TN 14 (04-11)

NL 00705.725 Child 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 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.

(NAME)

Disability Examiner

Phone Number, Extension ( )

cc:


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900705725
NL 00705.725 - Child Initial Case Development Letter - Sample - 06/23/2011
Batch run: 06/23/2011
Rev:06/23/2011