TN 4 (10-15)

DI 28040.300 Exhibits of Continuing Disability Review (CDR) Notices in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases

A. Exhibit reference chart

The disability determination services (DDS) must prepare and send a confirmatory review notice to the individual, payee, or representative to confirm the initiation of the CDR process.

The following chart indicates the type of notice to be sent, and corresponds with specific notice examples from DI 28040.300B, in this section.

Confirmatory Review Notices

 

Phone contact successful; SSA-454-BK completed via phone

See Exhibit 1, in DI 28040.300B.1.

Phone contact successful; individual, payee, or representative prefers to complete the SSA-454-BK

See Exhibit 2, in DI 28040.300B.2.

Preliminary phone contact unsuccessful

See Exhibit 3, in DI 28040.300B.3.

B. Exhibits of confirmatory review notices

1. Exhibit 1 (Phone contact successful; SSA-454-BK completed via phone)

Use this letter when you have successfully contacted the individual, payee, or representativeand completed the SSA-454-BK interview on the phone. You may use this letter for Title II only, Title XVI only or concurrent cases. Use the appropriate heading(s) for the letter and the appropriate type of case(s) in the second paragraph.

SOCIAL SECURITY ADMINISTRATION

[Social Security Disability Insurance

Supplemental Security Income – use correct title(s)]

Notice of Continuing Disability Review

Date:

Beneficiary/Recipient SSN:

N/H SSN, if applicable:

This is the letter we said we would send to you when we talked on the phone about Social Security reviewing your disability case. During our phone conversation, we asked you questions about your disability and recorded your answers. Just to make sure you understand what we said on the phone, we have sent this letter to explain our review process.

Periodically, we must review the cases of people who are receiving disability benefits to make sure that they are still disabled. We are getting ready to review your ________________________ case(s) and need to update the information in your file. [Use appropriate text for type of case - Social Security Disability; Supplemental Security Income; or, Social Security and Supplemental Security Income.]

What Will We Do In the Review Process?

Generally, we will review your case to see if your medical condition(s) has changed since the last time we looked at your case. To do this, we will need information from doctors, hospitals, clinics, and other sources that have treated you in the last 12 months. If you have not been treated in the last 12 months, we may ask for information from other people who can tell us about your condition(s). We will also ask how your condition(s) limits you. After we have received current information, we will look at how your condition(s) was at the time we last looked at your case and then look at how you are now to see if your condition(s) has changed. If we need more information, we will contact you again. When we have finished the review, we will send you a letter to let you know what we have decided.

What If the Review Shows You Are No Longer Disabled?

When we last looked at your case, we expected that your condition(s) would not get better. However, it is possible that we will find out that you are no longer disabled and that your checks should stop. If this happens, you can appeal our decision. You can have a face-to-face hearing with the person who will make the decision on your appeal. You can also ask us to keep paying you during your appeal.

What Should You Do Now?

We have included some forms (Authorization to Disclose Information to the Social Security Administration (SSA), SSA-827) that we need you to sign, date, have witnessed, and return to us. These forms give us permission to request information from your medical and other sources. We cannot continue the review process until we receive these forms. If you have additional information about your disability that you would like to give us, you may send it along with these forms. We have included a return envelope for you to use.

Please return all forms to us by ____________________ [14 calendar days from date of this letter] Please call ____________________ at phone number ____________________ if you have questions about this review process or these forms.

If we do not receive all forms by the above date, we may terminate your benefits.

2. Exhibit 2 (Phone contact successful; individual, payee, or representative prefers to complete the SSA-454-BK)

Use this letter when you have successfully made contact by phone, but the individual, payee, or representative prefers to complete the SSA-454-BK and then return it to the DDS instead of doing the interview on the phone. Before sending the SSA-454-BK, record the date of the comparison point decision (CPD) in the appropriate space on the first page of the form. You may use this letter for Title II only, Title XVI only or concurrent cases. Use the appropriate heading(s) for the letter and the appropriate type of case(s) in the second paragraph.

SOCIAL SECURITY ADMINISTRATION

[Social Security Disability Insurance

Supplemental Security Income – use correct title(s)]

Notice of Continuing Disability Review

Date:

Beneficiary/Recipient SSN:

N/H SSN, if applicable:

We talked to you earlier about Social Security reviewing your disability case. During our phone conversation, we told you that we could ask you questions about your disability and we would record your answers. You said that you wanted us to send you a form to complete instead of answering the questions on the phone. This letter explains our review process and includes the form (Continuing Disability Review Report, SSA-454-BK) for you to complete and return to us.

Periodically, we must review the cases of people who are receiving disability benefits to make sure that they are still disabled. We are getting ready to review your ____________________ case(s) and need to update the information in your file. [Use appropriate text for type of case - Social Security Disability; Supplemental Security Income; or, Social Security and Supplemental Security Income.]

What Will We Do In the Review Process?

Generally, we will review your case to see if your medical condition(s) has changed since the last time we looked at your case. To do this, we will need information from doctors, hospitals, clinics, and other sources that have treated you in the last 12 months. If you have not been treated in the last 12 months, we may ask for information from other people who can tell us about your condition(s). We will also ask how your condition(s) limits you. After we have received current information, we will look at how your condition(s) was at the time we last looked at your case and then look at how you are now to see if your condition(s) has changed. If we need more information, we will contact you again. When we have finished the review, we will send you a letter to let you know what we have decided.

What If the Review Shows You Are No Longer Disabled?

When we last looked at your case, we expected that your condition(s) would not get better. However, it is possible that we will find out that you are no longer disabled and that your checks should stop. If this happens, you can appeal our decision. You can have a face-to-face hearing with the person who will make the decision on your appeal. You can also ask us to keep paying you during your appeal.

What Should You Do Now?

Complete the enclosed SSA-454-BK. We have also included some other forms (Authorization to Disclose Information to the Social Security Administration (SSA), SSA-827) that we need you to sign, date, have witnessed, and return to us. These forms give us permission to request information from your medical and other sources. We cannot continue the review process until we receive these forms. If you have additional information about your disability that you would like to give us, you may send it along with these forms. We have included a return envelope for you to use.

Please call ____________________ at phone number ____________________ if you have questions about this review process or these forms. Please return all forms to us by ____________________ [14 calendar days from date of this letter].

If we do not receive all forms by the above date, we may terminate your benefits.

3. Exhibit 3 (Preliminary phone contact unsuccessful)

Use this letter when you have been unable to make direct contact by phone and you are requesting the individual, payee, or representative to call the DDS for the SSA-454 phone interview. You may use this letter for Title II only, Title XVI only or concurrent cases. Use the appropriate heading(s) for the letter and the appropriate type of case(s) in the first paragraph.

SOCIAL SECURITY ADMINISTRATION

[Social Security Disability Insurance

Supplemental Security Income – use correct title(s)]

Notice of Continuing Disability Review

Date:

Beneficiary/Recipient SSN:

N/H SSN, if applicable:

Periodically, we must review the cases of people who are receiving disability benefits to make sure they are still disabled. We are getting ready to review your ____________________ case(s) and need to update the information in your file. [Use appropriate text for type of case – Social Security Disability; Supplemental Security Income; or, Social Security Disability and Supplemental Security Income.] This letter explains the review process.

We want to talk to you and ask you about your condition(s), but we have been unable to reach you by telephone. Please call ____________________ at phone number ____________________ by ____________________ [14 calendar days from the date of this letter].

What Will We Do In the Review Process?

Generally, we will review your case to see if your medical condition(s) has changed since the last time we looked at your case. To do this, we will need information from doctors, hospitals, clinics, and other sources that have treated you in the last 12 months. If you have not been treated in the last 12 months, we may ask for information from other people who can tell us about your condition(s). We will also ask how your condition(s) limits you. After we receive current information, we will look at how your condition(s) was at the time we last looked at your case and then look at how you are now to see if your condition(s) has changed. If we need more information, we will contact you again. When we have finished the review, we will send you a letter to let you know what we have decided.

What If the Review Shows That You Are No Longer Disabled?

When we last looked at your case, we expected that your condition(s) would not get better. However, it is possible that we will find out that you are no longer disabled and that your checks should stop. If this happens, you can appeal our decision. You can have a face-to-face hearing with the person who will make the decision on your appeal. You can also ask us to keep paying you during your appeal.

What Will Happen When You Call?

We will ask you these questions about your condition(s) and record your answers on a form.

  • A description of your current medical condition(s).

  • The names of any medicines that you are taking for your condition(s).

  • The names of any tests that you have had or will have