Basic (10-21)

DI 13006.100 Exhibit Notice to Initiate an Age-18 Redetermination

Social Security Administration

Supplemental Security Income

Notice of Disability Redetermination

Street Address:

City, State, ZIP Code:

Phone:

Office Hours:

Date:

Claim Number: XXX-XX-XXXX

Jane G. Beneficiary

101 Main Street

My City, ST 00001

Important Notice - You must contact us or your SSI may stop.

We must review the cases of people getting Supplemental Security Income (SSI) payments based on childhood disability after they become age 18. We are writing to let you know that we are starting to review your SSI disability case to decide if you are disabled under the disability rules for adults.

What You Need To Do

Choice 1

Please call us and ask for _____________ .

Choice 2

We would like you to come to our office on ______________ .

When you come in, please ask for _____________ .

If you cannot come in on the date shown or would prefer to talk with us by telephone, please call us as soon as possible.

The office address, telephone number, and office hours are shown above.

If We Do Not Hear From You

We may stop your SSI if you do not answer this letter by Month/Day/ Year or contact us by this date to tell us why we haven't heard from you. Before we stop your SSI, we will send you another letter to explain our decision. The letter will also explain your right to appeal the decision and how to continue getting benefits during the appeal.

Information About Medical Assistance

If your SSI payments stop, any medical assistance you have that is based on SSI may also stop. If this happens, your medical assistance agency should contact you.

The Information We Will Need

When you come in or call, please try to have all of the following things with you. Even if you do not have everything, you still must call us or come in. We will help you get anything you do not have.

• •

  This letter.

• •

  The enclosed form(s). Please be sure to complete as much of the form(s) as you can before you come in or call.

• •

  The names of any medicines you use.

• •

  Any other information that shows your condition, such as information about:

  • –

    hospital stays and/or surgeries, including the dates and reasons;

  • –

    visits to doctors and/or clinics, including the dates and reasons;

  • –

    work activity;

  • –

    counseling and/or therapy;

  • –

    schools and/or special classes or tutoring; and

  • –

    teachers and/or counselors who have knowledge of your condition.

    We may ask for further information later.

We Will Let You Know What We Decide

Doctors and other trained staff will decide if you are disabled. When we decide your case we will use the same disability rules we use for adults who file new claims. However, we will not apply the rule that says we must deny your claim if you are working.

We may decide that you are not disabled under the disability rules for adults and your SSI payments could stop. The disability rules for adults are different than the disability rules for children we used when we last looked at your case. So we may find you are not disabled now even though we found you disabled before.

How Your Benefits May Continue If We Find You Are Not Disabled

If we find that you do not have a disability under our rules for adults, your SSI benefits will usually stop.

However, your benefits may continue while you are:

• •

  Attending school under an individualized education program (IEP), or

• •

  Taking part in certain vocational rehabilitation or similar programs.

To qualify, you must be participating in the program before the month your disability ends under our rules. Your SSI benefits could continue until you finish school or complete the program. Be sure to tell us about any program you take part in when you contact us to give us the information we need. We may ask for more information later. You must tell us when you finish school or complete the program. If you get too much SSI money because you do not tell us right away, you must pay back the money. When we decide, we will write and let you know our decision. Our letter will tell you whether you are disabled under the disability rules for adults. Our letter also will explain your right to appeal the decision. If you appeal the decision you can also choose to have us continue to pay benefits until we decide the appeal.

Information About Work

There are special rules that help people with disabilities return to work without losing their SSI benefits and Medicaid. You must follow these rules and report your earnings, or you may have to repay a large part of your benefits. When you report your earnings, we will give you a receipt to verify your report. Keep this receipt with your other important papers from us. For more information on how work may affect your benefits and our work incentive programs, please request our free publication.

• •

  “Working While Disabled—How We Can Help” (Publication No. 05-10095)

• •

  “The Red Book,” a guide to our employment support programs.

  You can get these publications online at www.socialsecurity.gov/pubs/EN-05-10095.pdf and www.socialsecurity.gov/redbook. They also include information about the Ticket to Work program, which can help you work or increase your earnings. To learn more, call 1-866-968-7842 (TTY 1-866-833-2967) or visit www.socialsecurity.gov/work.

  Suspect Social Security Fraud?

  Please visit http://oig.ssa.gov/report or call the Inspector General’s Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

  If You Have Any Questions

  We will be glad to answer any questions that you have. Whether we talk to you by phone or in person, you can have a lawyer, friend, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. Our office has a list of groups that can help you. If you get someone to help you, you should let us know.

  Remember, if you cannot come in or would prefer to talk to us by phone, please call us right away. Our telephone number is shown on the first page of this letter.

  Field Office Manager

  Enclosure(s)

  [The enclosures may include any of the following:

  Form Number SSA-3368 - Disability Report - Adult

  Form Number SSA-827 - Authorization for Source to Release

  Information to the Social Security Administration]