TN 13 (06-09)

4147 modified

We are writing to you about your Social Security benefits. We recently looked at (1) disability claim again to make sure our decision was correct. After reviewing all the information carefully, we are changing our decision. We now find that (2) disability began (3) .

Fill-ins:

(1) your/claimant’s name (possessive)

(2) your/his/her

(3) month, day, year of partially favorable onset

Enter the Personalized Disability Explanation (PDE) language per DI 26530.020 and DI 26530.055, including a list of the evidence, an explanation of what the evidence shows, and the detailed, personalized reasons for the determination. For additional guidance, see Reopening of Prior Determination DI 27536.015. If merged text is not used, use paragraph 4041 “We have enclosed a page that gives you more details about how we made the decision on your case.” (NL 00708.100).

If concurrent claims are involved, include paragraph 842:

This decision refers only to (1) Social Security Disability Insurance benefits. You will get a separate letter about (2) Supplemental Security Income payments.

Fill-ins:

(1) your/claimant’s name (possessive)

(2) your/his/her

Other Requirements

(1) must meet certain medical and non-medical requirements to qualify for disability benefits. Based on our rules, we have found that (2) the medical requirements.

Fill-ins:

(1) You/He/She

(2) you meet/he meets/she meets

We have not decided whether (1) our non-medical requirements. We will make that decision soon. Then we will send you another letter explaining our decision. That letter will also tell you what to do if you disagree with our decision. After you get that letter you will have 60 days to appeal, in writing, our decision about (2) claim for disability benefits.

Fill-ins:

(1) you meet/he meets/she meets

(2) your/his/her