NL 00701.000 Form Notices

Subchapter Table of Contents
Section   Latest
Transmittal
Form Notice Locator Charts
NL 00701.001 Usage Chart for RSDI Authorization and General Use Form Notices
NL 00701.003 Usage Chart for Form Notices Relating Specifically to Disability Issues
NL 00701.005 Usage Chart for HI/SMI Form Notices
NL 00701.007 Usage Chart for Benefit Adjustment Form Notices
NL 00701.024 Form SSA-L51 — Determination of One-Half Support (At Time N/H's Disability Began — Disapproved) TN BASIC 11-81
NL 00701.036 Form SSA-L223 — Auxiliary Disapproval — N/H Not Entitled
NL 00701.060 Form SSA-L236 — CDB Disapproval — Not Disabled Before Age 22 TN BASIC 11-81
NL 00701.063 Form SSA-L236A — CDB Disapproval — Not Disabled Through Point of Decision (Not Yet Age 22) TN BASIC 11-81
NL 00701.066 Form SSA-L237 — DIB Denial — Miscellaneous (Fill-In Letter) TN BASIC 11-81
NL 00701.069 Form SSA-L237B — DIB Denial — Death Before End of 5-Month Waiting Period TN BASIC 11-81
NL 00701.093 Form SSA-L250 — Approval of Withdrawal
NL 00701.114 Form SSA-L412 — Reconsideration — Initial Interim Notice — Additional Evidence is Being Obtained TN BASIC 11-81
NL 00701.116 Form SSA-L445-U2 — Notice to Spouse in Separate Household
NL 00701.117 Form CMS-L457 — Acknowledgement of Request for Medicare Part B Termination
NL 00701.120 Form CMS-L458 — Acknowledgement of Request for Premium Hospital Insurance Termination
NL 00701.126 Form SSA-L467 — Disability Benefit Suspension Notice (Miscellaneous)
NL 00701.135 SSA-L501 Home Visit Letter TN 15 06-10
NL 00701.136 SSA-L502 Telephone Interview Letter TN 15 06-10
NL 00701.137 SSA-L503 Centenarian Project -- Representative Payee Notice of Interview TN 15 06-10
NL 00701.138 SSA-L504 Centenarian Project -- Nursing Home Notice of Interview TN 15 06-10
NL 00701.139 SSA-L505 Residence Address Request Letter TN 15 06-10
NL 00701.198 Form SSA-L679 — Student Not Eligible for Benefits After Age 22
NL 00701.199 Form SSA-L680 — Student Not Eligible for Benefits After Age 19
NL 00701.205 SSA-L725, Employer Verification of Monthly Wages TN 13 09-06
NL 00701.237 Form SSA-L761 — Miscellaneous Adjustment Notice
NL 00701.255 Form SSA-L795-U2 — Reconsideration — Affirmation of DIB or CDB Cessation
NL 00701.267 Form SSA-L800-U2 — Reconsideration — Affirmation of DIB Denial
NL 00701.270 Form SSA-L801-U2 — Reconsideration — Affirmation of DWB Cessation TN BASIC 11-81
NL 00701.354 Form SSA-L823 — Auxiliary Denial — N/H Not Entitled
NL 00701.360 Form SSA-L829-U2-Disapproval -- Miscellaneous Fill-In Letter TN BASIC 11-81
NL 00701.387 Form SSA-L850 — Approval of Request for Withdrawal (Disability) TN BASIC 11-81
NL 00701.390 Form SSA-L917 — Reconsideration — DIB Earnings Requirement Not Met TN BASIC 11-81
NL 00701.391 Form SSA-L928 – Reconsideration -- Affirmation of DIB, DWB, or CDB Denial TN 14 09-07
NL 00701.425 Form SSA-L1013 — DIB Continuance — Title II
NL 00701.430 Form SSA-L1014 — DIB Continuance — Title XVI
NL 00701.435 Form SSA-L1016 (Formerly SSA-L368) — DIB Cessation (T21) No OPA/UPA — No HI/SMI TN BASIC 11-81
NL 00701.440 Form SSA-L1017 (Formerly SSA-L368A) — DIB Cessation (T21) — No DIB OPA/UPA HI/SMI Arrearage TN BASIC 11-81
NL 00701.445 Form SSA-L1018 (Formerly SSA-L368B) — DIB Cessation (T21) — No DIB OPA/UPA — SMI Refund TN BASIC 11-81
NL 00701.450 Form SSA-L1019 (Formerly SSA-L368C) — DIB Cessation (T21) — DIB Underpayment — SMI Premium Arrearage TN BASIC 11-81
NL 00701.455 Form SSA-L1020 (Formerly SSA-L368D) — DIB Cessation (T21) — No DIB OPA/UPA HI/SMI With No Overage or Arrearage TN BASIC 11-81
NL 00701.460 Form SSA-L1021 (Formerly SSA-L369) — DIB Cessation (T20 and T28) — No DIB OPA/UPA — No HI/SMI TN BASIC 11-81
NL 00701.465 Form SSA-L1022 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI Premium Arrearage TN BASIC 11-81
NL 00701.470 Form SSA-L1023 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — SMI Premium Refund TN BASIC 11-81
NL 00701.475 Form SSA-L1024 — DIB Cessation (T20 and T28) — DIB Underpayment — SMI Premium Arrearage TN BASIC 11-81
NL 00701.480 Form SSA-L1025 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI With No Premium Overage or Arrearage TN BASIC 11-81
NL 00701.485 Form SSA-L1026 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — No HI/SMI Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.490 Form SSA-L1027 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI Premium Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.495 Form SSA-L1028 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — SMI Refund — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.500 Form SSA-L1029 — DIB Cessation (T20 and T28) DIB U/P Premium Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.505 Form SSA-L1030 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI With No Overage or Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.515 Form SSA-L1032 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI Premium Arrearage TN BASIC 11-81
NL 00701.520 Form SSA-L1033 — Disability Cessation (T22) — No DIB OPA/UPA — SMI Refund TN BASIC 11-81
NL 00701.525 Form SSA-L1034 — Disability Cessation (T22) — DIB Underpayment SMI Arrearage TN BASIC 11-81
NL 00701.530 Form SSA-L1035 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI With No Premium Arrearage or Overage TN BASIC 11-81
NL 00701.535 Form SSA-L1036 — Disability Cessation (T22) — No DIB OPA/UPA — No HI/ SMI — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.540 Form SSA-L1037 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI Premium Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.545 Form SSA-L1038 — Disability Cessation (T22) — No DIB OPA/UPA — SMI, Refund — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.550 Form SSA-L1039 — Disability Cessation (T22) — DIB Underpayment — SMI Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.555 Form SSA-L1040 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI With No Premium Overage or Arrearage — Auxiliaries In NH's Household TN BASIC 11-81
NL 00701.600 Form SSA-L1064-C1 — Lump Sum Approval TN BASIC 11-81
NL 00701.612 Form SSA-L1157-U2 — DI Medical Requirements Met — Non Medical Requirements To Be Determined
NL 00701.615 Form SSA-L1221 — RIB Disapproval — Lack of Insured Status TN BASIC 11-81
NL 00701.620 Form SSA-L1222 — RIB Disapproval — Lack of Insured Status — Date of Birth Not Established TN BASIC 11-81
NL 00701.625 Form SSA-L1223 — RIB Disapproval — Not Retirement Age TN BASIC 11-81
NL 00701.630 Form SSA-L1224 — RIB Disapproval — Not Yet Age 62 TN BASIC 11-81
NL 00701.740 Form SSA-L4967-U2 — Reconsideration — Affirmation of Cessation
NL 00701.750 Form SSA-L5620 — One Check Only Adjustment — Reconsideration Paragraph Required — Beneficiary In Conditional Pay or Suspense Status After Action

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900701000
NL 00701.000 - Form Notices - Table of Contents - 12/07/2010
Batch run: 12/07/2010
Rev:12/07/2010