TN 3 (04-12)

A. Guidelines for pre-determination notices to auxiliaries

Provide auxiliaries advance notice of any proposed adverse action before taking action. Contact with the primary beneficiary provides advance notice for all auxiliaries (i.e., family members entitled on the beneficiary’s social security number) who are living with him or her; therefore, we do not require a separate notice for auxiliaries who are living with the beneficiary. If an auxiliary is not living with the beneficiary, take the steps below.

• Send a pre-determination notice to the auxiliary whether the number holder is a title II only or a concurrent title II/title XVI beneficiary.

• Prepare a pre-determination notice to the auxiliary on Disability Determination Service (DDS) letterhead, or the appropriate Social Security Administration blank letterhead.

• Provide due process to the auxiliary, even if he or she is in suspense. Delete the information about “receipt of benefits” and “benefits being paid” if the auxiliary is not in pay status.

• Prepare and release auxiliary notices at the same time you send a pre-determination notice to the primary beneficiary. Obtain the address for the auxiliaries from the official claims folder (the field office should provide the DDS relevant auxiliary information). Follow the model language in DI 28080.020B.

• Retain a copy of all auxiliary notices in the official claims file.

NOTE: Only one notice is necessary for each auxiliary.

B. Pre-determination notice sample language to auxiliaries

We are writing to you about the benefits you are receiving on the record of (name of primary beneficiary).

We reviewed (name of primary beneficiary’s ) record to see if (he or she) is still eligible for Social Security disability insurance benefits. Based on the information we have, we plan to decide that (he or she) can do substantial gainful activity starting in (date). We will stop all benefits on that record starting (date).

What You Should Do

Please write to us within 10 days if you have more information that you want us to consider. You can write to us at this address: DDS Name, Street, City and State, Zip Code.”

If We Do Not Hear From You

If we do not hear from you within 10 days, we will make our decision about your disability benefits based on the information we have. We will end you another letter when we make our final decision.

If You Have Any Questions

Insert contact information including telephone number.