BASIC (11-81)

A. Sample form

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B. Purpose/Use

This notice is used, in disability cases, where a parent has filed a certificate of support. It advises the parent that he or she did not meet the support requirement at the time the period of disability began.

C. Preparation of form

The claims authorizer will indicate the notice and appropriate fill-ins on Form SSA-559. Prepare two form notices—one for the claimant and one for the servicing district office.

Fill-ins:

• (1) “son” or “daughter” or “husband” and the name of the wage earner

  (2) “his” or “her”