Clark Court Order Case Flag
Recipient Name: _____________________________
Recipient SSN: _____________________________
Type of Clark Relief (select one):
Protective Filing Date: _________________________
_______ No subsequent claim after an N25 technical denial
_______ Subsequent claim with a disability determination or decision after an N25
technical denial
_______ Subsequent non-Clark technically denied claim
______ Title XVI claim with a title II disability denial determination or decision
for the same period or later
_______ Title XVI claim with a title II allowance determination or decision with an
established onset date later than the title XVI application date of the N25 technically
denied claim
_______ FO can reinstate benefits-vacate subsequent medical denial determination
______ Age 18 Disability Redetermination
______ Other (please explain): ________________________________________________