Senior Benefits Appeal Template

USE THIS TO REQUEST RECONSIDERATION / APPEAL A SENIORS-BENEFITS DECISION

This template covers the two routes:

• Federal (OAS, GIS, CPP Disability): reconsideration with Service Canada, then appeal to the Social Security Tribunal of Canada (SST).
• Ontario GAINS: objection to the Ontario Ministry of Finance.

⏱️ DEADLINES ARE SHORT — 90 days from the decision date. Do not wait.

📋 INSTRUCTIONS:

1. Fill in all [BRACKETS] with your information.
2. Delete the route that does not apply to you.
3. Attach the decision letter and any medical/income evidence.
4. Keep a copy and proof of when you sent it (registered mail / MSCA confirmation).

PART A — YOUR DETAILS

Full legal name: [Your name] SIN (last 3 digits only if by mail): [--___] Date of birth: [YYYY-MM-DD] Address: [Street, City, Province, Postal Code] Phone: [Phone] Email: [Email] Benefit affected: [OAS / GIS / CPP Disability / GAINS] Date of decision you are appealing: [YYYY-MM-DD] Decision reference / claim number: [Number]

PART B — FEDERAL ROUTE (OAS, GIS, CPP Disability)

Step 1 — Reconsideration with Service Canada

Send this within 90 days of the decision. Use form ISP-3134 (OAS/GIS) or ISP-1145 (CPP Disability), or attach this letter.

TO: Service Canada — Reconsideration FROM: [Your name], [address]

I respectfully request reconsideration of the decision dated [decision date] concerning my [OAS / GIS / CPP Disability] claim/entitlement (reference [number]).

Why I disagree: [Explain in plain language. e.g., “I have lived in Canada for 30 years since age 18 and meet the residency requirement,” or “My doctor’s report shows my condition prevents substantially all work.”]

Evidence I am providing:

• [Medical report from Dr. __ dated __]
• [Proof of residence — e.g., tax returns / immigration records]
• [Income information — e.g., T1, T4]

I ask that the decision be reversed and full benefits paid from the date I became entitled.

Signature: ______ **Date:** ______

Step 2 — Appeal to the Social Security Tribunal of Canada (if reconsideration refuses)

If Service Canada upholds the refusal, you have 90 days from that decision to appeal to the SST General Division. File online at sst-tss.gc.ca or by mail.

TO: Social Security Tribunal of Canada — General Division FROM: [Your name], [address]

I appeal the reconsideration decision dated [date] about my [benefit]. I disagree because [summary of your argument and evidence]. I request a hearing and ask the Tribunal to allow my claim.

PART C — ONTARIO GAINS ROUTE

File a Notice of Objection within 90 days of the mailed decision. Call 1-866-668-8297 first.

TO: Ministry of Finance c/o Director, Advisory, Objections, Appeals and Services Branch 33 King Street West, P.O. Box 699, Station A Oshawa, Ontario L1H 8S6

FROM: [Your name], [address]

I object to the GAINS decision dated [date] (reference [number]). I disagree because [e.g., “My private income is below the $4,416 limit and I receive OAS and GIS”].

Evidence:

• [OAS/GIS statement]
• [2025 income tax return / GIS application]

I ask that the decision be reversed.

Signature: ______ **Date:** ______

Sources & deadlines (verified 2026-10-07)

• OAS/GIS reconsideration form ISP-3134; CPP-D form ISP-1145; SST: sst-tss.gc.ca
• GAINS objection: ontario.ca/GAINS · Ministry of Finance 1-866-668-8297
• Full guide: Seniors Benefits guide

Not legal advice. Confirm current forms and deadlines with the source before filing.