TN 11 (03-04)

Social Security Administration

Supplemental Security Income

Important Information 

Date:

Claim Number: XXX-99-XXXXDC 

Jane Doe for

John Smith

Street Address

City ST ZIP 

IMPORTANT INFORMATION

PLEASE READ ALL OF THIS LETTER CAREFULLY 

Earlier we wrote to tell you that we would review John Smith's disability case to decide if he is still disabled. Now, we are writing to tell you that he is still disabled under our rules. He will continue to receive Supplemental Security Income (SSI) payments if he meets all the other requirements. Also, if he is getting medical assistance based on SSI, his coverage should continue. 

We Will Review John Smith's Case Again 

We must review the cases of children who receive SSI based on disability to decide if they are still disabled. Our rules require us to review, at least once every three years, the cases of children whose health we think may improve. We may also review their cases at other times, even if we do not think that their health may improve. 

The doctors and other trained staff who decided that John Smith is still disabled expect his health to improve. Therefore, we will review his case again in (Month/Year).  

***[NOTE: Do NOT use the following treatment language if the child is his/her own payee.] 

When we review John Smith's case again, we may ask you to show proof that he is and has been receiving treatment that is medically necessary and available for his condition. Before we ask for this proof, we will consider the nature of his condition. 

See Next Page 

XXX-99-XXXXDC Page 2 of 3 

If you do not show proof of treatment when we ask you, and you do not have a good reason why he is not receiving treatment, we may stop making payments to you and select another payee for him if it is in his best interests. 

We will send you a letter before we start the review. We will tell you then what information we need. We will help you get any information you do not have. 

Things To Remember 

The decisions we made on John Smith's case are based on information we have now.

If this information changes, it could affect his SSI. For this reason, it is important that you report changes right away. Be sure to tell us about any of the following changes: 

• His doctor says his health is better.

• He marries.

• He moves, or anyone else moves from or into his house.

• There is a change in income or resources for him or members of the house.

• He stops or starts going to school regularly.

• He goes to work. 

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 receive 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 Form SSA-561-U2, called “Request for Reconsideration.” Contact one of our offices if you want help. 

     

How the Appeal Works  

You have the right to review the facts in your case. You can give us more facts to add to your file. Then we will decide your case again. You will not meet the person who will decide your case.   

See Next Page  

XXX-99-XXXXDC Page 3 of 3 

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.  

If You Have Any Questions  

If you have any questions you may call us toll-free at 1-800-772-1213, or call your local Social Security office at [FO phone number from TRIDE]. 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:  

[Field Office Address

City, ST, ZIP]  

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

(Signature)

Regional Commissioner