of appealing a Social Security Administration (SSA) decision. However, many individuals make common mistakes that can hinder their appeal. Understanding these pitfalls can help ensure that your application is processed smoothly.

One frequent error is incomplete information. Applicants often overlook sections of the form, leaving questions unanswered. Each part of the form is designed to gather specific information that supports your case. Missing details can delay processing or even lead to a denial of your appeal.

Another mistake is providing inaccurate personal information. It's essential to double-check your name, Social Security number, and other identifying details. Errors in this information can cause confusion and may complicate the review process, leading to unnecessary delays.

Some individuals fail to include supporting documentation that is crucial to their appeal. The SSA-561-U2 form requests various pieces of evidence to substantiate your claim. Without this documentation, your appeal may lack the necessary support, which can result in a negative outcome.

Additionally, many applicants neglect to sign and date the form. A signature is a vital component of any legal document. Without it, the SSA may consider your application incomplete, which can stall the entire process.

Another common oversight is not reviewing the form thoroughly before submission. Taking a moment to read through your answers can help identify mistakes or inconsistencies. This simple step can save you time and frustration later on.

Lastly, some people underestimate the importance of timeliness. There are strict deadlines for filing appeals. Delaying the submission of your SSA-561-U2 form can result in the loss of your right to appeal. It is crucial to be aware of these timelines and act promptly.

By being mindful of these common mistakes, you can improve your chances of a successful appeal. Taking the time to fill out the SSA-561-U2 form carefully will benefit you in the long run.

Documents used along the form

The SSA SSA-561-U2 form is essential for individuals seeking reconsideration of a Social Security Administration (SSA) decision. Along with this form, several other documents and forms may be required to support your case. Below is a list of commonly used forms and documents that can help streamline the process.

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 from your healthcare providers.
SSA-3368: The Adult Function Report helps the SSA understand how your condition affects your daily activities and overall functioning.
SSA-3373: The Work History Report provides details about your past employment, including job duties and the duration of each position held.
SSA-8000: This form is used to apply for Supplemental Security Income (SSI). It collects information about your financial situation and living arrangements.
SSA-16: The Application for Disability Insurance Benefits is used to apply for Social Security Disability Insurance (SSDI) and includes personal and work history information.
SSA-45: This form is a Request for Reconsideration that can be used for various types of appeals, not just disability-related issues.
Medical Records: These documents provide evidence of your medical condition and treatment history, which are crucial for supporting your appeal.
Personal Statement: A written statement detailing your condition and how it impacts your daily life can strengthen your case.
Tax Returns: Providing copies of your tax returns can help verify your income and financial situation, especially for SSI applications.
Letters from Employers: Documentation from past employers can verify your work history and the impact of your condition on your job performance.

Gathering these forms and documents can significantly enhance your chances of a successful appeal. Ensure that you provide accurate and complete information to the SSA to support your case effectively.

Similar forms

The SSA-561-U2 form is a request for reconsideration of a decision made by the Social Security Administration (SSA) regarding benefits. It is essential to understand that there are other documents that serve similar purposes within the SSA framework. Here are six forms that share similarities with the SSA-561-U2:

SSA-3441: This form is used to provide information about a disability claim. Like the SSA-561-U2, it seeks to gather relevant details to support a claim or reconsideration.
SSA-827: This is a medical release form. It allows the SSA to obtain medical records. Similar to the SSA-561-U2, it is often necessary for reconsideration processes to ensure all relevant medical information is considered.
SSA-501: The Request for Reconsideration form is another document that directly parallels the SSA-561-U2. It is specifically designed for appealing decisions regarding benefits and requires similar information.
SSA-16: This application for disability benefits is related to the SSA-561-U2 in that it initiates a claim. Both forms are part of the process of securing benefits from the SSA.
SSA-21: The Work History Report collects information about an applicant’s work history. This form is often used in conjunction with the SSA-561-U2 to provide context for a reconsideration appeal.
SSA-833: This form is used for a determination of disability. It is similar to the SSA-561-U2 in that it is part of the evaluation process for disability claims, often influencing the outcome of a reconsideration request.

Dos and Don'ts

When filling out the SSA SSA-561-U2 form, it's important to follow certain guidelines to ensure your application is processed smoothly. Here are some things you should and shouldn't do:

Do read the instructions carefully before starting.
Don't leave any required fields blank.
Do provide accurate and complete information.
Don't use abbreviations or slang in your responses.
Do double-check your entries for spelling and accuracy.
Don't submit the form without reviewing it first.
Do keep a copy of the completed form for your records.
Don't forget to sign and date the form before submission.
Do follow up if you don’t receive a response in a timely manner.

By adhering to these guidelines, you can help ensure that your SSA-561-U2 form is filled out correctly and submitted successfully.

Misconceptions

The SSA-561-U2 form, commonly associated with Social Security Administration (SSA) appeals, is often misunderstood. Here are four misconceptions that frequently arise regarding this important document:

Misconception 1: The SSA-561-U2 form is only for those who have been denied Social Security benefits.

While many individuals use the SSA-561-U2 to appeal a denial, it is also applicable for those seeking to challenge other decisions made by the SSA, such as reductions in benefits or changes in eligibility criteria.

Misconception 2: Completing the SSA-561-U2 guarantees a favorable outcome.

Submitting the form does not ensure that the SSA will reverse its decision. The form initiates the appeal process, but the outcome depends on the merits of the case and the evidence presented.

Misconception 3: The SSA-561-U2 must be submitted in person at a local SSA office.

In fact, the SSA allows for the SSA-561-U2 to be submitted online, by mail, or in person. This flexibility can make the process more convenient for individuals navigating their appeals.

Misconception 4: The SSA-561-U2 is a lengthy and complicated form.

While the form requires specific information, it is designed to be straightforward. Clear instructions accompany the form, helping individuals provide the necessary details without excessive complexity.

Key takeaways

Filling out the SSA SSA-561-U2 form can be a crucial step in appealing a decision made by the Social Security Administration (SSA). Here are some key takeaways to keep in mind:

The SSA-561-U2 form is used to request reconsideration of a decision made by the SSA regarding benefits.
Ensure that you fill out the form completely and accurately to avoid delays in processing.
Include all relevant information and documentation to support your appeal.
Be mindful of deadlines; you typically have 60 days from the date you receive the decision to file your appeal.
Provide a clear explanation of why you believe the decision should be changed.
Keep a copy of the completed form and any supporting documents for your records.
Submit the form to the appropriate SSA office as indicated in the instructions.
Consider seeking assistance from a representative or attorney if you feel overwhelmed by the process.
Stay organized by tracking your submission and any correspondence from the SSA.
Be patient; the reconsideration process may take several weeks or longer, depending on the complexity of your case.

By following these guidelines, you can navigate the appeal process more effectively and increase your chances of a favorable outcome.