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

A. DIB denials

Situation/Usage Form Notice POMS Section
Disability Denial DIB Miscellaneous Fill-In Letter SSA-L237 NL 00701.066
Death Before End of 5 Month Waiting Period SSA-L237B NL 00701.069

B. CDB denials

Situation/Heading Form Notice POMS Section
Not Disabled Before Age 22 SSA-L236 NL 00701.060
CDB Not Disabled through Point of Decision—Not Yet Age 22 SSA-L236A NL 00701.063

C. Disability continuance

Situation/Usage From Notices POMS Section
DIB Continuance—Title II SSA-L1013 NL 00701.425
DIB Continuance—Title XVI SSA-L1014 NL 00701.430

D. Chart for selecting disability cessation notices

Cessation Paragraphs Usage/Situation Applicable Form Notice Section
T20 &T28 No DIB overpayment or underpayment No HI/SMI involvement. SSA-L1021 NL 00701.460
Same as SSA-L1021 except auxiliaries in W/E's household. SSA-L1026 NL 00701.485
No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. SSA-L1022 NL 00701.465
Same as SSA-L1022 except auxiliaries in W/E's household. SSA-L1027 NL 00701.490
No DIB overpayment or underpayment HI/SMI involved. SMI premium to be refunded. SSA-L1023 NL 00701.470
Same as SSA-L1023 except auxiliaries in W/E's household. SSA-L1028 NL 00701.495
DIB underpayment and HI/SMI involvement with a SMI premium arrearage. SSA-L1024 NL 00701.475
No DIB overpayment or underpayment HI/SMI involvement with no premium coverage or arrearage. SSA-L1025 NL 00701.480
Same as SSA-L1025 except auxiliaries in W/E's household. SSA-L1030 NL 00701.505
DIB cessation—DIB U/P SMI Premium Arrearage Auxiliaries in NH's Household. SSA-L1029 NL 00701.500
T21 No DIB overpayment or underpayment No HI/SMI involvement. SSA-L1016 NL 00701.435
No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. SSA-L1017 NL 00701.440
No DIB overpayment or underpayment HI/SMI involved. SMI premium to be refunded. SSA-L1018 NL 00701.445
DIB underpayment and HI/SMI involved with a SMI premium arrearage. SSA-L1019 NL 00701.450
No DIB overpayment or underpayment HI/SMI involvement with no premium coverage or arrearage. SSA-L1020 NL 00701.455
T22 Same as SSA-L1031 except auxiliaries in W/E's household. SSA-L1036 NL 00701.535
No DIB overpayment or underpayment HI/SMI involved with a premium arrearage. SSA-L1032 NL 00701.515
Same as SSA-L1032 except auxiliaries in W/E's household. SSA-L1037 NL 00701.540
No DIB overpayment or underpayment HI/SMI involved. SMI premiums to be refunded. SSA-L1033 NL 00701.520
Same as SSA-L1033 except auxiliaries in W/E's household. SSA-L1038 NL 00701.545
DIB underpayment and HI/SMI involvement with a SMI premium arrearage. SSA-L1034 NL 00701.525
Same as SSA-L1034 except auxiliaries in W/E's household. SSA-L1039 NL 00701.550
No DIB overpayment or underpayment HI/SMI involved with no premium coverage or arrearage. SSA-L1035 NL 00701.530
Same as SSA-L1035 except auxiliaries in W/E's household. SSA-L1040 NL 00701.555

E. Miscellaneous disability form notices

Situation/Usage Form Notice POMS Section
Disability Suspension Notice (Miscellaneous) SSA-L467 NL 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 - 11/07/2011
Batch run: 04/14/2014
Rev:11/07/2011