Agency
Letterhead
Date: [Fill-in
Case ID: Fill-in
Addressee Name
Address Line 1
Address Line 2
City, State, Zip Code
We are the office that makes disability decisions for the Social Security Administration.
We are writing about your disability claim.
If Adult
To be eligible for disability benefits, you/]claimant name] must meet our rules. You/[claimant
name] must have a medical condition(s) that keeps you/[claimant name] from doing any
type of work, and has lasted or is expected to last for at least 12 months in a row
or result in death.
If Child
To be eligible for disability benefits, you/[claimant name] must meet our rules. You/[claimant
name] 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 result in
death.
Your qualifying event occurred recently, so we will need to know what your condition is after end date. We will make every effort to get the updated information we need to make a decision
on your claim.
If You Have Any Questions
If you have any questions or wish to provide more information, please call us at the
number(s) shown below Monday-Friday local office hours. When you call or leave a message, please provide the Case ID: case ID, your name, and a call back number.
Thank you for your help,
[Name]
[Phone Number]
[Fax Number]
Enclosures:
Multi-Language Insert (if enclosed)