TN 18 (03-12)

A. Notification to the claimant of medical deferment

                                                                                             **BARCODE**

AGENCY
LETTERHEAD

                                                                        Date: _______________

                                                                  Case ID: ____________

Addressee Name

Address Line 1

Address Line 2

City, State, Zip code

Dear (Mr. or Ms.) (Last name):

We are the office that makes disability decisions for the Social Security Administration. We received your claim for disability. We will decide if you qualify for disability benefits. To be eligible for disability benefits, you must meet our rules. You must have a medical condition(s) that keeps you from doing any type of work, and has lasted or is expected to last for at least 12 months in a row or result in death. Since your ____occurred so recently, we will need to know what your condition is as of ____. We will make every effort we can to get the requested information before we make a decision on your claim.

Thank you,

(Name)

Disability Examiner

(XXX) XXX-XXX

Toll Free: 1-800-XXX-XXXX, extension XXXX

cc:

B. Reference

DI 25505.040 Notice to Claimant of Medical Deferment