If the disability examiner or claims authorizer requests this notice, use Form SSA-L250.
The source of information for completing the fill-ins for this notice is Form SSA-559,
Transmittal Slip for Claims Folder.
“Type of Benefit” shown on Form SSA-559.
NOTE: Paragraph 258 will be automatically included on Form SSA-L250 by the typist unless
dictated information or paragraph 257 is indicated on Form SSA-559.