the Serrano Law Firm

Attorney at Law

800 856-6400

Print and Sign

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

    I authorize the Serrano Law Firm, or their designated agent, to review my child's Supplemental Security Income file.

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

 

Signed:  _________________________________________________