TN 13 (06-09)
NL 00705.211 Reopening 3 – Auxiliary – Title II
Use one of the following lead-in paragraphs:
4158 Auxiliary – Lead-In -- Allowance to Denial
We are writing to you about your Social Security benefits. We recently looked at (1) disability case again to make sure our decision was correct. After reviewing all
of the information carefully, we are changing our decision. We now find that (2) was not disabled. Therefore, based on our rules, we are denying your claim for benefits.
You will get another letter soon about when your payments will stop.
(1) number holder’s name (possessive)
4014 Auxiliary – Lead-In – Closed Period
We are writing to let you know that we recently reviewed __(1)__ disability case.
After reviewing all of the information carefully, we have decided __(2)__ is no longer
disabled. When __(3)__ payments stop, your benefits will also stop.
(1) number holder’s name (possessive)
If You Disagree With The Decision
If you disagree with this decision, you have the right to appeal. We will review (1) case and consider any new facts you have. A person who did not make the first decision
will decide (2) case. We will review those parts of the decision which you believe are wrong and
will look at any new facts you have. We may also review those parts which you believe
are correct and may make them unfavorable or less favorable to (3) .
You have 60 days to ask for an appeal in writing.
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
You must have a good reason for waiting more than 60 days to ask for an appeal.
You have to ask for an appeal in writing. We will ask you to complete a Form SSA-561-U2,
called “Request for Reconsideration.” Contact one of our offices if you want help.
(1) your/ number holder’s name (possessive)
Please read the enclosed pamphlet, “Your Right to Question the Decision Made on Your
Claim.” It contains more information about the appeal.
Do not send the following caption and paragraph (4060) if there is a determination of fraud or similar fault (FSF), since FSF precludes the payment of statutory benefit continuation. Do not send the following caption and paragraph if the revision is due to a non-medical
reason, such as work, or other reason that precludes statutory benefit continuation
(SBC) payments (see DI 27540.025). However, a predetermination due process notice is needed.
4060 Statutory Benefit Continuation – Auxiliary
Contact Us In 10 Days To Keep Getting Your Payment
Please let us know if you would like us to continue your benefits during your appeal.
You have only 10 days to ask us in writing to continue your benefits.
Both you and (1) must ask for your payments to continue, and either you or (2) must file an appeal.
If the appeal is lost, you might have to pay back some or all of the money you got.
(1) number holder’s name
(2) number holder’s name
If You Want Help With Your Appeal
You can have a friend, representative, or someone else help you. There are groups
that can help you find a representative or give you free legal services if you qualify.
There also are representatives who do not charge unless you win your appeal. Your
local Social Security office has a list of groups that can help you with your appeal.
If you get someone to help you, please let us know. If you hire someone, we must approve
the fee before he or she can collect it. If you hire a representative who is eligible
for direct pay, we will withhold up to 25 percent of any past-due benefits to pay
toward the fee.
If You Have Any Questions
If you have any questions, please call us toll free at 1-800-772-1213, or call your local Social Security office at [FO phone number from DOORS. We can answer most questions over the phone. You can also write or visit any Social
Security office. The office that serves your area is located at:
[Field Office Address
City, State, ZIP] per DOORS
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
SSA Pub. No. 05-10058