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SOCIAL SECURITY ADMINISTRATIONForm Approved
OMB No. 09600622TOE 710(Do not write in this space)REQUEST FOR RECONSIDERATION
NAME OF CLAIMANTCLAIMANT CLAIM NUMBER
(if different from SSN)CLAIMANT SURNAME
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What is my reasons are?
Your reasons are your explanation or justification for a particular action or decision.
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The individual or organization who made the decision or took the action is required to file the reasons.
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