TN 30 (06-25)
AGENCY LETTERHEAD
Date: [Fill-in]
Case ID: [Fill-in]
Addressee Name
Address Line 1
Address Line 2
City, State, ZIP code
INTRODUCTION
LETTER
If initial or reconsideration claim use:
We are the office that makes disability decisions for the Social Security Administration.
We are writing to tell you that we are reviewing your/[claimant's full name]'s disability
claim.
If Age 18 Redetermination use:
We are the office that makes disability decisions for the Social Security Administration.
Because you/[claimant full name] are/is now age 18 or older, we need to re-evaluate
your/his/her case using adult disability rules.
If CDR use:
We are the office that makes disability decisions for the Social Security Administration.
Periodically, we must review the cases of people who are receiving disability benefits
to make sure they remain disabled under our rules.
If initial or reconsideration claim include:
How We
Decide Eligibility For Disability
Benefits
If child claim use:
To be eligible for disability benefits, you/he/she must have a medical condition(s)
that:
-
•
Causes marked and severe functional limitations, and
-
•
Has lasted or is expected to last for at least 12 months in a row, or is expected
to result in death.
If adult claim use:
To be eligible for disability benefits, you/he/she must have a medical condition(s)
that:
-
•
Keeps you/him/her from doing your/his/her past work or adjusting to other work, and
-
•
Has lasted or is expected to last for at least 12 months in a row, or is expected
to result in death.
What We Will Do
If initial or reconsideration claim use:
We will review the medical and other information we have. If we need more information
to decide whether you/he/she are/is disabled, we may arrange an exam or test which
we will pay for. We may also reimburse some travel expenses to the exam or test site
based on a set rate.
If Age 18 Redetermination use:
Doctors and other trained staff will decide if you/he/she are/is disabled. To do this,
we may need to request information from your/his/her doctors, hospitals, clinics,
and other sources, at no cost to you/him/her. If we need more information to decide
whether you/he/she are/is disabled, we may arrange an exam or test. We will pay for
the exam or test. When we have finished the review, we will send a letter to let you
know what we have decided.
If CDR
use:
Doctors and other trained staff will review your/his/her case to see if your/his/her
medical condition(s) have changed since the last time we reviewed your/his/her case.
To do this, we may need to request information from your/his/her doctors, hospitals,
clinics, and other sources, at no cost to you/him/her. If we need more information
to decide whether you/he/she are/is still disabled, we may arrange an exam or test.
We will pay for the exam or test. When we have finished the review, we will send a
letter to let you know what we have decided.
What You Need To Do
Please respond quickly to any letters or forms that you receive from us. Let us know
right away if any of the following things happen while we [process this claim[1] /re-evaluate this case[2] ]:
-
•
New doctor or hospital visit,
-
•
Additional tests, therapy, or surgery,
-
•
Changes in dosage, addition, or discontinuation of medication(s),
-
-
•
Additional current or past medical, educational, or mental health sources not listed
on the application.
If adult claim, also include:
You must report to SSA right away any changes to your/his/her address, telephone number(s)
or any other personal information.
Contact Your Medical Source(s)
Obtaining all necessary medical records is critical in reviewing your/his/her disability
[claim[3] /case[4] ]. If additional medical information is needed, we may request a consultative examination(s).
We encourage you to contact your/his/her medical source(s) to:
-
•
Ensure they submit your/his/her medical records to SSA as soon as possible, and
-
•
Determine if they are willing to perform a consultative examination if one is necessary.
Contacting your/his/her medical source(s) can help expedite obtaining your/his/her
records, avoid delays in processing your/his/her claim, and assist us in making a
timely and accurate determination. If your/his/her medical source is available to
conduct the consultative examination, please have them contact the DDS at the number
or address listed in this letter.
Suspect Social Security Fraud?
Please visit https://oig.ssa.gov/report or call the Inspector General's Fraud Hotline at (800) 269-0271. If you are deaf
or hard of hearing, call TTY (866) 501-2101.
If You Have Any Questions
If you have any questions or wish to provide more information, please call us at the
number(s) shown [DDS
office hours]. When you call or leave a message, please provide the Case ID: [case
ID number], your name, and a call back number.
Thank you for your cooperation,
[Name]
[Phone Number]
[Fax Number]
Enclosures:
Multi-Language Insert