1. a. 

   Lead-in or other introductory statement explaining the purpose of the notice (mandatory).

2. b. 

   Personalized explanation, or reference to a personalized attachment (when required).

3. c. 

   A statement as to who made the denial decision. This can be:

   • •

     DDS physicians and other trained personnel, e.g., disability examiners;

   • •

     disability hearing officer (DHO);

   • •

     other trained personnel, e.g., claims representatives (CR).

4. d. 

   When payments and/or Medicare coverage end (when appropriate).

5. e. 

   Rules for Social Security Disability and/or Rules for SSI Disability or Blindness (when appropriate)

6. f. 

   Information About Substantial Work (when appropriate)

7. g. 

   Closeout language — no entitlement to other benefits (when appropriate). (On some notices, this language may be on an attachment.)

8. h. 

   Information About Medicaid or Medicare (when appropriate)

9. i. 

   Medical reexamination diary — awards and continuances.

10. j. 

    Appeal rights (mandatory for a determination).

11. k. 

    Res judicata language — consequences of filing a new application instead of an appeal - all denials.

12. l. 

    Claimant right to representation language (all required on domestic notices that contain appeals language).

13. m. 

    Benefit continuation language (when appropriate).

14. n. 

    Family benefits language - (when appropriate) explaining that a spouse or child cannot be paid unless the worker is entitled to Social Security benefits.

15. o. 

    Additional information — e.g., future entitlement (optional).

16. p. 

    FO referral (mandatory).

    NOTE: Foreign claim notices will have an OIO referral paragraph.

17. q. 

    Signature line.

Enclosure information (personalized attachments and pamphlets) is shown on the notice to alert those responsible for releasing the notice that these must be included.

Title II notices are prepared on blank SSA-L951-U2/C2 letterhead, and title XVI notices are prepared on SSA-L8052-U2/C2 letterhead, unless a specific form notice is required by instructions. When a form notice is unavailable, the text may be reproduced on the SSA-L951-U2/C2, or SSA-L8052-U2/C2, as appropriate, and should comply with the above guidelines.