TN 31 (01-00)
DI 23570.100 Age 18 Notice of Disability Redetermination — CDR to Disability Redetermination — Exhibit
Social Security Administration
Supplemental Security Income
Claim Number: XXX-XX-XXXX
John Payee for
Jane G. Beneficiary
101 Main Street
My City, ST 00001
This letter is about your SSI. You do not need to call us.
Earlier we wrote to tell you that we would review your Supplemental Security Income (SSI) disability case to decide if you were still disabled. We are writing now to tell you that because you are over age 18, we will use the same disability rules we use for adults who file new claims to decide your case. However, we will not apply the rule that says we must deny your claim if you are working.
We Will Let You Know What We Decide
See Next Page
Doctors and other trained staff will decide if you are disabled under the disability rules for adults.
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.
When we decide we will let you know our decision. Our letter will explain your right to appeal the decision. If you appeal the decision you can also choose to have us continue to make payments until we decide the appeal.
XXX-XX-XXXX Page 2 of 2
Information About Work
If You Have Any Questions
If you have any questions, you may call us toll free at 1-800-772-1213, 7 a.m. to 7 p.m. Monday through Friday. We can answer most of your questions over the phone. Our busiest times are the first week of the month and Mondays. So, we may be able to handle your call more quickly if you can call us at other times.
You can write or visit any Social Security office. The address of the office that serves your area is:
123 Main Street
Anywhere, USA 00000
If you call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.