TN 13 (09-23)
The notices for concurrent title II/title XVI claims continuing disability review
(CDR) cases are governed by the same principles which apply to each claim separately.
In concurrent CDR title II/title XVI cessations, it will be necessary to prepare a
separate notice and personalized explanation for each claim. (See DI 26530.001 for preparation of the personalized explanation.), unless the cessation fits one
of the following situations:
If the cessation fits one of the situations listed above, a concurrent cessation notice
may be prepared. (Exhibits 1, 2, and 3 contain sample language for each respective
situation.)
When separate notices are prepared for concurrent title II/title XVI claims each notice
must contain a reference to the other claim. Paragraph 841 is the title II disclaimer
paragraph to be included on the title XVI notice (when not preprinted on the form
letter). Paragraph 842 is the title XVI disclaimer paragraph to be included on the
title II notice (when not preprinted).
Exhibit 1
CONCURRENT CDR CESSATION NOTICE – MEDICAL
IMPROVEMENT
SOCIAL SECURITY ADMINISTRATION
Retirement, Survivors and Disability Insurance
Supplemental Security Income
Notice of Disability Cessation
Date
Case
Number
Claimant Name
Address
City, State Zip
We are writing to let you know that we have made a decision on (1) Social Security and Supplemental Security Income (SSI) cases. After reviewing all
of the information carefully, we have decided that (2) health has improved since we last reviewed (3) case. And (4) now able to work. This means that (5) benefits will stop.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: your
Choice 2: their
-
(3)
Choice 1: your
Choice 2: their
-
(4)
Choice 1: you are
Choice 2: they are
-
(5)
Choice 1: your
Choice 2: their
When (1) Payment Will Stop
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
(1) no longer disabled as of (2) . If (3) getting payments, (4) will receive them for that month and the next 2 months, and (5) last payment will be for (6) .
Fill-ins:
-
(1)
Choice 1: You are
Choice 2: They are
-
-
(3)
Choice 1: you are
Choice 2: they are
-
(4)
Choice 1: you
Choice 2: they
-
(5)
Choice 1: your
Choice 2: their
-
(6)
Last month and year of entitlement/eligibility
The Decision On (1) Case
PDN Portion of Notice (2)
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
-
Information About (1) Medicare and Medicaid
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
If (1) Medicare, (2) coverage will end the last day of (3) .
For information about any change in (4) Medicaid eligibility caused by this action, you should get in touch with (5) .
Fill-ins:
-
(1)
Choice 1: you have
Choice 2: they have
-
(2)
Choice 1: your
Choice 2: their
-
(3)
Last month and year of Medicare coverage
-
(4)
Choice 1: your
Choice 2: their
-
If You Disagree With The Decision
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason for waiting more than 60 days to ask for an appeal.
-
•
You have to ask for an appeal in writing. We will ask you to sign a Form SSA-789-U4,
called "Request for Reconsideration – Disability Cessation." Contact one of our offices
if you want help.
Please read the enclosed pamphlet, "Your Right to Question the Decision to Stop Your
Disability Benefits." It contains more information about the appeal.
Appeal In 10 Days To Keep Getting (1) Payment And
Medicare
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
You have only 10 days to ask us to continue (1) payments during your appeal.
-
•
The 10 days start the day after you get this letter.
-
•
You can ask us to keep paying (2) and (3) family.
-
•
Also, if you ask us to keep paying (4) and (5)
covered by Medicare, (6) Medicare will continue.
-
•
f you lose your appeal, you might have to pay back some or all of this money, but
you will not have to pay back Medicare.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: you
Choice 2: them
-
(3)
Choice 1: your
Choice 2: their
-
(4)
Choice 1: you
Choice 2: them
-
(5)
Choice 1: you are
Choice 2: they are
-
(6)
Choice 1: your
Choice 2: their
How The Appeal Works
A Disability Hearing Officer will decide your appeal. We will call this person a DHO
in the rest of our letter. The DHO will meet with you before making the decision on
your appeal. The meeting works like this.
-
•
The DHO will write you about the time and place for the meeting.
-
•
You can look at (1) file before the meeting.
-
•
You can tell the DHO why you think (2) still disabled. You can give the DHO more facts.
And you can bring people to say why (3) disabled.
-
•
You can have the DHO ask people to come to the meeting and bring important papers.
You can question these people at the meeting.
-
•
You do not have to go to the meeting in person. If you do not want to go, you can
give the DHO more facts you may have. The DHO will decide your case using these facts,
and what is now in (4) file. But if you go to the meeting, it may help the DHO decide your case.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: Disability claimant (possessive)
-
(2)
Choice 1: your are
Choice 2: they are
-
(3)
Choice 1: you are
Choice 2: they are
-
(4)
Choice 1: your
Choice 2: their
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it. And if you hire a lawyer, we will
withhold up to 25 percent of any past due Social Security benefits to pay toward the
fee.
If (1) Health Gets Worse
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
If (1) health gets worse and you feel that (2)
disabled again, please get in touch with us. (3) may be able to get benefits again.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: you are
Choice 2: they are
-
(3)
Choice 1: You
Choice 2: They
If You Have Any Questions
-
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 [FO phone number from DOORS].
[Field Office Address, City, ST, ZIP]
How are we doing? Go to www.ssa.gov/feedback to tell us.
Regional Commissioner
Enclosure:
Exhibit 2
CONCURRENT CDR CESSATION NOTICE – GROUP I EXCEPTION
SOCIAL SECURITY ADMINISTRATION
Retirement, Survivors and Disability Insurance
Supplemental Security Income
Notice of Disability Cessation
Date
Case
Number
Claimant Name
Address
City, State Zip
We are writing to let you know that we have made a decision on (1) Social Security and Supplemental Security Income (SSI) cases. After reviewing all
of the information carefully, we have decided that (2) able to work. This means that (3) benefits will stop.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: you are
Choice 2: they are
-
(3)
Choice 1: your
Choice 2: their
When (1) Payment Will
Stop
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
(1) no longer disabled as of (2) . If (3) getting payments, (4) will receive them for that month and the next 2 months, and (5) last payment will be for (6) .
Fill-ins:
-
(1)
Choice 1: You are
Choice 2: They are
-
-
(3)
Choice 1: you are
Choice 2: they are
-
(4)
Choice 1: you
Choice 2: they
-
(5)
Choice 1: your
Choice 2: their
-
(6)
Last month and year of entitlement/eligibility
The Decision On (1) Case
PDN Portion of Notice (2)
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
-
Information About (1) Medicare and
Medicaid
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
If (1) Medicare, (2) coverage will end the last day of (3) .
For information about any change in (4) Medicaid eligibility caused by this action, you should get in touch with (5) .
Fill-ins:
-
(1)
Choice 1: you have
Choice 2: they have
-
(2)
Choice 1: your
Choice 2: their
-
(3)
Last month and year of Medicare coverage
-
(4)
Choice 1: your
Choice 2: their
-
If You Disagree With The Decision
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason for waiting more than 60 days to ask for an appeal
-
•
You have to ask for an appeal in writing. We will ask you to sign a Form SSA-789-U4,
called "Request for Reconsideration – Disability Cessation." Contact one of our offices
if you want help.
Please read the enclosed pamphlet, "Your Right to Question the Decision to Stop Your
Disability Benefits." It contains more information about the appeal.
Appeal In 10 Days To Keep Getting (1)
Payment And Medicare
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
You have only 10 days to ask us to continue (1) payments during your appeal.
-
•
The 10 days start the day after you get this letter.
-
•
You can ask us to keep paying (2) and (3) family.
-
•
Also, if you ask us to keep paying (4) and (5)
covered by Medicare, (6) Medicare will continue.
-
•
If you lose your appeal, you might have to pay back some or all of this money, but
you will not have to pay back Medicare.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: you
Choice 2: them
-
(3)
Choice 1: your
Choice 2: their
-
(4)
Choice 1: you
Choice 2: them
-
(5)
Choice 1: you are
Choice 2: they are
-
(6)
Choice 1: your
Choice 2: their
How The Appeal Works
A Disability Hearing Officer will decide your appeal. We will call this person a DHO
in the rest of our letter. The DHO will meet with you before making the decision on
your appeal. The meeting works like this.
-
•
The DHO will write you about the time and place for the meeting.
-
•
You can look at (1) file before the meeting.
-
•
You can tell the DHO why you think (2) still disabled. You can give the DHO more facts. And you can bring people to say
why (3) disabled.
-
•
You can have the DHO ask people to come to the meeting and bring important papers.
You can question these people at the meeting.
-
•
You do not have to go to the meeting in person. If you do not want to go, you can
give the DHO more facts you may have. The DHO will decide your case using these facts,
and what is now in (4) file. But if you go to the meeting, it may help the DHO decide your case.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: Disability claimant (possessive)
-
(2)
Choice 1: your are
Choice 2: they are
-
(3)
Choice 1: you are
Choice 2: they are
-
(4)
Choice 1: your
Choice 2: their
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it. And if you hire a lawyer, we will
withhold up to 25 percent of any past due Social Security benefits to pay toward the
fee.
If (1) Health Gets Worse
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
If (1) health gets worse and you feel that (2)
disabled again, please get in touch with us. (3) may be able to get benefits again.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: you are
Choice 2: they are
-
(3)
Choice 1: You
Choice 2: They
If You Have Any Questions
-
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 [FO phone number from DOORS].
[Field Office Address, City, ST, ZIP]
How are we doing? Go to www.ssa.gov/feedback to tell us.
Regional Commissioner
Enclosure: SSA Pub. No. 05-10058
Exhibit 3
CONCURRENT CDR CESSATION NOTICE – GROUP II
EXCEPTION
SOCIAL SECURITY ADMINISTRATION
Retirement, Survivors and Disability Insurance
Supplemental Security Income
Notice of Disability Cessation
Date
Case
Number
Claimant Name
Address
City, State Zip
We are writing to let you know that we have made a decision on (1)
Social Security and Supplemental Security Income (SSI) cases. After reviewing all
of the information carefully, we have decided (2) no longer eligible for benefits.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: you are
Choice 2: they are
When (1) Payment Will Stop
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
(1) no longer disabled as of (2) . If (3) getting payments, (4) will receive them for that month and the next 2 months, and (5) last payment will be for (6) .
Fill-ins:
-
(1)
Choice 1: You are
Choice 2: They are
-
-
(3)
Choice 1: you are
Choice 2: they are
-
(4)
Choice 1: you
Choice 2: they
-
(5)
Choice 1: your
Choice 2: their
-
(6)
Last month and year of entitlement/eligibility
The Decision On (1) Case
PDN Portion of Notice (2)
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
-
Information About (1) Medicare and
Medicaid
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
If (1) Medicare, (2) coverage will end the last day of (3) .
For information about any change in (4) Medicaid eligibility caused by this action, you should get in touch with (5) .
Fill-ins:
-
(1)
Choice 1: you have
Choice 2: they have
-
(2)
Choice 1: your
Choice 2: their
-
(3)
Last month and year of Medicare coverage
-
(4)
Choice 1: your
Choice 2: their
-
If You Disagree With The Decision
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason for waiting more than 60 days to ask for an appeal
-
•
You have to ask for an appeal in writing. We will ask you to sign a Form SSA-789-U4,
called "Request for Reconsideration – Disability Cessation." Contact one of our offices
if you want help.
Please read the enclosed pamphlet, "Your Right to Question the Decision to Stop Your
Disability Benefits." It contains more information about the appeal.
Appeal In 10 Days To Keep Getting (1) Payment And Medicare
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
You have only 10 days to ask us to continue (1) payments during your appeal.
-
•
The 10 days start the day after you get this letter.
-
•
You can ask us to keep paying (2) and (3) family.
-
•
Also, if you ask us to keep paying (4) and (5)
covered by Medicare, (6) Medicare will continue.
-
•
If you lose your appeal, you might have to pay back some or all of this money, but
you will not have to pay back Medicare.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: you
Choice 2: them
-
(3)
Choice 1: your
Choice 2: their
-
(4)
Choice 1: you
Choice 2: them
-
(5)
Choice 1: you are
Choice 2: they are
-
(6)
Choice 1: your
Choice 2: their
How The Appeal Works
A Disability Hearing Officer will decide your appeal. We will call this person a DHO
in the rest of our letter. The DHO will meet with you before making the decision on
your appeal. The meeting works like this.
-
•
The DHO will write you about the time and place for the meeting.
-
•
You can look at (1) file before the meeting.
-
•
You can tell the DHO why you think (2) still disabled. You can give the DHO more facts. And you can bring people to say
why (3) disabled.
-
•
You can have the DHO ask people to come to the meeting and bring important papers.
You can question these people at the meeting.
-
•
You do not have to go to the meeting in person. If you do not want to go, you can
give the DHO more facts you may have. The DHO will decide your case using these facts,
and what is now in (4) file. But if you go to the meeting, it may help the DHO decide your case.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: Disability claimant (possessive)
-
(2)
Choice 1: your are
Choice 2: they are
-
(3)
Choice 1: you are
Choice 2: they are
-
(4)
Choice 1: your
Choice 2: their
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it. And if you hire a lawyer, we will
withhold up to 25 percent of any past due Social Security benefits to pay toward the
fee.
If (1) Health Gets Worse
Fill-ins:
-
(1)
Choice 1: Your
Choice 2: Disability claimant (possessive)
If (1) health gets worse and you feel that (2)
disabled again, please get in touch with us. (3) may be able to get benefits again.
Fill-ins:
-
(1)
Choice 1: your
Choice 2: their
-
(2)
Choice 1: you are
Choice 2: they are
-
(3)
Choice 1: You
Choice 2: They
If You Have Any Questions
-
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 [FO phone number from DOORS].
[Field Office Address, City, ST, ZIP]
How are we doing? Go to www.ssa.gov/feedback to tell us.
Regional Commissioner
Enclosure: SSA Pub. No. 05-10058