TN 13 (06-09)

4147 modified

We are writing to you about your Supplemental Security Income payments. We recently looked at (1) 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) (3) began (4) .

Fill-ins:

(1) your/claimant’s name (possessive)

(2) your/his/her

(3) disability/blindness

(4) month, day, year of later 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 841:

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

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 (2) benefits. Based on our rules, we have found that (3) the medical requirements.

Fill-ins:

(1) You/He/She

(2) disability/blindness

(3) 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. The 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 (3) benefits.

Fill-ins:

(1) you meet/he meets/she meets

(2) your/his/her

(3) disability/blindness