DI 13006.100 Exhibit Notice to Initiate an Age-18 Redetermination
Social Security Administration
Supplemental Security Income
Notice of Disability Redetermination
City, State, ZIP Code:
Claim Number: XXX-XX-XXXX
Jane G. Beneficiary
101 Main Street
My City, ST 00001
Important Notice - You must contact us or your SSI may stop.
We must review the cases of people getting Supplemental Security Income (SSI) payments
based on childhood disability after they become age 18. We are writing to let you
know that we are starting to review your SSI disability case to decide if you are
disabled under the disability rules for adults.
What You Need To Do
Please call us and ask for _____________ .
We would like you to come to our office on ______________ .
When you come in, please ask for _____________ .
If you cannot come in on the date shown or would prefer to talk with us by telephone,
please call us as soon as possible.
The office address, telephone number, and office hours are shown above.
If We Do Not Hear From You
We may stop your SSI if you do not answer this letter by Month/Day/ Year or contact us by this date to tell us why we haven't heard from you. Before we stop
your SSI, we will send you another letter to explain our decision. The letter will
also explain your right to appeal the decision and how to continue getting benefits
during the appeal.
Information About Medical Assistance
If your SSI payments stop, any medical assistance you have that is based on SSI may
also stop. If this happens, your medical assistance agency should contact you.
The Information We Will Need
When you come in or call, please try to have all of the following things with you.
Even if you do not have everything, you still must call us or come in. We will help
you get anything you do not have.
The enclosed form(s). Please be sure to complete as much of the form(s) as you can
before you come in or call.
The names of any medicines you use.
Any other information that shows your condition, such as information about:
hospital stays and/or surgeries, including the dates and reasons;
visits to doctors and/or clinics, including the dates and reasons;
counseling and/or therapy;
schools and/or special classes or tutoring; and
teachers and/or counselors who have knowledge of your condition.
We may ask for further information later.
We Will Let You Know What We Decide
Doctors and other trained staff will decide if you are disabled. When we decide your
case we will use the same disability rules we use for adults who file new claims.
However, we will not apply the rule that says we must deny your claim if you are working.
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.
How Your Benefits May Continue If We Find You Are Not Disabled
If we find that you do not have a disability under our rules for adults, your SSI
benefits will usually stop.
However, your benefits may continue while you are:
Attending school under an individualized education program (IEP), or
Taking part in certain vocational rehabilitation or similar programs.
To qualify, you must be participating in the program before the month your disability
ends under our rules. Your SSI benefits could continue until you finish school or
complete the program. Be sure to tell us about any program you take part in when you
contact us to give us the information we need. We may ask for more information later.
You must tell us when you finish school or complete the program. If you get too much
SSI money because you do not tell us right away, you must pay back the money. When
we decide, we will write and let you know our decision. Our letter will tell you whether
you are disabled under the disability rules for adults. Our letter also will explain
your right to appeal the decision. If you appeal the decision you can also choose
to have us continue to pay benefits until we decide the appeal.
Information About Work
There are special rules that help people with disabilities return to work without
losing their SSI benefits and Medicaid. You must follow these rules and report your
earnings, or you may have to repay a large part of your benefits. When you report
your earnings, we will give you a receipt to verify your report. Keep this receipt
with your other important papers from us. For more information on how work may affect
your benefits and our work incentive programs, please request our free publication.
“Working While Disabled—How We Can Help” (Publication No. 05-10095)
“The Red Book,” a guide to our employment support programs.
You can get these publications online at www.socialsecurity.gov/pubs/EN-05-10095.pdf and www.socialsecurity.gov/redbook. They also include information about the Ticket to Work program, which can help you
work or increase your earnings. To learn more, call 1-866-968-7842 (TTY 1-866-833-2967) or visit www.socialsecurity.gov/work.
Suspect Social Security Fraud?
Please visit http://oig.ssa.gov/report or call the Inspector General’s Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).
If You Have Any Questions
We will be glad to answer any questions that you have. Whether we talk to you by phone
or in person, you can have a lawyer, friend, or someone else help you. There are
groups that can help you find a lawyer or give you free legal services if you qualify.
Our office has a list of groups that can help you. If you get someone to help you,
you should let us know.
Remember, if you cannot come in or would prefer to talk to us by phone, please call
us right away. Our telephone number is shown on the first page of this letter.
Field Office Manager
[The enclosures may include any of the following:
Form Number SSA-3368 - Disability Report - Adult
Form Number SSA-827 - Authorization for Source to Release
Information to the Social Security Administration]