This form is used to establish a date on which a claimant's eligibility for benefit payments is determined (sometimes called the protective filing date). An application must be filed with the Social Security Administration before one can be entitled to Social Security payments or Supplemental Security Income (SSI). A letter, filed with the SSA, may serve as an application if all of the necessary requirements are met.
Subject: Fulton Georgia Letter or Statement to Social Security Administration: Establishing Claimant's Date of Eligibility for Benefits [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] Social Security Administration [Benefit Claims Office Address] [City, State, ZIP Code] Dear Social Security Administration, RE: Fulton Georgia — Letter or Statement to Establish Claimant's Date of Eligibility for Benefits I am writing to provide crucial documentation and information required to establish the date of eligibility for benefits for the individual named below: Claimant’s Full Name: [Claimant's Full Name] Claimant’s Social Security Number: [Claimant's SSN] Claimant's Date of Birth: [Claimant's Date of Birth] I am the authorized representative of the claimant, and attached to this letter, please find the necessary supporting documents as proof of their residency in Fulton, Georgia: 1. Proof of Residency: — Fulton Georgia State Identification Card/Driver's License — Fulton County Property Tax Bill or Rental Agreement — Recent utility bills (e.g., water, gas, or electric) in the claimant's name and address, indicating residency in Fulton County, Georgia — Recent bank statement with Fulton County, Georgia address — Voter registration card issued in Fulton County, Georgia 2. Employment and Income Verification: — Employment contract or letter from the employer indicating the start and end dates of employment in Fulton County, Georgia — Pay stubs or bank statements showing income received while working in Fulton County, Georgia — State income tax forms indicating the claimant's employment in Fulton County, Georgia 3. Medical and Treatment Records: — Medical records from healthcare providers within Fulton County, Georgia — Pharmacy receipts or prescription labels indicating the claimant's residence in Fulton County, Georgia — Prescription history outlining medications prescribed during the relevant period of residency in Fulton County, Georgia 4. School Enrollment or Attendance: — School records or enrollment letters indicating the claimant's education within Fulton County, Georgia — High school or college transcripts showing attendance at educational institutions within Fulton County, Georgia I kindly request that you expedite the review and processing of this information to accurately establish the claimant's date of eligibility for benefits. If further documentation or information is required, please do not hesitate to contact me. I appreciate your time and attention to this matter. Your cooperation and prompt response would greatly assist in ensuring the claimant receives the benefits deserved. Thank you for your assistance. Sincerely, [Your Name] [Your Signature] CC: [Claimant's Full Name] (Claimant) [Additional Authorized Representative, if applicable]Subject: Fulton Georgia Letter or Statement to Social Security Administration: Establishing Claimant's Date of Eligibility for Benefits [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] Social Security Administration [Benefit Claims Office Address] [City, State, ZIP Code] Dear Social Security Administration, RE: Fulton Georgia — Letter or Statement to Establish Claimant's Date of Eligibility for Benefits I am writing to provide crucial documentation and information required to establish the date of eligibility for benefits for the individual named below: Claimant’s Full Name: [Claimant's Full Name] Claimant’s Social Security Number: [Claimant's SSN] Claimant's Date of Birth: [Claimant's Date of Birth] I am the authorized representative of the claimant, and attached to this letter, please find the necessary supporting documents as proof of their residency in Fulton, Georgia: 1. Proof of Residency: — Fulton Georgia State Identification Card/Driver's License — Fulton County Property Tax Bill or Rental Agreement — Recent utility bills (e.g., water, gas, or electric) in the claimant's name and address, indicating residency in Fulton County, Georgia — Recent bank statement with Fulton County, Georgia address — Voter registration card issued in Fulton County, Georgia 2. Employment and Income Verification: — Employment contract or letter from the employer indicating the start and end dates of employment in Fulton County, Georgia — Pay stubs or bank statements showing income received while working in Fulton County, Georgia — State income tax forms indicating the claimant's employment in Fulton County, Georgia 3. Medical and Treatment Records: — Medical records from healthcare providers within Fulton County, Georgia — Pharmacy receipts or prescription labels indicating the claimant's residence in Fulton County, Georgia — Prescription history outlining medications prescribed during the relevant period of residency in Fulton County, Georgia 4. School Enrollment or Attendance: — School records or enrollment letters indicating the claimant's education within Fulton County, Georgia — High school or college transcripts showing attendance at educational institutions within Fulton County, Georgia I kindly request that you expedite the review and processing of this information to accurately establish the claimant's date of eligibility for benefits. If further documentation or information is required, please do not hesitate to contact me. I appreciate your time and attention to this matter. Your cooperation and prompt response would greatly assist in ensuring the claimant receives the benefits deserved. Thank you for your assistance. Sincerely, [Your Name] [Your Signature] CC: [Claimant's Full Name] (Claimant) [Additional Authorized Representative, if applicable]
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.
