TN 95 (04-23)

NL 00703.480 Good Cause Denial Notice for Statutory Benefit Continuation Request

Document Processing System (DPS) Identifier: (Continuing Disability Review (CDR) Folder)


We are writing about your request to continue (1) payments during (2) appeal. We have to deny the request, because we did not receive it on time and you did not have a good reason for the delay.

You Asked For Review Too Late

We sent you a letter on (3) to tell you about our decision. The letter explained that you had up to 10 days from the date you received the letter to ask for (4) payments to continue. You asked for a review on (5), which was after the 10-day time limit.


What Are We Doing

We have (7) request for appeal filed on (8). Even though we cannot pay (9) benefits during (10) appeal, we will still consider (11) appeal. We will write to you again when we make a decision on (12) appeal.

Suspect Social Security Fraud?

Please visit or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

Need more help?

1. Visit for fast and simple online service.

2. Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm. If you are deaf or hard of hearing , call TTY 1-800-325-0778. Please mention this letter when you call.

3. You may also call your local office at *(13).

(14 )

(15 )

How are we doing? Go to to tell us.


Send this notice when good cause is not found after a late filing for statutory benefit continuation (SBC) after a medical cessation .


(1) your, Claimant Name possessive

(2) your, his, her

(3) Date of original decision MM/DD/YYYY

(4) your, Claimant Name possessive

(5) Date claimant requested good cause review MM/DD/YYYY

(6) Dictated text explaining why SSA cannot approve benefit continuation

(7) your, his, her

(8) Date claimant filed medical appeal MM/DD/YYYY

(9) you, him, her

(10) your, his. her

(11) your, his, her

(12) your, his, her

(13) Field Office General Inquiry Line phone number

(14) Servicing field office name

(15) Servicing field office address

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NL 00703.480 - Good Cause Denial Notice for Statutory Benefit Continuation Request - 04/13/2023
Batch run: 04/13/2023