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”