TN 14 (04-11)
NL 00705.720 Adult Initial Case Development Letter - Sample
**BARCODE**
AGENCY
LETTERHEAD
Date:
_______________
Case
ID: ____________
Addressee Name
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 your disability claim.
To be eligible for disability benefits, you must have a medical condition(s) that:
-
•
keeps you from doing any type of work, 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 you are 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 that you receive from us. Let us know
right away if any of the following things happen while we process your claim:
-
•
Your address or telephone number changes,
-
•
You see a new doctor or go to the hospital,
-
•
You have any additional tests, medications, therapy, or surgery,
-
•
You begin or return to work,
-
•
You have any new conditions,
-
•
You have any additional current or past medical 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.
(NAME)
Disability Examiner
Phone Number, Extension ( )
cc: