AGENCY LETTERHEAD
Date: [Fill-in]
Case ID: [Fill-in]
Addressee Name
Address Line 1
Address Line 2
City, State, Zip code
THIRD
PARTY CALL IN LETTER
We are the office that makes disability decisions for the Social Security Administration.
[Claimant full name] identified you as someone we could contact for assistance.
If
addressed to appointed representative:
It is very important that we speak to you. If you do not respond by [10 calendar days],
we may decide [Claimant full name]'s case based on the information we already have
in file. This means that we could find that he/she is not disabled based on our rules
or that his/her disability has ended if he/she is already getting benefits.
If
addressed to third party:
It is very important that we speak to you by [10 calendar days]. We are attempting
to assist [Claimant full name] with his/her case. If we are not able to speak with
you in a timely manner, we may not have enough information to make a determination
on his/her case and may have to make a finding of not disabled because of insufficient
evidence.
[Free form text]
Please call the phone number(s) shown below Monday-Friday between [DDS office open]
and [DDS office close]. When you call or leave a message, please provide the Case
ID: [case ID number], your name, [Claimant full name]'s name, and a call back number.
Thank you for your help.
[Name]
[Phone Number]
[Fax Number]
Enclosure:
Multi-Language Insert (if enclosed)
cc: