Effective Dates: 02/14/2020 - Present Previous | Next

TN 21 (02-20)

NL 00705.740 Third Party Call-in Letter - Sample

A. Sample of third party call-in letter

**BARCODE**

       

AGENCY
LETTERHEAD

         

        

                                                       Date: ______________________________

 Case ID: (Insert a non-SSN case identifier.)

Claimant:       (Insert the claimant’s name.)

Addressee Name

Address Line 1

Address Line 2

City, State Zip code  

     

Dear (Mr. or Ms.) (Last name):

                       

We are the office that makes disability decisions for Social Security.

The above named individual applied for disability benefits and identified you as someone we could contact for assistance. We would like to speak to you about helping (him or her) with (his or her) claim.

 

(Insert a free-form paragraph here, if needed.)

 

Please call the phone number shown below, Monday – Friday between (insert hours of operation), within 10 days of the date on this letter.

 

Thank you for your help.

 

(Name)

Disability Examiner

(XXX) XXX-XXX

Toll Free: 1-800-XXX-XXXX, extension XXXX

cc:

 

B. References

1. Third party disclosure policy

GN 03316.005: Disclosure Without Consent to Administer SSA Programs

2. Required third party contacts

  • •

    DI 22510.016: Claimant Consultative Examination (CE) Notice and Confirmation Procedures

  • •

    DI 22510.019: Consultative Examination (CE) Appointment Notice Follow up and Reminder

  • •

    DI 23007.005: Contacting the Claimant, Applicant, Appointed Representative, or Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence

  • •

    DI 23007.010: A Reasonable Effort to Identify and Involve a Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900705740
NL 00705.740 - Third Party Call-in Letter - Sample - 02/14/2020
Batch run: 02/14/2020
Rev:02/14/2020