NL 00705: Disability Sample Guide Letters
TN 11 (03-04)
Social Security Administration
Supplemental Security Income
Important Information
Date:
Claim Number: 999-99-9999DC
Jane Doe for
John Smith
Street Address
City ST ZIP
IMPORTANT INFORMATION
PLEASE READ ALL OF THIS LETTER CAREFULLY
Earlier we wrote to tell you that we would review John Smith's disability case to see if he is disabled. Now, we are writing to tell you that he is still disabled under our rules. He will continue to receive Supplemental Security Income (SSI) payments if he still meets all the other eligibility requirements. Also, if he is getting medical assistance based on SSI, his coverage should continue.
We Will Review John Smith's Case Again
Doctors and other trained staff decided that he is still disabled. However, under our rules, if a child is qualified for SSI because of disability the month before his 18th birthday, we must look at his case again once he is 18 years old. We will do this by using the same disability rules we use for adults who file new applications. We will send you another letter describing the disability rules before we do the redetermination.
[Optional Language: Use the medical diary language only if the decision establishes a medical diary date before the child is 18 years old:
We must review the cases of children who receive SSI based on disability to decide if they still meet our disability rules. Our rules require us to review, at least once every three years, the cases of children whose health we think may improve. We may also review his case at other times, even if we do not think that his health may improve.
The doctors and other trained staff who decided that he is still disabled expect his health to improve. Therefore, we will review his case again in Month/Year).
See Next Page
999-99-9999DC Page 2 of 3
***[NOTE: Do NOT use the treatment language if the child is his/her own payee.]
When we review John Smith's case again, we may ask you to show proof that he is and has been receiving treatment that is medically necessary and available for his condition. Before we ask for this proof, we will consider the nature of his condition.
If you do not show proof of treatment when we ask you, and you do not have a good reason why he is not receiving treatment, we may stop making payments to you and select another payee for him if it is in his best interests.
We will send you a letter before we start the review. We will tell you then what information we need. We will help you get any information you do not have.
John Smith May Be Able To Get Training For A Job
You may want to contact your local State vocational rehabilitation agency. They may be able to help him get training for a job and to find work.
Things To Remember
The decision we made on his case is based on information we have now. If this information changes, it could affect his SSI. For this reason, it is important that you report changes right away. Be sure to tell us about any of the following changes.
His doctor says his health is better.
He marries.
He moves, or anyone else moves from or into his house.
There is a change in income or resources for him or members of the house.
He stops or starts going to school regularly.
He goes to work.
-
His job, pay or work expenses change, if he is working now.
If You Disagree With The Decision
If you disagree with the decision, you have the right to appeal. We will review your case again and consider any new facts you have. A person who did not make the first decision will decide your case.
You have 60 days to ask for an appeal.
See Next Page
999-99-9999DC Page 3 of 3
The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.
You must have a good reason if you wait more than 60 days to ask for an appeal.
You have to ask for an appeal in writing. We will ask you to sign Form SSA-561-U2, called “Request for Reconsideration.” Contact one of our offices if you want help .
How the Appeal Works
You have the right to review the facts in your case. You can give us more facts to add to your file. Then we will decide your case again. You will not meet the person who will decide your case.
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.
If You Have Any Questions
If you have any questions you may call us toll-free at 1-800-772-1213, or call
your local Social Security office at [FO phone number from TRIDE]. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:
[Field Office Address
City, ST, ZIP]
If you do call or visit an office, please have this letter with you. It will help us answer your questions.
(Signature)
Regional Commissioner
Continuance Notice Language
Fill-ins
IMPORTANT INFORMATION
PLEASE READ ALL OF THIS LETTER CAREFULLY
Earlier we wrote to tell you that we would review (1) disability case to decide if (2) still disabled. Now, we are writing to tell you that (3) still disabled under our rules. (4) will continue to receive Supplemental Security Income (SSI) payments if (5) all the other requirements. Also, if (6) getting medical assistance based on SSI, (7) coverage should continue.
-
Choice 1: Recipient's name (possessive)
Choice 2: your
-
Choice 1: he is
Choice 2: she is
Choice 3: you are
-
Choice 1: he is
Choice 2: she is
Choice 3: you are
-
Choice 1: He
Choice 2: She
Choice 3: You
-
Choice 1: he meets
Choice 2: she meets
Choice 3: you meet
-
Choice 1: he is
Choice 2: she is
Choice 3: you are
-
Choice 1: his
Choice 2: her
Choice 3: your
***[NOTE: For children ages 16-17, use the medical diary language only if the decision establishes a medical diary date before the child is 18 years old.]
We Will Review (1) Case Again
We must review the cases of children who receive SSI based on disability to decide if they are still disabled. Our rules require us to review, at least once every three years, the cases of children whose health we think may improve. We may also review their cases at other times, even if we do not think that their health may improve.
The doctors and other trained staff who decided that (2) still disabled expect (3) health to improve. Therefore, we will review (4) case again in (Month/Year).
***[NOTE: Do NOT use the treatment language if the child is his/her own payee.]
When we review (5) case again, we may ask you to show proof that (6) is and has been receiving treatment that is medically necessary and available for (7) condition. Before we ask for this proof, we will consider the nature of (8) condition.
If you do not show proof of treatment when we ask you, and you do not have a good reason why (9) is not receiving treatment, we may stop making payments to you and select another payee for him if it is in (10) best interests.
We will send you a letter before we start the review. We will tell you then what information we need. We will help you get any information you do not have.
-
Choice 1: Recipient's name (possessive)
Choice 2: Your
-
Choice 1: (Recipient's name) is
Choice 2: you are
-
Choice 1: his
Choice 2: her
Choice 3: your
-
Choice 1: his
Choice 2: her
Choice 3: your
-
Choice 1: Recipient's name
-
Choice 1: he
Choice 2: she
-
Choice 1: his
Choice 2: her
-
Choice 1: his
Choice 2: her
-
Choice 1: he
Choice 2: she
-
Choice 1: his
Choice 2: her
***[NOTE: Use only for the child who is age 16 or 17 years old.]
May Be Able To Get Training For A Job
You may want to contact your local State vocational rehabilitation agency. They may be able to help (2) get training for a job and to find work.
-
Choice 1: Recipient's name
Choice 2: You
-
Choice 1: him
Choice 2: her
Choice 3: you
Things To Remember
The decisions we made on (1) case are based on information we have now. If this information changes, it could affect (2) SSI. For this reason, it is importunately you report changes right away. Be sure to tell us about any of the following changes:
(3) doctor says (4) health is better.
(5)
(6), or anyone else moves from or into (7) house.
There is a change in income or resources for (8) or members of the house.
(9) going to school regularly.
-
(10) to work.
-
Choice 1: Recipient's name (possessive)
Choice 2: your
-
Choice 1: his
Choice 2: her
Choice 3: your
-
Choice 1: His
Choice 2: Her
Choice 3: Your
-
Choice 1: his
Choice 2: her
Choice 3: your
-
Choice 1: He marries.
Choice 2: She marries.
Choice 3: You marry.
-
Choice 1: He moves
Choice 2: She moves
Choice 3: You move
-
Choice 1: his
Choice 2: her
Choice 3: your
-
Choice 1: him
Choice 2: her
Choice 3: you
-
Choice 1: He stops or starts
Choice 2: She stops or starts
Choice 3: You stop or start
-
Choice 1: He goes
Choice 2: She goes
Choice 3: You go
If You Disagree With The Decision
If you disagree with the decision, you have the right to appeal. We will review your case again and consider any new facts you have. A person who did not make the first decision will decide your case.
You have 60 days to ask for an appeal.
The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.
You must have a good reason if you wait more than 60 days to ask for an appeal.
-
You have to ask for an appeal in writing. We will ask you to sign Form SSA-561-U2, called “Request for Reconsideration.” Contact one of our offices if you want help.
How the Appeal Works
You have the right to review the facts in your case. You can give us more facts to add to your file. Then we will decide your case again. You will not meet the person who will decide your case.
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal. If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.
If You Have Any Questions
If you have any questions you may call us toll-free at 1-800-772-1213, or call your local Social Security office at [FO phone number from TRIDE]. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:
[Field Office Address
City, ST, ZIP]
If you do call or visit an office, please have this letter with you. It will help us answer your questions.