NL 00701.003 Usage Chart for Form Notices Relating Specifically to Disability Issues

A. DIB denials

Situation/UsageForm NoticePOMS Section
Disability Denial DIB Miscellaneous Fill-In LetterSSA-L237NL 00701.066
Death Before End of 5 Month Waiting PeriodSSA-L237BNL 00701.069

B. CDB denials

Situation/HeadingForm NoticePOMS Section
Not Disabled Before Age 22SSA-L236NL 00701.060
CDB Not Disabled through Point of Decision—Not Yet Age 22SSA-L236ANL 00701.063

C. Disability continuance

Situation/UsageFrom NoticesPOMS Section
DIB Continuance—Title IISSA-L1013NL 00701.425
DIB Continuance—Title XVISSA-L1014NL 00701.430

D. Chart for selecting disability cessation notices

Cessation ParagraphsUsage/SituationApplicable Form NoticeSection
T20 &T28No DIB overpayment or underpayment No HI/SMI involvement.SSA-L1021NL 00701.460
 Same as SSA-L1021 except auxiliaries in W/E's household.SSA-L1026NL 00701.485
 No DIB overpayment or underpayment HI/SMI involved with a premium arrearage.SSA-L1022NL 00701.465
 Same as SSA-L1022 except auxiliaries in W/E's household.SSA-L1027NL 00701.490
 No DIB overpayment or underpayment HI/SMI involved. SMI premium to be refunded.SSA-L1023NL 00701.470
 Same as SSA-L1023 except auxiliaries in W/E's household.SSA-L1028NL 00701.495
 DIB underpayment and HI/SMI involvement with a SMI premium arrearage.SSA-L1024NL 00701.475
 No DIB overpayment or underpayment HI/SMI involvement with no premium coverage or arrearage.SSA-L1025NL 00701.480
 Same as SSA-L1025 except auxiliaries in W/E's household.SSA-L1030NL 00701.505
 DIB cessation—DIB U/P SMI Premium Arrearage Auxiliaries in NH's Household.SSA-L1029NL 00701.500
T21No DIB overpayment or underpayment No HI/SMI involvement.SSA-L1016NL 00701.435
 No DIB overpayment or underpayment HI/SMI involved with a premium arrearage.SSA-L1017NL 00701.440
 No DIB overpayment or underpayment HI/SMI involved. SMI premium to be refunded.SSA-L1018NL 00701.445
 DIB underpayment and HI/SMI involved with a SMI premium arrearage.SSA-L1019NL 00701.450
 No DIB overpayment or underpayment HI/SMI involvement with no premium coverage or arrearage.SSA-L1020NL 00701.455
T22Same as SSA-L1031 except auxiliaries in W/E's household.SSA-L1036NL 00701.535
 No DIB overpayment or underpayment HI/SMI involved with a premium arrearage.SSA-L1032NL 00701.515
 Same as SSA-L1032 except auxiliaries in W/E's household.SSA-L1037NL 00701.540
 No DIB overpayment or underpayment HI/SMI involved. SMI premiums to be refunded.SSA-L1033NL 00701.520
 Same as SSA-L1033 except auxiliaries in W/E's household.SSA-L1038NL 00701.545
 DIB underpayment and HI/SMI involvement with a SMI premium arrearage.SSA-L1034NL 00701.525
 Same as SSA-L1034 except auxiliaries in W/E's household.SSA-L1039NL 00701.550
 No DIB overpayment or underpayment HI/SMI involved with no premium coverage or arrearage.SSA-L1035NL 00701.530
 Same as SSA-L1035 except auxiliaries in W/E's household.SSA-L1040NL 00701.555

E. Miscellaneous disability form notices

Situation/UsageForm NoticePOMS Section
Disability Suspension Notice (Miscellaneous)SSA-L467NL 00701.126

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900701003
NL 00701.003 - Usage Chart for Form Notices Relating Specifically to Disability Issues - 06/10/2013
Batch run: 06/10/2013
Rev:06/10/2013