Effective Dates: 10/11/2024 - Present

Identification Number:
NL 00705 TN 29
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Disability Sample Guide Letters
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part NL – Notices, Letters and Paragraphs

Chapter 007 – Letters and Paragraphs for Title II, Title XVI, and Title XVIII

Subchapter 05 – Disability Sample Guide Letters

Transmittal No. 29, 10/11/2024

Audience

PSC: CA, CS, DE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BIES, CC, CCRE, CR, ERE, FDE, PETL, RECONE, RECONR, RECOVR;
OCO-ODO: BET, BTE, CCE, CR, CST, CT, CTE, DE, DEC, DS, DSE, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR;
FO/TSC: CS, CS TII, CSR, DRT, FR, OA, OS, RR, TA, TSC-CSR;
ODD: DDS-ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

The Office of Disability Policy created this new NL POMS section to provide model language templates for the cover letters outlined in revised POMS DI 22510.065 and new POMS DI 22510.070. We created these templates for consistency with the cover letters in the Disability Case Processing System (DCPS).

Summary of Changes

NL 00705.753 Consultative Examination Report to Medical Source Cover Letter

This section provides model language for the following situations:

  • •

    If claimant has a medical source - permission granted; and

  • •

    If claimant has an emergency, life or death situation where harm is believed to be imminent.

NL 00705.753 Consultative Examination Report to Medical Source Cover Letter

AGENCY

LETTERHEAD

Date: Fill-in

Case ID: Fill-in

Addressee Name

Address Line 1

Address Line 2

City, State, Zip Code

RE: Claimant Full Name

AKA: AKA Name

DOB: DOB

 

We are the office that makes disability decisions for the Social Security Administration. [Claimant's full name] is applying for or is receiving disability benefits due to their medical condition(s).

 

If claimant has a medical source - permission granted:

[Claimant Full Name] has asked us to provide you a copy of the enclosed Social Security consultative examination/test report.

 

If claimant has an emergency, life or death situation where harm is believed to be imminent:

URGENT: Review is needed as soon as possible for a potentially life-threatening finding.

The Social Security consultative examination/test indicated a situation that requires immediate medical evaluation and/or treatment.

NOTE: Notify the claimant if a copy of the CE report was sent to the medical source without the claimant's permission. Include a copy of the letter to the claimant in Section E (Disability Related Development (Blue)) of the disability folder. See GN 03316.135C and DI 22510.070.

 

If You Have Any Questions

If you have any questions or wish to provide more information, please call us at the number(s) shown below Monday-Friday local office hours. When you call or leave a message, please provide the Case ID: case ID, your name, First Name Last Name's name, and a call back number.

Thank you for your help,

 

[Name]

[Phone Number]

[Fax Number]

 

Enclosures:

Copy of Consultative Examination Report


NL 00705 TN 29 - Disability Sample Guide Letters - 10/11/2024