TN 16 (09-11)
NL 00705.740 Third Party Call-in Letter - Sample
A. Sample of third party call-in letter
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
1. Third party disclosure policy
GN 03316.005 Disclosure Without Consent to Administer SSA Programs
2. Required third party contacts
DI 22510.016 Consultative Examination (CE) Appointment Special Scheduling Procedures
DI 22510.019 Consultative Examination (CE) Appointment Notice Follow up and Reminder
DI 23007.005 Failure to Cooperate With Requests to the Claimant for Evidence or Action
DI 23007.010 Failure to Attend a Consultative Examination (CE) Appointment