Case ID: (Insert a non-SSN case identifier.)
Claimant: (Insert the claimant’s 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 Social Security.
The above named individual applied for disability benefits and identified you as someone
we could contact for assistance. We would like to speak to you about helping (him
or her) with (his or her) claim.
(Insert a free-form paragraph here, if needed.)
Please call the phone number shown below, Monday – Friday between (insert hours of operation), within 10 days of the date on this letter.
Thank you for your help.
Toll Free: 1-800-XXX-XXXX, extension XXXX