TN 46 (09-05)

Document Identifier for Word Processor: E3954

EXHIBIT LETTER

We are writing about the reinstated disability benefits you have been receiving.

(Mandatory Choice 1 of 3 (If SGA occurred during IRP but has since ceased))

Earlier, we wrote to let you know that your benefits could be affected because the information we have shows you were doing substantial gainful work. We are now writing to tell you that we will not pay you reinstated disability benefits for the month(s) of __(1)__. This is because we have decided that you were performing substantial gainful work during those months. You will be paid reinstated benefits beginning with the month of __(2)__ because you stopped doing substantial gainful work

Fill-ins

(1) mm/yyyy, mm/yyyy and mm/yyyy, mm/yyyy through mm/yyyy (choice)

(2) mm/yyyy (custom)

(Mandatory Choice 2 of 3 (If SGA occurred during IRP and has not ceased))

Earlier, we wrote to let you know that your benefits could be affected because the information we have shows you have been doing substantial gainful work. We are now writing to tell you that we will not pay you reinstated disability benefits __(1)__. This is because we have decided that you are performing substantial gainful work.

If you stop doing substantial gainful work, your monthly payments based on disability can be started again without a new application. Contact any Social Security office right away if this happens.

Fill-ins

(1) mm/yyyy, mm/yyyy and mm/yyyy, mm/yyyy and later (choice)

(Mandatory Choice 3 of 3 (If benefits were previously suspended during IRP due to SGA and SGA has now ceased))

Your reinstated disability benefits were stopped because you were working. Your disability benefits can be started again because you are no longer doing substantial gainful work. Your benefit checks will start beginning the month of __(1)__. They can continue as long as you have a disabling medical condition and do not perform substantial gainful work.

Fill-ins

(1) mm/yyyy (custom)

INFORMATION ABOUT MEDICARE

(Mandatory Choice 1 of 2 (Medicare Notice when benefits are suspended during IRP))

If __(1)__ __(2)___ Medicare, __(3)___ coverage will continue after ___(4)___ __(5)___ ___(6)___last monthly payment. If __(7)__ __(8)___ supplementary medical insurance (Medicare “Part B”), ___(9)___ will be billed for ___(10)___ medical insurance premiums every 3 months. Please pay the premiums promptly to avoid losing coverage. If ___(11)___ no longer __(12)___ this coverage, please let us know right away. {HIB116}

Fill-ins

(1) you/beneficiary’s full name

(2) have/has

(3) your/his/her

(4) you/he/she

(5) receive/receives

(6) your/his/her

(7) you/he/she

(8) have/has

(9) you/he/she

(10) your/his/her

(11) you/he/she

(12) want/wants

(Mandatory Choice 2 of 2 (Medicare Notice when IRP payments are resumed))

If you have Medicare and are disabled, that protection continues without change except that if you were billed every 3 months for your insurance premiums they will now be deducted monthly from your check beginning with the month of __(1)__. {DIB038}

Fill-ins

(1) mm/yyyy (custom)

IF YOU RETURN TO WORK

Generally, we consider work to be substantial and gainful if the monthly earnings are over __(1)__ per month (for the year __(2)___.) In deciding whether your work is substantial and gainful, we consider how much you actually earn, the nature of your job duties, the skills and experience you need to do the job, and expenses related to your disability. If you are self-employed, we may give more consideration to the kind and value of your work, including your part in the management of the business, than to your actual income alone.

As long as your medical condition(s) still meets our definition of a disabling impairment(s), we can pay reinstated benefits for each month your work is not substantial and gainful until you have been eligible for 24 months of payable benefits. Benefits will not be payable for a month in which your work is substantial and gainful, if that month occurs during the 24 month initial reinstatement period. These 24 payable months do not have to be in a row. Even if you are not receiving payments because of work, your Medicare coverage will continue.

At the end of these 24 months, you may be eligible for additional work incentives, such as a trial work period, and another extended period of eligibility for Medicare. Please see the enclosed pamphlet, “Working While Disabled,” for more information about work incentives.

Fill-ins

(1) Custom

(2) Custom- yyyy

Optional Paragraph (Notice of completed IRP months)

You have had __(1)__ payable months of your 24-month initial reinstatement benefit period. You were eligible for payable benefits in the following month(s): __(2)__.

Fill-ins

(1) Custom

Custom-mm/yyy

YOUR REPORTING RESPONSIBILITIES

You must tell us right away about any changes that may affect your benefits. You should tell us if:

• You change your mailing address;

• You return to work or you increase your work hours;

• Your doctor says your condition has improved;

• You plan to leave the United States for 30 days or more;

• You have been convicted of a criminal offense; or

• You marry and your benefits have been reinstated as either a disabled widow/widower or a disabled adult child.

IF YOU DISAGREE WITH THE DECISION

If you disagree with the decision, you have the right to appeal. We will review your case again and consider any new facts you have. A person who did not make the first decision will decide your case.

• You have 60 days to ask for an appeal.

• The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

• You must have a good reason if you wait more than 60 days to ask for an appeal.

• You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2, called "Request for Reconsideration." Contact one of our offices if you want help.

     

Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your Social Security Claim." It contains more information about the appeal.

IF YOU WANT HELP WITH YOUR APPEAL

You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it. And if you hire a lawyer, we will withhold up to 25 percent of any past due benefits to pay toward the fee.

IF YOU HAVE ANY QUESTIONS

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at __(1)__ . We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

__ (2) __

__ (3) __

__ (4) __

__ (5) __

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment.

This will help us serve you more quickly when you arrive at the office.

Fill-ins

(1) Field Office phone number

(2) First line of Field Office address

(3) Second line of Field Office address

(4) Third line of Field Office address

(5) Fourth line of Field Office address

(6) Fifth line of Field Office address

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

                                                                                                                   Regional Commissioner

Enclosure(s)

__(1)__

Fill-ins

(1) Publication Number of Enclosure