TN 10 (12-17)

“This is to notify you that it appears a determination will have to be made that you do not meet the disability requirements of the law. You may not be entitled to benefits based on your present application. Therefore, we may have to revise the previous determination continuing benefits based on disability.”

“You were initially found disabled because of      . Our records now show that this condition is based on an impairment connected with the commission of a felony after October 19, 1980, for which you have subsequently been convicted.

The law does not allow us to consider this impairment in determining if you are disabled. This exclusion includes an impairment that arose during the commission of a felony.”

“This exclusion also includes the aggravation of impairment if the aggravation occurred during the felony. The law does not allow us to consider these impairments in determining whether you are disabled. Where the jurisdiction does not classify a crime as a felony, we apply these provisions to a crime as though the crime was committed in the nature of a felony.”

“When a combination of impairments is the basis for disability, we must give an explanation as to why the remaining impairment(s) does not meet the definition of disability.” (Note: do not use this paragraph when we base disability solely on a felony-related impairment).

“We are giving you the opportunity to request a disability hearing and to present additional statements or evidence that you want to be considered before a decision is made. If you want to request a disability hearing or submit statements or additional evidence, please complete the attached Form SSA-789 “Request For Reconsideration - Disability Cessation - Right to Appear,” and send it to us within 10 days from receipt of this notice. The enclosed envelope, which requires no postage, may be used to return the form and any additional material.”

“If you do not contact us within 10 days from the receipt of this notice, a formal decision concerning your entitlement to benefits based on disability will be made. If we reverse the continuance to a cessation of benefits, your benefit payments will be stopped. If you want a disability hearing but need more time to submit a statement or additional evidence, it is important that you let us know that you need more time within the next 10 days.”