Follow instructions in DPS to complete the fill-ins. Retain a dated copy in the Online Notice Retrieval System (ONRS) to document the 30-day closeout period for initial requests. The second request closeout period is 15-days.

1. a. 

   Follow these steps to complete page 1:

   Step	Action
   1	Review the Supplemental Security Record (SSR) to determine if a face-to-face or telephone interview is appropriate. Examples: • ZH09 coding in the CG field of the SSR tells you that the individual has a hearing impairment and uses sign language. A telephone interview may not be appropriate. • An individual has earned income. A telephone interview may be the preferred method for a personal contact due to the individual's work schedule. • The individual needs to bring evidence to a face-to-face interview, due to issues such as their immigration status needs to be re-verified see SI 02305.082. • The individual needs to submit documentation following a telephone interview. NOTE: The presence of a diary on the SSR may be an indicator that we must obtain evidence.
   2	When completing the address section include the: • Representative payee's (payee) name, if applicable; • Individual's name; • Mailing address; • Field office (FO) address; and • Date you issued the notice.
   3	Complete the "What You Need To Do" section. Check the appropriate boxes, and if scheduling an appointment, complete the: • Date and time of the appointment; • For a telephone interview: – Name of technician and telephon number for the individual to call; or – The telephone number the technician will call to reach the individual for a telephone interview at the date and time indicated. • For a face-to-face interview: – The FO address and the name of the technician that will be conducting the interview.

2. b. 

   Follow these steps to complete page 2

   Step	Action
   1	In the "If We Don't Hear From You" section, fill in the month, day, and year the individual must contact you to avoid payment suspension. Enter a date that allows the individual 30 calendar days after the date at the top of the letter, plus 5 days for mailing.
   2	Fill in the dates for which we require evidence. If completing the request to pursue further development of redetermination (RZ) or limited issue (LI) data, follow the rules of administrative finality in SI 04070.015 to determine the earliest month and year for which you may request information.
   3	Check the items the individual must bring to the interview or submit to the FO by fax or mail. Write the name of the individual to whom each item belongs.
   4	If paystubs are being requested, include the dates of the earliest through the latest month and year of the pay stubs you are requesting.
   5	Fill in the telephone number and name of the technician the individual must ask for if they have questions about the request.
   6	Sign the letter with the FO manager's name.
   7	Include any appropriate enclosures with the letter.
   8	Retain a dated copy of the letter in ORS to document the 30-day closeout for an initial request or the 15-day closeout for second request)

Send a second request for information or appointment with a 15-day close out, plus 5 days for mailing, to follow up on an initial request when the individual:

• •

  Has not responded and 15 calendar days, plus 5 days for mailing, has elapsed after the date on the initial request letter; or

• •

  Fails to comply with the appointment date scheduled in the initial request letter.

If the individual fails to provide the requested information or comply with a scheduled appointment, and 15 days plus 5 days for mailing have elapsed after the date on the second request for information, for policy and procedures on when to apply the N20 suspension refer to SI 02301.235.