TN 37 (09-22)

DI 23570.100 Age 18 Notice of Disability Redetermination — CDR to Disability Redetermination — Exhibit

Social Security Administration
Supplemental Security Income
Important Information

Date:
[Case number or BNC #]

 

John Payee for
Jane G. Beneficiary
101 Main Street
My City, ST 00001

 

This letter is about your SSI. You do not need to call us.

Earlier we wrote to tell you that we would review your Supplemental Security Income (SSI) disability case to decide if you were still disabled. We are writing now to tell you that because you are over age 18, we will use the same disability rules we use for adults who file new claims to decide your case. However, we will not apply the rule that says we must deny your claim if you are working.

We Will Let You Know What We Decide

•  

  Doctors and other trained staff will decide if you are disabled under the disability rules for adults.

  We may decide that you are not disabled under the disability rules for adults and your SSI payments could stop. The disability rules for adults are different than the disability rules for children we used when we last looked at your case. So we may find you are not disabled now even though we found you disabled before.

  When we decide we will let you know our decision. Our letter will explain your right to appeal the decision. If you appeal the decision you can also choose to have us continue to make payments until we decide the appeal.

   

   

See Next Page

Page 2 of 2

[Case number or BNC #]

Information About Work

•  

  If you work or want to work but are concerned about losing your SSI or medical assistance, your local Social Security office can tell you more about work incentives and how work and earnings can affect your SSI.

Need More Help?

1. Visit www.ssa.gov for fast, simple, and secure online service.

2. Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm. If you are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention this letter when you call.

3. You may also call your local office at *F1 (Field Office General Inquiry Line phone number).

*F2 (Office name)

*F3

*F4

*F5

*F6

*F7

 

How Are We Doing? Go to www.ssa.gov/feedback to tell us.

 

Regional Commissioner

 

 

Fill-ins:

F1- FO Phone contact info

C1 – Business Number from DOORS (Preferred choice when present)

C2 – T2 Number from DOORS for T2 Notices (Use only when Business Number is not present)

C3 – T16 Number from DOORS for SSI Notices (Use only when Business Number is not present)

F2 – Line 1 of FO Address in DOORS

F3 – Line 2 of FO Address in DOORS

F4 – Line 3 of FO Address in DOORS

F5 – Line 4 of FO Address in DOORS

F6 – Line 5 of FO Address in DOORS

F7 – Line 6 of FO Address in DOORS

C1 - Line 6 of FO Address in DOORS

C2 – Null (use when address is less than 6 lines)