TN 30 (03-96)

Document Identifier for Word Processor: E3569

A. Exhibit letter

It has been determined that (1) is under a disability within the meaning of the disability insurance provisions of the Social Security Act. Therefore, benefit payments will be continued.

The claim will be reviewed from time to time to see if (2) is still eligible for benefits based on disability or blindness. When the claim is reviewed, you will be contacted if there is any question as to whether (3) eligibility continues.

3567A
 OR
3567B

Read the enclosed instructions for important information and events which affect the payments 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

CTDO - Domestic

3901D - Foreign

Enclosure:
SSA Pub. No. 05-10153

B. Requesting instructions

This notice is used in the same situation as Exhibit NL 00703.568, except that the child has a representative payee.

• Fill-ins:

  1. name of the child

  2. he or she

  3. name of the child

• Use 3567A when a medical exam is not being scheduled.

• Use 3567B when a medical reexam is being scheduled.

• Refer to NL 00703.567 for 3567A and 3567B text and fill-ins.

• Refer to NL 00703.005E for CTDO and 3901D text and fill-ins.

• Refer to NL 00703.180 for 3180A and 3180B text.

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.