TN 13 (06-09)

4147 modified

We are writing to you about your claim for Social Security benefits. We recently looked at (1) Disability Insurance benefits 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) disabled from (3) to (4) .

Fill-ins:

(1) your/claimant’s name( possessive)

(2) you were/he was/she was

(3) month, day, year of later onset

(4) cessation month, day, year

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 (NL 00708.100).

If concurrent claims are involved, include paragraph 842:

This decision refers only to (1) Social Security Disability Insurance benefits. You will receive 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) met the medical requirements.

Fill-ins:

(1) You/He/She

(2) you/he/she

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 receive 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