Use Form SSA-1021 to appeal SSA’s determinations regarding eligibility or continuing eligibility for a Medicare Part D subsidy. Please return your completed appeal form, including the signature page, and any additional information to: Social Security Administration Wilkes-Barre Data P.O. Box 1030 Wilkes-Barre, PA 18767-1030. Section 1860 D-14 of the Social Security Act authorizes the collection of information requested on this form. The information you provide will be used to enable the Social Security Administration to determine if you are eligible for help paying your share of the cost of a Medicare Prescription Drug Plan. You do not have to give us the information requested. However, if you do not provide the information, we will be unable to make an accurate and timely decision on your appeal. |