Attachment 2

(DRAFT)
LOCAL DISTRICT LETTERHEAD

	Date:
	Case Number:
	Case Name:

(Address of Local Social Security Office)
_____________________________

_____________________________

_____________________________	

Dear Social Security Administration:

Pursuant to New York State law and regulation, all applicants and legally responsible relatives must provide 

or apply for a Social Security Number for receipt of New York State Safety Net Assistance.  (Social Services 

Law § 134-a; 18 N.Y.C.R.R. § 370.2(c)(3))  

Please assign a Social Security Number to ___________________________________________________ 
                                                                                    (Alien/Immigrant's Name)                (Date of Birth)                      (Sex (M/F)) 

as the applicant has met all the eligibility requirements for Safety Net Assistance, except for the possession 

of a Social Security Number.

If you have any questions regarding this request, you may contact _________________________________

at ____________________________________________________________________________________.	

Sincerely,

___________________________________
(Name)

___________________________________
(Title)