TN 4 (05-95)
NL 00603.100 How to Prepare the Notice
The SSA Notice Standards Handbook provides agency guidelines for preparing notices to ensure uniformity in appearance, clarity and improved readability. All components that prepare disability notices must follow the standards in this handbook for notice appearance and signature policy. The following instructions cover additional requirements for disability notices.
B. Procedure - physical reparation
1. Notice/Letter to prepare
If a notice or letter must be prepared, see item 29 of the SSA-831-U3, SSA-832-U3, SSA-833-U3, SSA-573 or SSA-865 (if an “s” appears in item 29) for the proper letter and special instructions indicated by the use of suffixes. Also, see item 34 of SSA-831-U3 for possible additional notice instructions.
NOTE: See D. below for actions required by suffixes.
2. Preparing the notice
Prepare an original and one copy of the notice (two copies of the SSA-L442-U3 or if suffixes “A” or “Z” are shown).
Verify that the social security number (SSN) on the SSA-831-U3, SSA-832-U3 or SSA-833-U3 agrees with SSN on folder jacket. (Refer folder to the disability examiner (ODIO, PSC, DDS or DQB) or to the CR (FO) if SSN's do not agree.)
Use the actual date the notice is mailed, or expected to be mailed.
NOTE: The notice is dated by the office that actually releases the notice.
Type claimant's name as shown in item 5 of the SSA-831-U3 or item 2.B. of the SSA-832-U3 or SSA-833-U3. If a legal guardian filed on behalf of a legally incompetent claimant, type the name as follows:
Jane Doe (1st line)
for John Doe - (second line)
Type the address as shown in item 5 of the SSA-831-U3, item 3 of the SSA-832-U3 or item 2.C.of the SSA-833-U3. (When claimant's current whereabouts are unknown, use last known address in file.)
Type the complete text or body of the notice (not required if a form notice is involved). Include all designated paragraphs and fill-ins if appropriate.
Type the DDS/FO code in the lower right hand corner of the notice. Refer to item 12 of the SSA-831-U3 or item 7 of the SSA-832-U3 and SSA-833-U3.
Place the folder copy and a copy of all parts of the notice, excluding pamphlets, on the right side of the disability folder on top of all other material. See D. below for handling of additional copies.
C. Procedure - personalized explanation required
Use one of the following methods when preparing a notice which requires a personalized explanation.
1. How to prepare
Type the personalized explanation on an SSA-4268-U4/C4 (Explanation of Determination).
Write or type the form number of the preprinted notice and any rider number(s) in the lower left hand corner of the SSA-4268-U4/C4, if this information is not shown in item 29 of the SSA-831-U3, SSA-832-U3 or SSA-833-U3.
Staple the attachment to the preprinted form notice.
b. Merged text
Use “merged text” format (incorporate the personalized explanation into the body of the notice). Delete any reference to a personalized attachment when preparing a notice using merged text.
When using merged text format for the first time, the DDS must submit a sample through the RO to OD for approval before implementation. The RO must direct the request to:
ODP, Office of Process Policy
6401 Security Blvd.
Baltimore, MD 21235-6401
DO NOT OPEN IN MAILROOM
2. DHU decision notice
Attach a “Disability Hearing Officer's Decision” (SSA-1207, SSA-1207, Supp. 1, SSA-1207, Supp. 2 or SSA-1207, Supp. 3.), as shown on the cover notice.
NOTE: The DHO “decision” is the personalized explanation.
3. Special considerations - multiple claims
Prepare a separate notice and personalized explanation for:
concurrent reconsideration title II/title XVI denials.
initial DIB/DWB and DIB/CDB denials.
concurrent CDR cessations.
EXCEPTION: When merged text format is not used and the basis for a denial is the same for both claims (i.e., both are denied for medical reasons) and the contents of the personalized explanation are the same (e.g., decision and concluding paragraph,) photocopy the personalized explanation and attach it to each denial notice.
Show the correct claim number on each copy of the personalized explanation.
Use one form notice, SSA-L928 (Social Security Notice of Reconsideration), if both are title II reconsideration determinations.
D. Procedure - action required by suffixes
1. Suffix “S”
Review the left side of the folder for a form SSA-573 or SSA-865 containing special typing instructions for the notice. Follow the instructions on the request form when preparing the notice(s).
2. Suffix “A” - attorney or other authorized representative
For Suffix “A”:
Prepare two copies of the notice and personalized explanation.
Annotate original and copies of the notice with the remark: “Copy sent to:” and underneath it, type the name of the representative followed by “ESQ.” or “Attorney at Law”, if the representative is an attorney.
Place the annotation two lines after the signature.
Type the representative's name and address on an envelope with a “21241” return zip code (title II or title XVI).
Place the second copy in the envelope and mail it to the representative.
3. Suffix “Z” authorized disclosure of entitlement information
For Suffix “Z”, follow the procedure shown for Suffix “A” with the following changes:
Substitute the name of the organization that will receive the information.
Omit the personalized portion of the notice when releasing copies to the organization.
Type “See Attached Notice” on the authorization form located on the right side of the claim folder, and then photocopy the authorization.
File the photocopy of the authorization on the right side of the folder.
Staple the original authorization to the copy of the notice and mail it to the organization.
4. Suffix “C25” — return of document requested
For Suffix “C25”:
Photocopy the document(s) and file the copy(ies) on the right side of the folder.
Prepare the notice in the usual manner but add the remark “Document” under the enclosure if any, on the original and copy of the notice.
Place the original document in the same envelope with the notice and mail to the claimant.
Use registered or certified mail if the claimant expresses concern about the loss of the document, or requests that special care be taken.
NOTE: The document(s) to be returned will be found on the top of all material on the right side of the folder, and will have an “X” in pencil in the upper right hand corner.