TN 1 (10-15)

DI 28095.100 Stock Letters for Title II, Title XVI, and Concurrent (Title II and Title XVI) Claims Continuances

 

When preparing a manual notice for Title II, Title XVI and concurrent Title II and Title XVI continuances, use this chart:

 

Notices and Fill-ins

Add Suffix to the Notice *

Type of Case

Title II
SSA-L1013

Title XVI
SSA-L1014

Disability Continues--No Work Activity--No Medical Reexamination Scheduled (SSI and Title II DIB, CDB and DWB Claims)

Check Block None

Fill-in (Disabled)
Check Block None

“A”-“Z”-“C25”

Disability Continues--No Work Activity--Medical Re-exam Scheduled (SSI and Title II DIB and CDB Claims)

Check Block 6

Fill-in (Disabled) Check Block 6

“A”-“Z”-“C25”

Disability Continues--Trial Work Period Less Than 9 Months--Work Stopped--Medical Re-exam Scheduled (SSI and Title II DIB and CDB Claims)

Check Block 2, 6

Fill-in (Disabled) Check Block 2, 6

“A”-“Z”-“C25”

Disability Continues--Trial Work Period Less Than 9 Months--Work Stopped--No Medical Re-exam Scheduled (SSI and Title II DIB and CDB Claims)

Check Block 2

Fill-in (Disabled)
Check Block 2

“A”-“Z”-“C25”

Disability Continues--Trial Work Period Less Than 9 Months--Work Continuing--No Medical Reexamination Scheduled (SSI and Title II DIB and CDB Claims)

Check Block 3

Fill-in (Disabled)
Check Block 3

“A”-“Z”-“C25”

Disability Continues--Trial Work Period Completed--Work Stopped--Medical Re-exam Scheduled (SSI and Title II DIB, CDB Claims)

Check Block 2, 6

Fill-in (Disabled)
Check Block 2, 6

“A”-“Z”-“C25”

Disability Continues--Trial Work Period Completed--Work Stopped-No Medical Re-exam Scheduled (SSI and Title II DIB and CDB Claims)

Check Block 2

Fill-in (Disabled)
Check Block 2

“A”-“Z”-“C25”

Disability Continues--Trial Work Period Completed--Currently Working (Work Not SGA)--Medical Reexamination Scheduled (SSI and Title II DIB and CDB Claims)

Check Block 4, 6

Fill-in (Disabled)
Check Block 4, 6

“A”-“Z”-“C25”

Disability Continues--Trial Work Period Completed--Currently Working (Work Not SGA)--No Medical Reexamination Scheduled (SSI and Title II DIB and CDB Claims)

Check Block 4

Fill-in (Disabled)
Check Block 4

“A”-“Z”-“C25”

Blindness Continues--Medical Reexamination Scheduled (SSI and Title II DIB, DWB, CDB Claims)

Check Block 6

Fill-In (Blind)
Check Block 6

“A”-“Z”-“C25”

Blindness Continues--No Medical Reexamination Scheduled (SSI and Title II DIB, DWB, CDB Claims)

Check Block None

Fill-In (Blind)
Check Block None

“A”-“Z”-“C25”

Blindness Ends - Disability Continues - Follow DI 28080.065 for additional language needed. (SSI and Title II DIB, DWB, CDB Claims)

Check Block 6

Fill-in (Disabled)
Check Block 6

“A”-“Z”-“C25”

Disability Continues--Not Entitled to a Trial Work Period--Currently Working (Work Not SGA)--No Medical Re-exam Scheduled (Title II DIB, CDB, and DWB Claims)

Check Block 5

Fill-in (Disabled)
Check Block 5

“A”-“Z”-“C25”

Title XVI procedures and Title XVI-Title II notices

Legend of fill-ins for check blocks:

1 Check Block 6--No fill-ins.

Check Block 2--Number of trial work service months tallied. (Never indicate more than nine months)

Check Block 3--Number of months worked in the trial work period, and months counting toward the trial work period.

Check Blocks 4--Month and year of review at end of trial work period.

Check Blocks 5--Trial work period months.

*NOTE: Suffix “A”--Indicates a copy of the notice that will be sent to the representative identified in the Remarks portion of the SSA-832.

Suffix “Z”--Indicates a copy of the notice that will be sent to the authorized organization who requested a copy.

Suffix “C25”--Indicates the beneficiary or recipient requests the return of a document that he or she submitted.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428095100
DI 28095.100 - Stock Letters for Title II, Title XVI, and Concurrent (Title II and Title XVI) Claims Continuances - 10/13/2015
Batch run: 10/13/2015
Rev:10/13/2015