Ssa form 1021 2011-2025

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4 out of 5

41 votes

The document is an appeal form (SSA-1021) for individuals seeking Extra Help with Medicare Prescription Drug Plan costs. It collects personal information from the applicant, including names, Social Security numbers, and reasons for disagreement with a prior decision. The form also inquires about additional supporting information, the desire for a hearing, and any special requirements such as needing an interpreter. It includes instructions for submission to the Social Security Administration and outlines privacy considerations regarding the use of provided information.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (180 Votes)
2018	4.3 Satisfied (114 Votes)
2014	4.4 Satisfied (59 Votes)
2011	4 Satisfied (41 Votes)
2009	4.4 Satisfied (45 Votes)

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