This form notice is used to advise a DWB beneficiary that the cessation of benefits is 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:

1. 1. 

   Type the personalized and technical rationales on the Form SSA-4268-U6 or SSA-4268-C6.

2. 2. 

   Prepare appropriate rider (or include paragraphs on form notice if there is room).

3. 3. 

   Assemble form notice, personalized rationale and the rider stapled together in that order, with envelope for mailing.