NL 00701.255 Form SSA-L795-U2 — Reconsideration — Affirmation of DIB or CDB Cessation
A. Sample form
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This form notice is used to advise a DIB or CDB beneficiary that cessation of benefits was affirmed upon reconsideration.
This notice does not require any fill-ins.
NOTE: Personalized disability notice procedures implemented July 1, 1981, require that Forms SSA-4268-U6/C6 be attached to unfavorable disability form notices. In addition to preparing this form notice according to instructions, the typist must:
Type the personalized and technical rationales on the Form SSA-4268-U6 or SSA-4268-C6.
Prepare appropriate rider (or include paragraphs on form notice if there is room).
Assemble form notice, personalized rationale and the rider stapled together in that order, with envelope for mailing.