NL: Notices, Letters and Paragraphs
TN 30 (03-96)
Document Identifier for Word Processor: E3566
A. Exhibit letter
It has been determined that you are under a disability within the meaning of the disability insurance provisions of the Social Security Act.
You are entitled to a monthly benefit of $ (1) , beginning with the month of (2) . Your next payment in the amount of $ (3) , represents payment for the month(s) of (4) . You wll receive this payment (5) .
Your claim will be reviewed from time to time to see if you are still eligible for benefits based on disability or blindness. When your claim is reviewed, you will be contacted if there is any question as to whether your eligibility continues.
| 3566A | If you go to work while you are still disabled, you may be entitled to a trial work period to test your ability to work. During this period you may work in as many as 9 months (which need not be consecutive) and still receive your disability benefit payments no matter how high your earnings. After the trial work period has ended, we will consider the work you did in determining whether you have shown by your work activity that your disability ended. However, you are not entitled to a trial work period if: |
| You are entitled to a period of disability but not to disability cash benefits; or | |
| You are receiving benefits in a second period of disability for which you did not have to complete a waiting period. | |
| RESPONSIBILITIES OF PEOPLE RECEIVING DISABILITY BENEFITS | |
| To prevent any incorrect payments, please notify us promptly if: | |
| You have already gone to work when you receive this notice; or | |
| You go to work in the future, regardless of how much you earn. | |
| Other events you need to report are listed in the enclosed booklet entitled, “When You Get Social Security Disability Benefits...What You Need To Know.” | |
| OR 3566B |
Since your condition may improve, we have scheduled a review for (1) . At that time, you will be contacted if there is any question as to whether your condition remains severe. Also, a review of your claim may be necessary if you go to work. If we do get in touch with you, we may ask you to give us more information or to take a medical examination. If we find you are still disabled, your benefits will continue. But, if the evidence obtained shows you are no longer disabled, your benefits will be stopped. |
| RESPONSIBILITIES OF PEOPLE RECEIVING DISABILITY BENEFITS | |
| To prevent any incorrect payments please notify us promptly if: | |
| You have already gone to work when you receive this notice, or you go to work (regardless of how much you earn), or your doctor advises you that your condition has improved and that you are able to work. | |
| Other events you need to report are listed in the enclosed booklet entitled “When You Get Social Security Disability Benefits...What You Need To Know.” |
Read the enclosed instructions for important information and events which affect the payment of these benefits. You must notify the Social Security Administration promptly when any one of these events occurs.
If You Disagree With The Decision
ALS020
If You Have Any Questions
3901C - Domestic
3901D - Foreign
Enclosure:
SSA Pub. No. 05-10153
B. Requesting instructions
Use this notice when a child, previously terminated at age 18, has a disability established reinstating benefit payments effective the month of attainment of age 18 and the child is his/her own payee.
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Paragraph 3566A will be requested if a medical reexam is not being scheduled. Paragraph 3566B will be requested if a medical reexam is being scheduled. Use 3180A for domestic cases. Use 3180B for foreign cases. Refer to NL 00703.180 for 3180A and 3180B text. Use 3901C for domestic cases. Use 3901D for foreign cases. Refer to NL 00703.005E. for 3901C and D text.
Fill-ins:
the monthly benefit amount
the month the child attained age 18
the amount of the next check
the inclusive months for which payment is being made in the next check
the words “shortly after” followed by the date of the next check
C. Typing instructions
Information for this letter will be shown on Form SSA-573. The name and address, if not given, can be taken from the latest Form SSA-3926-EP in file.
Paragraph 3566B
date reexam has been scheduled.