BASIC (11-81)

NL 00701.615 Form SSA-L1221 — RIB Disapproval — Lack of Insured Status

A. Sample form

G-NL_00701.615A

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B. Preparation of form

Refer to Form SSA-3428-U2 (Determination of Disallowance Coding Sheet) “Name and Address Information” filed in block 2 for completing the name and address.

This notice requires two fill-ins:

  1. required quarters of coverage

  2. number of quarters of coverage the individual has

The necessary fill-ins for this notice should be shown in the “Disallowance Notice Information” filed in block 4. If the fill-ins are not shown, return the claim to the individual who initiated the action.

If additional paragraphs are required, they will be shown on Form SSA-3428-U2 or Form SSA-573.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900701615
NL 00701.615 - Form SSA-L1221 -- RIB Disapproval -- Lack of Insured Status - 06/18/2013
Batch run: 06/18/2013
Rev:06/18/2013