Fillable Request for Reconsideration ( SSA - 561 ) - Social Security - ssa
SOCIAL SECURITY ADMINISTRATION
Form Approved OMB No. 0960-0622
REQUEST FOR RECONSIDERATION
NAME OF CLAIMANT NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON (If different from claimant.)
(Do not write in this space)
CLAIMANT CLAIM NUMBER (if different from SSN)
SUPPLEMENTAL SECURITY INCOME (SSI) OR SPECIAL VETERANS BENEFITS (SVB) CLAIM NUMBER
SPOUSE'S NAME (Complete ONLY...
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