TN 15 (02-90)

1004. Situation Where Used:

Initial and reconsideration closed period and later onset date allowance.

We have now completed our consideration of    (1)    claim. We previously sent you a notice that    (2)    the medical requirements for disability payments. This notice tells you whether     (3)    the nonmedical requirements. Together, they explain the determination made in    (4)    claim.

1. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

2. Choice 1 - you meet

   Choice 2 - she meets

   Choice 3 - he meets

    

3. Choice 1 - you meet

   Choice 2 - she meets

   Choice 3 - he meets

    

4. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

1005. Situation Where Used:

Special message to field offices (FO). This language is included only on the copy of the blind notice sent to the FO.

For SSA Use Only—Special Notification of Blind Recipients

This recipient has elected the blind notice option of receiving a telephone call. Please call the recipient immediately and read this notice to     (1)    . The recipient's name, address and telephone number are as follows:    (2)          (3)   

1. Choice 1 - her

   Choice 2 - him

    

2. (Recipient's name and address)

    

3. (Recipient's telephone number)

    

1370. Situation Where Used:

Balance of payment due—presumptive disability payments made in the past.

Since we paid    (1)          (2)    ,    (3)    is the rest of the payment due    (4)    for    (5)    .

1. $$$.¢¢

    

2. Choice 1 - for (Month/Year) through (Month/Year)

   Choice 2 - for (Month/Year)

    

3. $$$.¢¢

    

4. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

5. Choice 1 - (Month/Year) through (Month/Year)

   Choice 2 - that month

   Choice 3 - that period

    

1371. Situation Where Used:

Denial—presumptive disability payments made—no overpayment.

While we were working on    (1)    claim we sent    (2)    monthly checks    (3)    Although    (4)    not eligible for Supplemental Security Income payments,    (5)    not have to repay any of the payments previously sent    (6)    .

1. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

2. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

3. Choice 1 - for 3 months

   Choice 2 - .

    

4. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

5. Choice 1 - you do

   Choice 2 - she does

   Choice 3 - he does

    

6. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

1372. Situation Where Used:

Allowance—presumptive disability payments made for 3 months.

While we were working on    (1)    claim, we sent monthly disability checks. Because of a requirement of the law,    (2)    payments were stopped after payment for 3 months.

1. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

2. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

1373. Situation Where Used:

Date of onset of disability or blindness is later than date of application. Attainment of age 65 for aged cases is later than date of application.

   (1)    cannot receive payment for    (2)           (3)    because the facts in    (4)    case establish that    (5)    first met the    (6)    requirements for eligibility in    (7)    .

1. Choice 1 - You

   Choice 2 - She

   Choice 3 - He

    

2. (Month/Day/Year)

    

3. Choice 1 - through (Month/Year)

   Choice 2 - Null

    

4. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

5. Choice 1 - you

   Choice 2 - she

   Choice 3 - he

    

6. Choice 1 - blindness

   Choice 2 - disability

   Choice 3 - disability/blindness

    

7. (Month/Year)

    

1407. Situation Where Used:

Denial—claimant disabled but ineligible for other reasons.

Although    (1)          (2)    , payments cannot be made to    (3)    because    (4)          (5)    not meet other requirements for eligibility.

1. Choice 1 - you

   Choice 2 - she

   Choice 3 - he

    

2. Choice 1 - are currently disabled

   Choice 2 - is currently disabled

   Choice 3 - were disabled in (Month/Year)

   Choice 4 - were disabled in (Month/Year) through (Month/Year)

   Choice 5 - was disabled in (Month/Year)

   Choice 6 - was disabled (Month/Year) through (Month/Year)

   Choice 7 - were blind in (Month/Year)

   Choice 8 - were blind (Month/Year) through (Month/Year)

   Choice 9 - was blind in (Month/Year)

   Choice 10 - was blind (Month/Year) through (Month/Year)

   Choice 11 - were blind and disabled in (Month/Year)

   Choice 12 - were blind and disabled (Month/Year) through (Month/Year)

   Choice 13 - was blind and disabled in (Month/Year)

   Choice 14 - was blind and disabled (Month/Year) through (Month/Year)

    

3. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

4. Choice 1 - you

   Choice 2 - she

   Choice 3 - he

    

5. Choice 1 - do

   Choice 2 - does

   Choice 3 - did

    

1414. Situation Where Used:

Allowance—medical improvement possible (disabled or disabled/blind).

NOTE: Although this new language has been cleared, it is not yet automated.

Doctors and other trained staff decided that    (1)    disabled under our rules. But, this decision must be reviewed at least once every 3 years. We will send    (2)    a letter before we start the review. Based on that review,    (3)    payments will continue if     (4)    still disabled, but will end if    (5)    no longer disabled.

1. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

2. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

3. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

4. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

5. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

1415. Situation Where Used:

Allowance—medical improvement not expected or medical improvement possible (blind)

NOTE: Although this new language has been cleared, it is not yet automated.

Doctors and other trained staff decided that    (1)    blind under our rules. But, this decision must be reviewed at least once every 3 years. We will send    (2)    a letter before we start the review. Based on that review,    (3)    payments will continue if    (4)    still blind or disabled but will end if    (5)    no longer blind or disabled.

1. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

2. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

3. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

4. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

5. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

1424. Situation Where Used:

Allowance—medical improvement not expected (blind)

Doctors and other trained personnel decided that    (1)    blind. But we will review    (2)    case in    (3)    . We will send    (4)    a letter before we start the review. Based on that review,    (5)    SSI will continue if    (6)    still blind. But it will end if    (7)    no longer blind.

1. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

2. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

3. (Month/Year)

    

4. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

5. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

6. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

7. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

1425. Situation Where Used:

Allowance—medical improvement not expected (disabled or disabled/blind)

Doctors and other trained personnel decided that    (1)           (2)    . And we realize that    (3)    health may not improve. But we must review all    (4)    cases. Therefore, we will review    (5)    case in 5 to 7 years. We will send    (6)    a letter before we start the review. Based on that review,    (7)     SSI will continue if    (8)    still    (9)    . But it will end if    (10)    no longer    (11)    .

1. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

2. Choice 1 - disabled

   Choice 2 - disabled and blind

    

3. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

4. Choice 1 - disability

   Choice 2 - disability and blindness

    

5. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

6. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

7. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

8. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

9. Choice 1 - disabled

   Choice 2 - disabled or blind

    

10. Choice 1 - you are

    Choice 2 - she is

    Choice 3 - he is

     

11. Choice 1 - disabled

    Choice 2 - disabled or blind

     

1617. Situation Where Used:

IC: Allowance based on disability — alcoholism and/or drug addiction involved — payee selected. (This paragraph is used on representative payee's notice only.)

PE: Disability continues — DA & A not previously applicable — recipient determined to be DA & A.

The medical evidence has been reviewed, and it has been determined that     (1)    disabled. In reaching this decision it was found that     (2)    to the finding of disability. Under the law, a disabled person who is medically determined to be a drug addict or alcoholic must receive     (3)    Supplemental Security Income payments    (4)    through another person on his or her behalf.

1. Choice 1 - you are

   Choice 2 - (Name of Recipient) is

   Choice 3 - you continue to be

   Choice 4 - she continues to be

   Choice 5 - he continues to be

    

2. Choice 1 - drug addiction contributes

   Choice 2 - alcoholism contributes

   Choice 3 - alcoholism and drug addiction contribute

    

3. Choice 1 - any

   Choice 2 - Null

    

4. Choice 1 - that might be due

   Choice 2 - Null

    

1619. Situation Where Used:

IC: Used with paragraph 1617 on representative payee's copy only.

PE: Disability continues — DA & A not previously applicable—recipient determined to be DA & A.

      (1)          (2)    must undergo any appropriate treatment for the condition of    (3)    if such treatment is available, in order to be eligible    (4)    .

1. Choice 1 - As you were previously informed

   Choice 2 - Null

    

2. Choice 1 - you

   Choice 2 - she

   Choice 3 - he

   Choice 4 - You

   Choice 5 - She

   Choice 6 - He

    

3. Choice 1 - drug addiction

   Choice 2 - alcoholism

   Choice 3 - drug addiction and alcoholism

    

4. Choice 1 - for payments

   Choice 2 - under the Supplemental Security Income program

    

1621. Situation Where Used:

IC: Allowance based on disability — alcoholism and/or drug addiction involved — payee not yet selected.

PE: Disability continues — DA & A not previously applicable — recipient determined to be DA & A.

NOTE: This replaces paragraph 1618.

We need information from you that will assist us in selecting a representative payee to receive    (1)    . Please contact your Social Security office within 15 days to arrange for an appointment. If you contact us, please have this notice available so that you may refer to it. If you believe the determination that    (2)    to the findings that you are disabled is not correct, you may request reconsideration as explained below.

1. Choice 1 - your Supplemental Security Income payments on your behalf

   Choice 2 - any Supplemental Security Income payments on your behalf

    

2. Choice 1 - drug addiction contributes

   Choice 2 - alcoholism contributes

   Choice 3 - drug addiction and alcoholism contribute

    

2600. Situation Where Used:

DA & A recipient is not in compliance with treatment requirement.

(Used with paragraph 2603.)

A disabled person whose disability is based in part on drug addiction or alcoholism must receive    (1)    Supplemental Security Income payments    (2)    through another person on his or her behalf. In addition, the person must undergo any appropriate treatment for the condition if such treatment is available in order to be eligible    (3)    .

1. Choice 1 - any

   Choice 2 - Null

    

2. Choice 1 - that might be due

   Choice 2 - Null

    

3. Choice 1 - for payments

   Choice 2 - under the Supplemental Security Income program

    

2602. Situation Where Used:

DA & A now willing to cooperate in having DA & A treatment or now back in treatment placement. (Used with paragraph 2618.)

   (1)    to be subject to the representative payee requirement. Therefore,    (2)    .

1. Choice 1 - You continue

   Choice 2 - She continues

   Choice 3 - He continues

    

2. Choice 1 - your payments must continue to be made to another person on your behalf

   Choice 2 - her payments must continue to be made to another person on her behalf

   Choice 3 - his payments must continue to be made to another person on her behalf

   Choice 4 - any payments that might be due in the future must be made to another person on your behalf

   Choice 5 - any payments that might be due in the future must be made to another person on her behalf

   Choice 6 - any payments that might be due in the future must be made to another person on his behalf

    

2603. Situation Where Used:

DA & A now willing to cooperate in having DA & A treatment or now back in treatment placement. (Used with paragraph 2618.)

After consideration of all the facts in    (1)    case, it has been determined that treatment for    (2)    condition of    (3)    is appropriate and available. Since    (4)    not complying with the treatment requirement, the provisions of the law are not met and    (5)          (6)    .

1. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

2. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

3. Choice 1 - drug addiction

   Choice 2 - alcoholism

   Choice 3 - drug addiction and alcoholism

    

4. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

5. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

6. Choice 1 - payments will be stopped as shown above

   Choice 2 - eligibility under the Supplemental Security program will end as shown above

    

2618. Situation Where Used:

DA & A now willing to cooperate in having DA & A treatment or now back in treatment placement. (Used with paragraph 2602.)

Since    (1)          (2)    treatment for    (3)    condition of    (4)    ,    (5)    eligible     (6)    .

1. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

2. Choice 1 - undergoing

   Choice 2 - willing to have appropriate and available

    

3. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

4. Choice 1 - drug addiction

   Choice 2 - alcoholism

   Choice 3 - drug addiction and alcoholism

    

5. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

6. Choice 1 - to receive Supplemental Security Income payments

   Choice 2 - under the Supplemental Security Income program

    

2641. Situation Where Used:

Lead-in—fact of disability.

   (1)    first became    (2)    in    (3)    .

1. Choice 1 - You

   Choice 2 - She

   Choice 3 - He

   Choice 4 - Your spouse

   Choice 5 - Her spouse

   Choice 6 - His spouse

    

2. Choice 1 - disabled

   Choice 2 - blind

    

3. (Month/Year)

    

Manual Paragraphs

Substantial Gainful Activity

SGAM50.  Situation Where Used:

Allowance—periods of ineligibility because of work activity.

To be disabled,    (1)    impairment must keep    (2)    from doing any substantial gainful work.    (3)    not disabled    (4)    because of    (5)    work and therefore cannot receive payment    (6)    .

1. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

2. Choice 1 - you

   Choice 2 - her

   Choice 3 - him

    

3. Choice 1 - You were

   Choice 2 - She was

   Choice 3 - He was

    

4. Choice 1 - in (Month/Year)

   Choice 2 - for (Month/Year) through (Month/Year)

    

5. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

6. Choice 1 - for that month

   Choice 2 - for those months

    

SGAM51.  Situation Where Used:

IC: Denial—adult performing SGA.

PE: Allowance revised to a denial—recipient engaged in SGA.

To get Supplemental Security Income disability checks,    (1)    must be unable to do any substantial gainful work because of a medical condition which has lasted or will last at least 12 months in a row.     (2)    age, education, training and any work experience are also considered in making the decision. Substantial gainful work is any work generally done for pay or profit, involving the performance of significant physical or mental duties. Work may be considered substantial even if done part-time. In evaluating work, consideration is given to job duties, skill, and experience required to do the job in addition to the pay. Although current work may pay less or may be different from previous work, a person may not necessarily be considered disabled. The evidence shows that the work     (3)    done in spite of    (4)    condition is substantial gainful work. Therefore,    (5)    not meet the disability requirements for eligibility.

1. Choice 1 - you

   Choice 2 - she

   Choice 3 - he

    

2. Choice 1 - Your

   Choice 2 - Her

   Choice 3 - His

    

3. Choice 1 - you have

   Choice 2 - she has

   Choice 3 - he has

    

4. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

5. Choice 1 - you do

   Choice 2 - she does

   Choice 3 - he does

    

SGAM52.  Situation Where Used:

Disability allowance revised to a denial—recipient engaged in SGA.

   (1)    claim for Supplemental Security Income payments has been reexamined because of the receipt of additional evidence. Review of this evidence and the evidence already in    (2)    file shows that    (3)    not meet the disability requirements of the law. It has been determined that the work    (4)    done despite    (5)    impairment shows that    (6)    able to do some type of substantial gainful work. Therefore,    (7)    claim must be denied. This revises our determination    (8)    that    (9)     eligible for these payments.

1. Choice 1 - Your

   Choice 2 - Her

   Choice 3 - His

    

2. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

3. Choice 1 - you do

   Choice 2 - she does

   Choice 3 - he does

    

4. Choice 1 - you have

   Choice 2 - she has

   Choice 3 - he has

    

5. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

6. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

7. Choice 1 - your

   Choice 2 - her

   Choice 3 - his

    

8. Choice 1 - of (Month/Year)

   Choice 2 - Null

    

9. Choice 1 - you are

   Choice 2 - she is

   Choice 3 - he is

    

SGAM53.  Situation Where Used:

Revision of allowance to denial—claimant engaging in SGA.

Use on an SSA-L8155-U2, Notice of Planned Action.

Your claim for Supplemental Security Income benefits has been reexamined because of the receipt of additional evidence. Review of this evidence and the evidence already in your file shows that you do not meet the disability requirements of the law. It has been determined that the work you have done despite your impairment shows that you are able to do some type of substantial gainful work. Therefore, your claim must be denied. This revised the determination recently made that you are entitled to these benefits.

(In order to satisfy the personalized notice requirements — insert here language individually tailored to cover the following elements: 1) a list of the reports evaluated; 2) a brief description of the findings supporting the determination of the SGA denial and the conclusion that the claimant is not disabled because he/she is engaging in SGA; 3) an explanation which includes the period of work evaluated, the employer's name, claimant's job title and a brief description of job duties, hourly rate of pay and average monthly earnings as well as the number of hours worked per week; a statement concerning subsidy, impairment related work expenses or absence of same; and 4) a statement regarding the SGA determination including a definition of SGA.

To qualify for disability payments, the law requires that you have a medical condition which prevents you from doing not only your usual work, but any other substantial gainful work for at least 12 months in a row. Substantial gainful work is any work usually done for wages or profit. Part time work, or work different or easier or for less money than the work which a person has done before, may be considered substantial gainful work. In making the determination that your work is substantial and gainful, we considered how many hours you work, how much money you earn, and what is required to do the work.

This decision refers only to your claim for Supplemental Security Income payments. Any decision about your benefits under the Social Security Disability Insurance Program will be sent to you in a separate notice.

Although we plan to take the action shown above, you may have your prior payment continued or reinstated if you requested an appeal within 10 days of receiving this notice.

SGAM54.  Situation Where Used:

Interim notification in favorable SGA/income and resource reconsideration determinations—to be used in reversals of initial determinations of denial because of SGA or income and resource criteria.

You were previously notified that your application for disability payments under the Supplemental Security Income Program was denied because you     (1)    as that term is defined under the law. Upon receiving your request for reconsideration, we reexamined your claim and find that    (2)    .

It is now necessary to determine whether your impairment is severe enough to qualify you as a disabled person who is eligible for the payments for which you applied. (It will be necessary for you to come in to our office to discuss your medical condition. Please phone    (3)    to arrange for an appointment. Your records are being sent for this purpose to the State Disability Determination Services in    (4)    which works with us in making disability determinations for residents of your State. (If a representative of the office contacts you, your cooperation will expedite the processing of your claim.)

This further determination of your claim will require additional time. You can be assured every effort will be made to make an early determination. You will be notified when this is completed.

1. Choice 1 - were found to be engaging in substantial gainful activity

   Choice 2 - has excessive income or resources

    

2. Choice 1 - you were not engaging in substantial gainful activity

   Choice 2 - you met the income and resource criteria for eligibility

    

3. (Telephone number of district/branch office)

    

4. (applicable State)

    

SGAM55.  Situation Where Used:

Acknowledging receipt of additional material and affirming prior notice. Use on an SSA-L8165-U2.

We have received the additional evidence concerning your application for Supplemental Security Income payments under the provisions of Title XVI of the Social Security Act.

In view of the information    (1)    , we have reviewed the evidence in your case and find that the prior determination made on your application is proper and in accordance with the law. Therefore, the decision on your application remains unchanged.    (2)   

1. Choice 1 - received

   Choice 2 - submitted by       

    

2. Choice 1 - (If the 60 day time period for appealing the decision has not expired, include the following: “As you were previously advised, if you believe that the determination is not correct, you have 60 days from the date you received our previous notice to request a reconsideration/hearing.”)

   Choice 2 - Null

    

NOTE: Show appropriate appeal right, e.g., show “reconsideration” if acknowledgement pertains to additional evidence received after an initial determination.