“The Social Security Administration selected your disability claim for an independent
review by the. This means we are reviewing your claim for compliance with the disability
requirements of the law.
On behalf of the Social Security Administration (delete this phrase when you using
SSA letterhead), this is to notify you that we will make a determination that you
did not become disabled until (new onset date) based on the evidence now in your file.
Therefore, we are revising the previous determination that your disability began (old
onset date). This proposed determination is being made by an agency of the State and
not by individuals who furnished the reports on which it is based.”
(Include the information required from DI 27525.005B -- items 4 through 11.)
“Before we make a determination, we are giving you the opportunity to present any
additional statements or evidence that you want us to consider. If you believe that
the previous date your disability began is correct and should not be changed to a
later date, submit any statements or evidence within 10 days from receipt of this
notice.”
“If you want to submit a statement or evidence, please send it to us within 10 days
to this address: DDS (or OIO if foreign claim), Street, City State ZIP Code.”
“If you don’t write us within 10 days, we will make a formal determination regarding
the date your disability began. It is important that you let us know within 10 days
if you want to submit a statement or evidence even though you may need more time to
submit it. We will inform you (and your auxiliaries, if applicable) in writing when
we make a formal determination, and what you must do to appeal if you disagree. If
the date your disability began is changed to a later date, your monthly benefit payment
may be lowered and you may have been overpaid for months you were not under a disability.”