Earlier we told you that (1) disability claim was due for a review. We sent you a Form SSA-455 (Disability Update
Report) to complete and return to us. We asked you to contact us if you had any questions
about the form or difficulty in completing it.
Our records show that you have not returned the form or contacted us.
What You Need to Do
We are sending you another copy of the form. Please complete, sign, and date it. Send
the completed form back to us in the enclosed envelope within 10 days.
CTDO or 3901D
Form SSA-455 (Disability Update Report).