TN 1 (10-02)
DI 55099.105 SSA-L1369 (Beneficiary/Recipient Notice Review of Ticket Eligibility Explanation Reason(s)
Given in Prior Explanation Was Incorrect Individual Was and Remains Ineligible Different
Reason or Set of Reasons)
Social Security Administration
Important Information
Social Security Administration
(1)
(2)
Date: (3)
Social Security Number: (4)
(5)
(6)
(7)
This is a notice about whether you are eligible to receive a Ticket to participate
in the Ticket to Work program. Please read it carefully.
The Reason We Gave You Was Incorrect, But You Are Still Not Eligible for a Ticket
You asked us to review our explanation of (8) about whether you are eligible to get
a Ticket because you believe that (9) we gave you (10) incorrect.
We have reviewed our records and prior explanation. We agree that (11) we gave you
for why you were not eligible for a Ticket (12) incorrect. However, our records show
that you were not eligible for a Ticket for the (13) shown below and that (14). The
correct (15) you are not eligible for a Ticket (16):(17)
You May Be Eligible for a Ticket at a Later Date
On a regular basis, we identify individuals who become eligible to receive a Ticket.
If your situation changes and the reason(s) listed above no longer exists, and you
meet all of the other requirements for getting a Ticket, we will identify your record
automatically and send you a Ticket in the mail. For this reason, you should report
any changes that might mean you could become eligible for a Ticket.
If You Disagree with this Explanation
If you disagree with our explanation of why you are not currently eligible to receive
a Ticket, you may ask us to review this explanation. We will consider any new facts
you have and send you another notice.
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You have 30 days to ask for a review.
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The 30 days start the day after you receive this notice. We assume you got this notice
5 days after the date on it unless you show us that you did not get it within the
5-day period.
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You must have a good reason for waiting more than 30 days to ask for a review.
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You may request a review in person at any Social Security office or by letter.
If You Have Any Questions
We invite you to visit our website at www.ssa.gov on the Internet to find general information about the programs of the Social Security
Administration. Also, you may wish to go directly to www.ssa.gov/work for specific information on employment supports for people with disabilities. If
you have specific questions or you want to let us know about a change that affects
your eligibility for a Ticket, you may call us toll-free at 1-800-772-1213, or call
your local Social Security office at (18). We can answer most questions over the phone.
If you have difficulty hearing or talking on a telephone, you may call our TTY/TDD
number, 1-800-325-0778. You can also write or visit any Social Security office. The
office that serves your area is located at:
(19)
(20).
If you do call or visit an office, please have this notice with you. It will help
us answer your questions. You may call before you visit an office to make an appointment.
This will help us serve you more quickly when you arrive.
Deputy Commissioner
for Operations
Fill-ins
(1) Street address of FO/PC
(2) City, State, and zip code of FO/PC
(3) Date
(4) Social Security Number
(5) Name of beneficiary/recipient
(6) Address
(7) City, State, and zip code
(8) Date of explanation notice
(10) (a) the reason
(b) the reasons
(c) one reason
(d) some of the reasons
(10)(a) was
(b) were
(11)(a) the reason
(b) the reasons
(c) one reason
(d) some of the reasons
(12) (a) was
(b) were
(13) (a) reason
(b) reasons
(14) (a) this reason still exists
(b) these reasons still exist
(15) (a) reason
(b) reasons
(16) (a) is
(b) are
(17)
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You are not eligible for benefits under the Social Security or Supplemental Security
Income disability program.
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You are not receiving a Federal cash disability-based benefit from us.
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We previously decided you recovered enough to work and are now paying you benefits
under special rules while you participate in an approved vocational rehabilitation
program.
We are not issuing Tickets to individuals who are receiving benefits under these special
rules.
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We previously decided you recovered enough to work and are now paying you benefits
under special rules while you appeal that decision. We are not issuing Tickets to
individuals who are receiving benefits under these special rules.
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We are not issuing Tickets to individuals whose health is expected to improve until
we review their cases at least once. The notice that we sent you when you were first
awarded disability benefits told you your health was expected to improve. That notice
also told you when we will review your case and that we will send you a notice before
we start this review.
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We are not issuing Tickets to individuals receiving disability benefits who turn age
18 unless we find them disabled based on the rules we use for adults filing new disability
claims. You became eligible for Supplemental Security Income benefits prior to your
18th birthday based on special rules we have for children. We have not yet decided if
you are eligible for benefits based on the rules we use for adults.
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We are not issuing Tickets to individuals who are getting provisional benefits. You
now get these temporary benefits because special rules allow us to pay you for up
to six months while we decide if we can reinstate your disability or blindness benefits.
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We are not issuing Tickets to individuals who are getting Supplemental Security Income
benefits while we are making a final determination about whether they are disabled
or blind.
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You now get these benefits because special rules allow us to pay you for up to 6 months
while we decide whether you are disabled or blind.
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At the present time, the Ticket to Work program is not available to individuals living
in your area.
(18) Phone number of resident FO
(19) Street address of resident FO
(20) City, State, and zip code of resident FO