TN 14 (04-11)
NL 00705.705 Child Initial Case Development Letter - Sample
Case ID: ____________
Address Line 1
Address Line 2
City, State, Zip code
Dear (Mr. or Ms.) (Last name):
We are the office that makes disability decisions for the Social Security Administration. We are writing to tell you that we are reviewing the disability claim you filed for (child’s name).
To be eligible for disability benefits, the child must have a medical condition(s) that:
causes marked and severe functional limitations, and
has lasted or is expected to last for at least 12 months in a row or result in death.
We will review the medical and other information we have. If we need more information to decide whether the child is disabled, we may ask you for it or arrange an exam or test. We will pay for the exam or test. We may also reimburse you for some of your travel expenses to the exam or test site based on a set rate.
Please respond quickly to any letters or forms you receive from us. Let us know right away if any of the following things happen while we process (child’s name)’s claim:
Your or (Child’s Name) address or telephone number changes,
(Child’s name) sees a new doctor or goes to the hospital,
(Child’s name) has any additional tests, medications, therapy, or surgery,
(Child’s name) has any additional current or past medical, educational, or mental health sources not listed on the application.
If you have any questions or wish to provide more information, please call the phone number shown below from Monday – Friday between 8:00 a.m. and 4:00 p.m.
Thank you for your help.
Phone Number, Extension ( )