DI 12095.165 Model Letters Regarding Benefit/Payment Continuation
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A.
Exhibit 1 - Benefit Continuation Model Letter A - (Pipeline Notice to Title II Beneficiary
Whose Disability Determination Is Being Appealed)
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B.
Exhibit 2 - Benefit Continuation Model Letter B - (Pipeline Notice to Auxiliary Title
II Beneficiary Whose Benefits Are Dependent on Another Beneficiary's Appeal)
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C.
Exhibit 3 - Payment Continuation Model Letter C - (Pipeline Notice to Title XVI Recipient
Where Goldberg/Kelly Payments Are not Being Paid Because the Claimant Either Waived G/K Payments or Did
Not File a Timely Appeal)
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D.
Exhibit 4 - Benefit Continuation Model Letter D - (Pipeline Notice to Beneficiary/Recipient
Who is Receiving Goldberg/Kelly Payments or Benefit Continuation Payments)
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E.
Exhibit 5 - Benefit Continuation Model Letter E - (Pipeline Notice to Beneficiary/Recipient
Who Was Receiving Goldberg/Kelly Payments Prior to the ALJ Decision and Appeals Council Dismissal)
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F.
Exhibit 6 - Benefit Continuation Model Letter F - (Pipeline Notice to the Title II
Beneficiary Entitled to EPE Whose Impairment Severity Determination Is Being Appealed)
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G.
Exhibit 7 - Benefit Continuation Model Letter G - (Pipeline Notice to Auxiliary or
Title II Beneficiary Entitled to EPE Whose Benefits Are Dependent on Another Beneficiary's
Appeal)
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H.
Exhibit 8 - Benefit Continuation Model Letter H - (Pipeline Notice to Title XVI Recipient
Entitled to EPE Goldberg/Kelly Payments Not Being Paid Because Claimant Waived G/K Payments or Did Not File a Timely
Appeal)
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I.
Exhibit 9 - Benefit Continuation Model Letter I - (Pipeline Notice to Beneficiary/Recipient
Who Is Receiving Extended Period of Eligibility Continuation)
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J.
Exhibit 10 - Benefit Continuation Model Letter J - (Pipeline Notice to Beneficiary/Recipient
Who Was Receiving EPE Continuation Under Goldberg /Kelly Prior to the ALJ Decision and Appeals Council Dismissal)
Exhibit 1
Benefit Continuation Model Letter A - (Pipeline Notice To The Title II Beneficiary
Whose Disability Determination is Being Appealed) (Prepare on Form SSA-L951 U2/C2)
A change in the Social Security law allows disability benefits to be paid until an
appeal of a decision that you are no longer disabled is decided by administrative
law judge. Under this change, benefits can be paid to people whose benefits were stopped
because they were found to be not disabled for medical reasons, if they are appealing
the decision.
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Contact any Social Security office within 10 days if you want benefits to be paid
while you appeal.
If you want to receive benefits until a decision is made on your appeal, you must
make a request in writing within 10 days after receiving this notice. Payments will
start from the month that your benefits ended. If you were entitled or were about
to become entitled to Medicare, you may also be entitled to Medicare. If you lose
your appeal, you will be asked to pay the disability benefit back, but you will have
the right to ask that you not be required to pay them back. You will not be asked
to pay back any Medicare benefits you receive while the appeal is being decided. If
you win the appeal, any money due you will be paid. If you cannot come within 10 days,
be sure to contact us by phone. If you wait longer than 10 days, we will not pay you any benefits while you appeal
unless you have a good reason for the delay.
The new law also changes the standards we use to decide whether a person's disability
continues. Your claim must be reviewed again under these new standards by an agency
of your State which helps us to decide if you are disabled. We expect our new rules
to be ready in about 6 months. If you request benefits now we will pay you until that
new decision is made. We will notify you when the new decision is made. You will have
the right to appeal that decision if you think it is wrong and to request further
continued benefits during that appeal.
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you visit
an office, please take this notice with you.
Exhibit 2
Benefit Continuation Model Letter B - (Pipeline Notices to Auxiliary Title II Beneficiary
Whose Benefits Are Dependent on Another Beneficiary's Appeal) (Prepare on Form SSA-L951
U2/C2)
This notice is about the benefits you were receiving on the claim of: (Insert the
name of the person on whose claim the appeal is filed).
A change in the Social Security law allows disability benefits to be paid until an
administrative law judge decides the appeal of a decision that a person is not disabled.
Under this change, benefits can be paid to people whose benefits were stopped because
they or the person on whose claim they received benefits were found to be not disabled
for medical reasons.
The person on whose claim you were receiving benefits has filed an appeal. You can
have your benefits paid while the appeal is being decided if that person also choose
to have your benefits paid.
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Contact any Social Security office within 10 days if you want benefits to be paid
during appeal.
If you want to receive benefits until a decision is made on the appeal, you must make
a request in writing within 10 days after receiving this notice. The person on whose
claim you receive benefits must also request that you receive benefits. Payments will
start from the month that your benefits ended. If the appeal is lost, you will be
asked to pay the benefits back, but you will have the right to ask that you not be
require to pay them back. You wil not be asked to pay back any Medicare benefits you
receive while the appeal is being decided. If the appeal is won, any money due you
will be paid. If you cannot come within 10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not pay you any benefits while the appeal
is being decided unless you have a good reason for the delay.
The new law also changes the standards we use to decide whether a person's disability
continues. The claim must be reviewed again under these new standards by a state agency
which helps us decide disability. We expect our new rules to be ready in about 6 months.
If you request benefits now we will pay you until that new decision is made. We will
notify you when the new decision is made. You will have the right to appeal that decision
if you think it is wrong and to request continued benefits if the person on whose
claim you receive benefits also makes such a request.
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you write,
please refer to social security number of the person on whose claim you were paid.
If you visit an office, please take this notice with you.
Exhibit 3
Payment Continuation Model Letter C - (Pipeline Notices to Title XVI Recipient Where
Goldberg/Kelly Payments Are Not Being Paid, Because Claimant Waived G/K Payments or Did Not File
a Timely Appeal) (Prepare on Form SSA-L8052 U2/C2)
A change in the Social Security law allows supplemental security income disability
payments to be paid until an appeal of a decision that you are no longer disabled
is decided by an administrative law judge. Under this change, payments can be paid
to people whose payments were stopped because they were found to be not disabled for
medical reasons.
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Contact any Social Security office within 10 days if you want payments to be paid
while you appeal.
If you want to receive payments until a decision is made on your appeal, you must
make a request in writing within 10 days after receiving this notice. In addition,
we will need information about non-disability factors such as your living arrangements,
money you receive, and things you own. Payments will start no earlier than November
1984. If you lose your appeal, you will be asked to pay the disability payment back,
but you will have the right to ask that you not be required to pay them back.
If you win the appeal, any money due you will be paid. If you cannot come in within
10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not pay you any payments while you appeal
unless you have a good reason for the delay.
(Insert paragraph 1152 (NL 00804.110) when SSA determines Medicaid eligibility).
The new law also changes the standards we use to decide whether a person's disability
continues. Your claim must be reviewed again under these new standards by an agency
of your State which helps us to decide if you are disabled. We expect our new rules
to be ready in about 6 months. If you request payments now we will pay you until that
new decision is made. We will notify you when the new decision is made. You will have
the right to appeal that decision if you think it is wrong and request further continued
payments during that appeal.
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you write,
please refer to your social security number in your letter. If you visit an office,
please take this notice with you.
Exhibit 4
Benefit Continuation Model Letter D - (Pipeline Notice to Beneficiary/ Recipient
Who Is Receiving Goldberg/Kelly Payments or Benefit Continuation Payments) (Prepare Title XVI Notice on Form SSA-L8052
U2/C2 and Title II Notice on Form SSA-L951 U2/C2)
A new law changes the standards we use to decide whether a person's disability continues.
We expect that the new rules we will use to process cases under these new standards
will be ready for use in about 6 months.
Your claim will be reviewed again by an agency of your State which helps us decide
if you are disabled. Since you are receiving payments while you appeal, we will continue
to pay you until a new decision is made on your claim.
We will notify you when a new decision is made using these new rules. You will have
the right to appeal that decision if you think it is wrong and request further continued
payments during that appeal.
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you write,
please refer to your social security number in your letter. If you visit an office,
please take this notice with you.
Exhibit 5
Payment Continuation Model Letter E - (Pipeline Notice to Beneficiary/ Recipient
Who Was Receiving Goldberg/Kelly Payments Prior To The ALJ Decision and Appeals Council Dismissal) (Prepare Title
XVI Notice on Form SSA-L8052 U2/C2 and Title II Notice on Form SSA-L951 U2/C2
A new law changes the standards we use to decide whether a person's disability continues.
We expect that the new rules we will use to process cases under these new standards
will be ready for use in about 6 months.
Your claim will be reviewed again by an agency of your State which helps us decide
if your are disabled.
Since you received payments until the administrative law judge decided your appeal,
we will start those payments again from the month they ended. They will be paid until
a new decision is made on your claim. We will notify you when a new decision is made
using these new rules. You will have the right to appeal that decision if you think
it is wrong and request further continued payment during that appeal. Please visit
our office to tell us current information about your living arrangments, money you
receive, and things you own.
(Insert paragraph 1152 (NL 00804.110) when SSA determines Medicaid eligibility.)
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you write,
please refer to your social security number in your letter. If you visit an office,
please take this notice with you.
Exhibit 6
Benefit Continuation Model Letter F - (Pipeline Notice to the Title II Beneficiary
Entitled to EPE Whose Impairment Severity Determination is Being Appealed) (Prepared
on Form SSA-L951 U2/C2)
A change in the Social Security law allows the extended period of eligibility to be
restarted until either an appeal of a decision that you are no longer disabled is
decided either by an administrative law judge or your extended period ends. Under
this change the right to restart the extended period of eligibility applies to people
found to be not disabled for medical reasons, if they are appealing the decision.
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Contact any Social Security office within 10 days if you want your extended period
of eligibility to apply while you appeal.
If you want your extended period of eligibility to apply until either a decision is
made on your appeal or your extended period ends, you must make a request in writing
within 10 days after receiving this notice. We will start your extended period of
eligibility again from the month it ended. If you were entitled to or were about to
become entitled to Medicare, you may also be entitled to Medicare. If you lose your
appeal, you will be asked to pay any disability benefits received back, but you will
have the right to ask that you not be required to pay them back. You will not be asked
to pay back any Medicare benefits you receive while the appeal is being decided. If
you win the appeal, any money due you will be paid. If you cannot come in within 10
days, be sure to contact us by phone. If you wait longer than 10 days, we will not apply your extended period of eligibility
while you appeal unless you have a good reason for the delay.
The new law also changes the standards we use to decide whether a person continues
to have a disabling impairment. Your claim must be reviewed again under these new
standards by an agency of your State which helps us to decide if you are disabled.
We expect our new rules to be ready in about 6 months. If you request that your extended
period of eligibility be continued, it will continue until either the new decision
is made or your extended period ends. We will notify you when the new decision is
made. You will have the right to appeal that decision if you think it is wrong and
to request further continuation of your extended period of eligibility during that
appeal.
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you visit
an office, please take this notice with you.
Exhibit 7
Benefit Continuation Model Letter G - (Pipeline Notice to Auxiliary of Title II Beneficiary
Entitled to EPE Whose Benefits Are Dependent on Another Beneficiary's Appeal) (Prepare
on Forms SSA-L951 U2/C2)
This notice is about the benefits you were receiving on the claim of (Insert the name
of the person on whose claim the appeal is filed).
A change in the Social Security law allows disability benefits which come from having
's (Insert the name of the person on whose claim the appeal is filed) extended period
of eligibility restarted to be paid until either an administrative law judge decides
the appeal of a decision that (Insert “his” or “her”) impairment is not disabling or the extended period ends. Under this change, benefits
can be paid to people whose benefits were stopped because they or the person on whose
claim they received benefits were found to be not disabled for medical reasons.
The person on whose claim you were receiving benefits has filed an appeal. You can
have any benefits due you paid while the appeal is being decided if that person also
chooses to have your benefits paid.
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Contact any Social Security office within 10 days if you want to receive any benefits
which may be due from the extended period of eligibility.
If you want to receive any benefits which come from having the extended period of
eligibility restarted until either a decision is made on the appeal, or the extended
period ends, you must make a request in writing within 10 days after receiving this
notice. The person on whose claim you receive benefits must also request that you
receive benefits. If you are due payments, they will start from the month that your
benefits ended. If the appeal is lost, you will be asked to pay the benefits back,
but you will have the right to ask that you not be required to pay them back. You
will not be asked to pay back any Medicare benefits you receive while the appeal is
being decided. If the appeal is won, any money due you will be paid. If you cannot
come in within 10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not pay you any benefits due while the appeal
is being decided unless you have a good reason for the delay.
The law also changes the standards we use to decide whether a person continues to
have a disabling impairment. The claim must be reviewed again under these new standards
by a State agency which helps us decide disability. We expect our new rules to be
ready in about 6 months. If you request benefits now we will pay you any money due
until either that new decision is made or the extended period of eligibility ends.
We will notify you when the new decision is made. You will have the right to appeal
that decision if you think it is wrong and to request continued benefits if the person
on whose claim you receive benefits also makes such a request.
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you write
please refer to the social security number of the person on whose claim you were paid.
If you visit an office, please take this notice with you.
Exhibit 8
Payment Continuation Model Letter H - (Pipeline Notice to Title XVI Recipient Entitled
to EPE (Goldberg/Kelly Payments Not Being Paid Because Claimant Waived G/K Payments or Did Not File a Timely
Appeal)) (Prepare on Form SSA-L8052 U2/C2.)
A change in the Social Security law allows the extended period of eligibility to be
restarted until either an appeal of a decision that you are no longer disabled is
decided by an administrative law judge or your extended period ends. Under this change,
the extended period of eligibility can be restarted for people who were found not
to have a disabling impairment.
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Contact any Social Security office within 10 days if you want your extended period
of eligibility restarted while you appeal.
If you want your extended period of eligibility to restart until either a decision
is made on your appeal or your extended period ends, you must make a request in writing
within 10 days after receiving this notice. Your extended period of eligibility will
restart no earlier than November 1984. If you lose your appeal, you will be asked
to pay any disability payments back, but you will have the right to ask that you not
be required to pay them back.
If you win the appeal, any money due you will be paid. If you cannot come in within
10 days, be sure to contact us by phone. If you wait longer than 10 days, we will not restart your extended period of eligibility
appeal unless you have a good reason for the delay.
(Insert paragraph 0152 or 1152 (NL 00804.110) when SSA determines Medicaid eligibility.)
The new law also changes the standards we use to decide whether a person's disability
continues. Your claim must be reviewed again under these new standards by an agency
of your State which helps us to decide if you have a disabling impairment. We expect
our new rules to be ready in about 6 months. If you request that your extended period
of eligibility be restarted it will continue until either that new decision is made
or your extended period ends. We will notify you when the new decision is made. You
will have the right to appeal that decision if you think it is wrong and to request
further continuation of your extended period of eligibility during that appeal.
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you write,
please refer to your social security number in your letter. If you visit an office,
please take this notice with you.
Exhibit 9
Benefit Continuation Model Letter I - (Pipeline Notice to Beneficiary/ Recipient
Who Is Receiving Extended Period of Eligibility Continuation (Prepare Title XVI Notice
on Form SSA-L8052 U2/C2 and Title II Notice on Form SSA-L951 U2/C2.)
A new law changes the standards we use to decide whether a person has a disabling
impairment. We expect that the new rules we will use to process cases under these
new standards will be ready for use in about 6 months.
Your claim will be reviewed again by an agency of your State which helps us decide
if you are disabled. Your extended period of eligibility will continue until either
a new decision is made on your claim or your extended period ends. We will notify
you when a new decision is made using these new rules. You will have the right to
appeal that decision if you think it is wrong and request further extended period
of eligibility continuation during that appeal.
(Insert paragraph 1152 (NL 00804.110) when SSA determines Medicaid eligibility.)
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you write,
please refer to your social security number in your letter. If you visit an office,
please take this notice with you.
Exhibit 10
Payment Continuation Model Letter J - (Pipeline Notice to Beneficiary/ Recipient
Who Was Receiving EPE Continuation Under Goldberg/Kelly Prior to the ALJ Decision and Appeals Council Dismissal) (Prepare Title XVI Notice
on Form SSA-L8052 U2/C2 and Title II Notice on Form SSA-L951 U2/ C2.)
A new law changes the standards we use to decide whether a person continues to have
a disabling impairment. We expect that the new rules we will use to process cases
under these new standards will be ready for use in about 6 months.
Your claim will be reviewed again by an agency of your State which helps us decide
if you are disabled.
Since you received continuation of your extended period of eligibility until the administrative
law judge decided your appeal, we will start your extended period of eligibility again
from the month it ended. Your extended period of eligibility will continue until either
a new decision is made on your claim or your extended period ends. We will notify
you when a new decision is made using these new rules. You will have the right to
appeal that decision if you think it is wrong and request that your extended period
of eligibility continue during that appeal.
(Insert paragraph 1152 (NL 00804.110) when SSA determines Medicaid eligibility.)
If you have any questions about this notice, you may get in touch with any Social
Security office. Most questions can be handled by telephone or mail. If you write,
please refer to your social security number in your letter. If you visit an office,
please take this notice with you.