Basic (01-09)
For complete notice instructions see DI 26535.000 – Notice Instructions. Use the chart below to determine the appropriate prisoner model letter or rider.
Alleged Impairment
Disability Insurance Benefit (DIB) Case
Disabled Widow(er) Benefit (DWB) Case or Childhood Disability Benefit (CDB) Case
Felony-related impairment only
Prisoner model letter “S”
Felony-related and non-felony-related impairments
Appropriate denial letter and prisoner model rider “W”
Confinement-related impairment only
Prisoner model letter “U”
Prisoner model letter “V”
(Fill in “disabled widow(er) benefits” or “childhood disability benefits”)
Confinement-related and non-confinement-related impairments
Appropriate denial letter and prisoner model rider “X”
NL 00705.520 - Prisoner Model Letter “S” – Felony Related Impairment – DIB, DWB, CDB
NL 00705.530 - Prisoner Model Letter “U” – Incarceration Related Impairment – DIB Freeze Established
NL 00705.535 - Prisoner Model Letter “V” – Incarceration Related Impairment – CDB, DWB
NL 00705.540 - Prisoner Model Letter “W” – Felony and Non-Felony Related Impairments – DIB, CDB, DWB
NL 00705.545 - Prisoner Model Rider “X” – Incarceration and Non-Incarceration Related Impairment – CDB, DWB
NOTE: A personalized disability notice (PDN) is needed with Model Letters S, U, and V.