NL 00701.430 Form SSA-L1014 — DIB Continuance — Title XVI

A. Sample form

G-NL_00701.430A-1

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Reverse Side

G-NL_00701.430A-2

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B. Preparation of form

Refer to Form SSA-833 for completing the name, address and claim number. This notice will be designated in the LTR/PAR NO. block of Form SSA-833-U5. This notice will be shown followed by the block number(s) to be checked; the appropriate fill-in for the block, enclosed in parentheses. (E.g., L1014-1 (9-77), 2(6)). Any additional paragraphs, if applicable, will also be shown.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900701430
NL 00701.430 - Form SSA-L1014 -- DIB Continuance -- Title XVI - 06/18/2013
Batch run: 06/18/2013
Rev:06/18/2013