NL 00701.387 Form SSA-L850 — Approval of Request for Withdrawal (Disability)
A. Sample form
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B. Preparation of form
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.
month and year.
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.