It has been determined that you are under a disability within the meaning of the disability
insurance provisions of the Social Security Act.
You are entitled to a monthly benefit of $ (1) , beginning with the month of (2) . Your next payment in the amount of $ (3) , represents payment for the month(s) of (4) . You wll receive this payment (5) .
Your claim will be reviewed from time to time to see if you are still eligible for
benefits based on disability or blindness. When your claim is reviewed, you will be
contacted if there is any question as to whether your eligibility continues.
| 3566A |
If you go to work while you are still disabled, you may be entitled to a trial work
period to test your ability to work. During this period you may work in as many as
9 months (which need not be consecutive) and still receive your disability benefit
payments no matter how high your earnings. After the trial work period has ended,
we will consider the work you did in determining whether you have shown by your work
activity that your disability ended. However, you are not entitled to a trial work
period if:
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You are entitled to a period of disability but not to disability cash benefits; or |
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You are receiving benefits in a second period of disability for which you did not
have to complete a waiting period.
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RESPONSIBILITIES OF PEOPLE RECEIVING DISABILITY BENEFITS |
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To prevent any incorrect payments, please notify us promptly if: |
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You have already gone to work when you receive this notice; or |
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You go to work in the future, regardless of how much you earn. |
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Other events you need to report are listed in the enclosed booklet entitled, “When You Get Social Security Disability Benefits...What You Need To Know.” |
OR
3566B
|
Since your condition may improve, we have scheduled a review for
(1) . At that time, you will be contacted if there is any question as to whether your
condition remains severe. Also, a review of your claim may be necessary if you go
to work. If we do get in touch with you, we may ask you to give us more information
or to take a medical examination. If we find you are still disabled, your benefits
will continue. But, if the evidence obtained shows you are no longer disabled, your
benefits will be stopped.
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RESPONSIBILITIES OF PEOPLE RECEIVING DISABILITY BENEFITS |
| |
To prevent any incorrect payments please notify us promptly if: |
| |
You have already gone to work when you receive this notice, or you go to work (regardless
of how much you earn), or your doctor advises you that your condition has improved
and that you are able to work.
|
| |
Other events you need to report are listed in the enclosed booklet entitled “When You Get Social Security Disability Benefits...What You Need To Know.” |
Read the enclosed instructions for important information and events which affect the
payment of these benefits. You must notify the Social Security Administration promptly
when any one of these events occurs.
If You Disagree With The Decision
ALS020
If You Have Any Questions
3901C - Domestic
3901D - Foreign
Enclosure:
SSA Pub. No. 05-10153