the Serrano Law Firm

Attorney at Law

800 856-6400

 

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Please Mail Form To:

Serrano Law Firm

690 Flatbush Ave.

West Hartford, CT  06110-1308

or Fax Form To:

860 523-9101

 

AUTHORIZATION TO REVIEW SOCIAL SECURITY FILE

 
Today's Date
Name
Social Security Number
Number, Street and Apartment
City, State, Zip Code
Telephone Number(s)

    I authorize the Serrano Law Firm, or its designated agent, to review my Social Security Disability and / or Supplemental Security Income file(s).

    I understand I am not hiring the Serrano Law Firm to represent me at this time.  I understand that I am still the person responsible for handling my case, including filing any appeals.

 

Signed:  _________________________________________________