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NL: Notices, Letters and Paragraphs

Effective Dates: 06/18/2013 - Present

BASIC (11-81)

A. Sample form

G-NL_00701.520A

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B. Preparation of form

This form notice and the appropriate fill-ins will be designated on Form SSA-573.

Refer to the latest Form SSA-3925-C1 or Form SSA-833-U5 in file for completing the name, address and claim number.

This notice requires three fill-ins:

  1. month and year disability ceased

  2. last month and year benefits due

  3. last month and year of HI/SMI entitlement

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