TN 13 (06-09)

Use the appropriate blank letterhead.

Add a third line heading:

IMPORTANT INFORMATION

4040 Lead-in modified

We recently looked at (1) case again to see if we should revise our decision. We carefully reviewed all of the information, including any additional information we may have received. Based on our rules, we find that we cannot revise our decision.

Fill-in:

(1) your/claimant’s name (possessive)

Explain the reason for not reopening and revising.

Do not provide any appeal paragraph or language (GN 04001.090D, SI 04070.050B.2).

If You Have Any Questions

If you have any questions, please call us toll free at 1-800-772-1213, or call your local Social Security office at [FO phone number from DOORS]. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:

Fill-in:

                 [Field Office Address

                 City, State, ZIP] per DOORS

If you do call or visit an office, please have this letter with you. It will help us answer your questions.