NL 00701.000 Form Notices

Subchapter Table of Contents
Section Latest
Transmittal
Form Notice Locator Charts
NL 00701.001Usage Chart for RSDI Authorization and General Use Form Notices 
NL 00701.003Usage Chart for Form Notices Relating Specifically to Disability Issues 
NL 00701.005Usage Chart for HI/SMI Form Notices 
NL 00701.007Usage Chart for Benefit Adjustment Form Notices 
NL 00701.024Form SSA-L51 — Determination of One-Half Support (At Time N/H's Disability Began — Disapproved)BASIC 11-81
NL 00701.036Form SSA-L223 — Auxiliary Disapproval — N/H Not Entitled 
NL 00701.060Form SSA-L236 — CDB Disapproval — Not Disabled Before Age 22BASIC 11-81
NL 00701.063Form SSA-L236A — CDB Disapproval — Not Disabled Through Point of Decision (Not Yet Age 22)BASIC 11-81
NL 00701.066Form SSA-L237 — DIB Denial — Miscellaneous (Fill-In Letter)BASIC 11-81
NL 00701.069Form SSA-L237B — DIB Denial — Death Before End of 5-Month Waiting PeriodBASIC 11-81
NL 00701.093Form SSA-L250 — Approval of Withdrawal 
NL 00701.114Form SSA-L412 — Reconsideration — Initial Interim Notice — Additional Evidence is Being ObtainedBASIC 11-81
NL 00701.116Form SSA-L445-U2 — Notice to Spouse in Separate Household 
NL 00701.117Form CMS-L457 — Acknowledgement of Request for Medicare Part B Termination 
NL 00701.120Form CMS-L458 — Acknowledgement of Request for Premium Hospital Insurance Termination 
NL 00701.126Form SSA-L467 — Disability Benefit Suspension Notice (Miscellaneous) 
NL 00701.135SSA-L501 Home Visit LetterTN 15 06-10
NL 00701.136SSA-L502 Telephone Interview LetterTN 15 06-10
NL 00701.137SSA-L503 Centenarian Project -- Representative Payee Notice of InterviewTN 15 06-10
NL 00701.138SSA-L504 Centenarian Project -- Nursing Home Notice of InterviewTN 15 06-10
NL 00701.139SSA-L505 Residence Address Request LetterTN 15 06-10
NL 00701.198Form SSA-L679 — Student Not Eligible for Benefits After Age 22 
NL 00701.199Form SSA-L680 — Student Not Eligible for Benefits After Age 19 
NL 00701.205SSA-L725, Employer Verification of Monthly WagesTN 13 09-06
NL 00701.237Form SSA-L761 — Miscellaneous Adjustment Notice 
NL 00701.255Form SSA-L795-U2 — Reconsideration — Affirmation of DIB or CDB Cessation 
NL 00701.267Form SSA-L800-U2 — Reconsideration — Affirmation of DIB Denial 
NL 00701.270Form SSA-L801-U2 — Reconsideration — Affirmation of DWB CessationBASIC 11-81
NL 00701.354Form SSA-L823 — Auxiliary Denial — N/H Not Entitled 
NL 00701.360Form SSA-L829-U2-Disapproval -- Miscellaneous Fill-In LetterBASIC 11-81
NL 00701.387Form SSA-L850 — Approval of Request for Withdrawal (Disability)BASIC 11-81
NL 00701.390Form SSA-L917 — Reconsideration — DIB Earnings Requirement Not MetBASIC 11-81
NL 00701.391Form SSA-L928 – Reconsideration -- Affirmation of DIB, DWB, or CDB DenialTN 14 09-07
NL 00701.425Form SSA-L1013 — DIB Continuance — Title II 
NL 00701.430Form SSA-L1014 — DIB Continuance — Title XVI 
NL 00701.435Form SSA-L1016 (Formerly SSA-L368) — DIB Cessation (T21) No OPA/UPA — No HI/SMIBASIC 11-81
NL 00701.440Form SSA-L1017 (Formerly SSA-L368A) — DIB Cessation (T21) — No DIB OPA/UPA HI/SMI ArrearageBASIC 11-81
NL 00701.445Form SSA-L1018 (Formerly SSA-L368B) — DIB Cessation (T21) — No DIB OPA/UPA — SMI RefundBASIC 11-81
NL 00701.450Form SSA-L1019 (Formerly SSA-L368C) — DIB Cessation (T21) — DIB Underpayment — SMI Premium ArrearageBASIC 11-81
NL 00701.455Form SSA-L1020 (Formerly SSA-L368D) — DIB Cessation (T21) — No DIB OPA/UPA HI/SMI With No Overage or ArrearageBASIC 11-81
NL 00701.460Form SSA-L1021 (Formerly SSA-L369) — DIB Cessation (T20 and T28) — No DIB OPA/UPA — No HI/SMIBASIC 11-81
NL 00701.465Form SSA-L1022 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI Premium ArrearageBASIC 11-81
NL 00701.470Form SSA-L1023 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — SMI Premium RefundBASIC 11-81
NL 00701.475Form SSA-L1024 — DIB Cessation (T20 and T28) — DIB Underpayment — SMI Premium ArrearageBASIC 11-81
NL 00701.480Form SSA-L1025 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI With No Premium Overage or ArrearageBASIC 11-81
NL 00701.485Form SSA-L1026 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — No HI/SMI Auxiliaries in NH's HouseholdBASIC 11-81
NL 00701.490Form SSA-L1027 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI Premium Arrearage — Auxiliaries in NH's HouseholdBASIC 11-81
NL 00701.495Form SSA-L1028 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — SMI Refund — Auxiliaries in NH's HouseholdBASIC 11-81
NL 00701.500Form SSA-L1029 — DIB Cessation (T20 and T28) DIB U/P Premium Arrearage — Auxiliaries in NH's HouseholdBASIC 11-81
NL 00701.505Form SSA-L1030 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI With No Overage or Arrearage — Auxiliaries in NH's HouseholdBASIC 11-81
NL 00701.515Form SSA-L1032 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI Premium ArrearageBASIC 11-81
NL 00701.520Form SSA-L1033 — Disability Cessation (T22) — No DIB OPA/UPA — SMI RefundBASIC 11-81
NL 00701.525Form SSA-L1034 — Disability Cessation (T22) — DIB Underpayment SMI ArrearageBASIC 11-81
NL 00701.530Form SSA-L1035 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI With No Premium Arrearage or OverageBASIC 11-81
NL 00701.535Form SSA-L1036 — Disability Cessation (T22) — No DIB OPA/UPA — No HI/ SMI — Auxiliaries in NH's HouseholdBASIC 11-81
NL 00701.540Form SSA-L1037 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI Premium Arrearage — Auxiliaries in N