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NL 00701: Form Notices

Effective Dates: 06/10/2013 - Present

A. DIB denials

Situation/Usage Form Notice POMS Section
Disability Denial DIB Miscellaneous Fill-In Letter SSA-L237 NL 00701.066
Death Before End of 5 Month Waiting Period SSA-L237B NL 00701.069

B. CDB denials

Situation/Heading Form Notice POMS Section
Not Disabled Before Age 22 SSA-L236 NL 00701.060
CDB Not Disabled through Point of Decision—Not Yet Age 22 SSA-L236A NL 00701.063

C. Disability continuance

Situation/Usage From Notices POMS Section
DIB Continuance—Title II SSA-L1013 NL 00701.425
DIB Continuance—Title XVI SSA-L1014 NL 00701.430

D. Chart for selecting disability cessation notices

Cessation Paragraphs Usage/Situation Applicable Form Notice Section
T20 &T28 No DIB overpayment or underpayment No HI/SMI involvement. SSA-L1021 NL 00701.460
  Same as SSA-L1021 except auxiliaries in W/E's household. SSA-L1026 NL 00701.485
  No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. SSA-L1022 NL 00701.465
  Same as SSA-L1022 except auxiliaries in W/E's household. SSA-L1027 NL 00701.490
  No DIB overpayment or underpayment HI/SMI involved. SMI premium to be refunded. SSA-L1023 NL 00701.470
  Same as SSA-L1023 except auxiliaries in W/E's household. SSA-L1028 NL 00701.495
  DIB underpayment and HI/SMI involvement with a SMI premium arrearage. SSA-L1024 NL 00701.475
  No DIB overpayment or underpayment HI/SMI involvement with no premium coverage or arrearage. SSA-L1025 NL 00701.480
  Same as SSA-L1025 except auxiliaries in W/E's household. SSA-L1030 NL 00701.505
  DIB cessation—DIB U/P SMI Premium Arrearage Auxiliaries in NH's Household. SSA-L1029 NL 00701.500
T21 No DIB overpayment or underpayment No HI/SMI involvement. SSA-L1016 NL 00701.435
  No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. SSA-L1017 NL 00701.440
  No DIB overpayment or underpayment HI/SMI involved. SMI premium to be refunded. SSA-L1018 NL 00701.445
  DIB underpayment and HI/SMI involved with a SMI premium arrearage. SSA-L1019 NL 00701.450
  No DIB overpayment or underpayment HI/SMI involvement with no premium coverage or arrearage. SSA-L1020 NL 00701.455
T22 Same as SSA-L1031 except auxiliaries in W/E's household. SSA-L1036 NL 00701.535
  No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. SSA-L1032 NL 00701.515
  Same as SSA-L1032 except auxiliaries in W/E's household. SSA-L1037 NL 00701.540
  No DIB overpayment or underpayment HI/SMI involved. SMI premiums to be refunded. SSA-L1033 NL 00701.520
  Same as SSA-L1033 except auxiliaries in W/E's household. SSA-L1038 NL 00701.545
  DIB underpayment and HI/SMI involvement with a SMI premium arrearage. SSA-L1034 NL 00701.525
  Same as SSA-L1034 except auxiliaries in W/E's household. SSA-L1039 NL 00701.550
  No DIB overpayment or underpayment HI/SMI involved with no premium coverage or arrearage. SSA-L1035 NL 00701.530
  Same as SSA-L1035 except auxiliaries in W/E's household. SSA-L1040 NL 00701.555

E. Miscellaneous disability form notices

Situation/Usage Form Notice POMS Section
Disability Suspension Notice (Miscellaneous) SSA-L467 NL 00701.126
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NL 007: Letters and Paragraphs for Title II, Title XVI, and Title XVIII
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