NL: Notices, Letters and Paragraphs
TN 23 (12-17)
DIBC01 Caption
The Date You Became Disabled
DIBC02 Caption
The Basis For Our Decision
DIBC03 Caption
Our Decision
DIB001 5 Month Waiting Period – Month of Entitlement
To qualify for disability benefits, (1) must be disabled for five full calendar months in a row. The first month (2) entitled to benefits is (3) .
Fill-ins:
(1) “you”/“FN”
(2) “you are”/“he is”/“she is”
(3) date of entitlement to disability
DIB002 Lead-in Language for Closed Period and Later Onset Date Allowance
We recently told you that (1) met the medical requirements to receive Social Security benefits. Now we are writing to tell you that (2) (3) the other requirements. Therefore, (4) (5) for (6) beginning (7) .
Fill-ins:
(1) “you”/FN
(2) “you”/“she”/“he”
(3) “meet”/“meets”
(4) “you”/“she”/“he”
(5) “qualify”/“qualifies”
(6) “period of disability”/“monthly disability benefits from Social Security”
(7) date of entitlement to disability
DIB003 DIB/DWB/CDB Closed Period
We determined that (1) disability ended (2) . The first month that we could pay (3) benefits was (4) . We could pay (5) through the month (6) disability ended and the next two months. This means that the last month for which (7) entitled to benefits was (8) .
Fill-ins:
(1) FN possessive/”her”/”his”/”your”
(2) effective date (Date beneficiary went into T8/T6 LAF status in the format “Month YYYY”)
(3) ”her”/“him”/“you”
(4) date of entitlement in the format “Month YYYY)
(5) ”her”/“him”/“you”
(6) “her”/“his”/“your”
(7) “she was”/“he was”/“you were”
(8) effective date (Date beneficiary went into T8/T6 LAF status - 3 months in the format “Month YYYY”)
DIB004 State Agency and Medical Doctor Participation in Decision
Doctors and other trained personnel made the disability decision for us. They work for (1) State but used our rules to make their decision.
Fill-in:
(1) “your”/FN possessive
DIB005 Medical Doctor Participation in Non-State Decision
Our doctors and other trained personnel made the disability decision in (1) case.
Fill-in:
(1) “your”/FN possessive
DIB006 Benefits Payable up to 12 Months before DIB Filing Date
By law, we can pay benefits no earlier than 12 months before the month of filing. Since (1) filed for benefits on (2) , monthly payments will begin (3) .
Fill-ins:
(1) “you”/FN in format “Mr. Jack Jones”
(2) DOF in format “January 10, 1993”
(3) DOEC in format “April 1994”
DIB014 Benefits Terminated – DIB Cessation
The last month for which (1) (2) entitled to benefits was (3) .
Fill-ins:
(1) Number holder's name, possessive/your
(2) family was/wife was/husband was/child was/children were
(3) effective date minus one month in format April 1997
DIB015
The trained staff who decided this case work for the state but used our rules.