AGENCY LETTERHEAD
Date: [Fill-in]
Case ID: [Fill-in]
Addressee Name
Address Line 1
Address Line 2
City, State, Zip code
CALL IN LETTER
We are the office that makes disability decisions for the Social Security Administration.
It is very important that we speak to you by [10 calendar days].
[Free form/Canned text]
If you do not respond by [10 calendar days], we may decide your case based on the
information we already have in file. This means that we could find that you are not
disabled based on our rules or that your disability has ended if you are already getting
benefits.
Please call the phone number(s) show below Monday-Friday between [DDS office open]
and [DDS office close]. When you call or leave a message, please provide the Case
ID: [case ID number], your name, and a call back number.
Thank you for your help.
[Name]
[Phone Number]
[Fax Number]
Enclosure:
Multi-Language Insert (if enclosed)