A. Sample form

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B. Purpose/Use

This notice corresponds to NL 00703.556. It is used to notify the number holder or CDB, directly, of the suspension of benefits and the reason for the investigation.

C. Preparation of form

Information for this notice will be shown on Form SSA-573. The name and address, if not given, can be taken from the latest Form SSA-3926-C2 in file.

The benefit authorizer will indicate on Form SSA-573 one of the following reasons by either writing it out or identifying the reason by letter.

Coded Reason for Suspension:

1. we received notice that you have returned to work

2. we have received notice that your condition has improved

3. we have been unable to locate you

4. we have not received the information requested