TN 31 (01-00)
DI 23570.100 Age 18 Notice of Disability Redetermination — CDR to Disability Redetermination —
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 work or want to work but are concerned about losing your SSI or medical assistance,
your local Social Security office can tell you more about work incentives and how
work and earnings can affect your SSI.
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.