TN 46 (09-05)
NL 00703.954 Expedited Reinstatement (EXR) Initial Reinstatement Period (IRP) Benefit Change Letter
Document Identifier for Word Processor: E3954
EXHIBIT LETTER
We are writing about the reinstated disability benefits you have been receiving.
(Mandatory Choice 1 of 3 (If SGA occurred during IRP
but has since ceased))
Earlier, we wrote to let you know that your benefits could be affected because the
information we have shows you were doing substantial gainful work. We are now writing
to tell you that we will not pay you reinstated disability benefits for the month(s)
of __(1)__. This is because we have decided that you were performing substantial gainful
work during those months. You will be paid reinstated benefits beginning with the
month of __(2)__ because you stopped doing substantial gainful work
Fill-ins
(1) mm/yyyy, mm/yyyy and mm/yyyy, mm/yyyy through mm/yyyy (choice)
(2) mm/yyyy (custom)
(Mandatory Choice 2 of 3 (If SGA occurred during IRP
and has not ceased))
Earlier, we wrote to let you know that your benefits could be affected because the
information we have shows you have been doing substantial gainful work. We are now
writing to tell you that we will not pay you reinstated disability benefits __(1)__.
This is because we have decided that you are performing substantial gainful work.
If you stop doing substantial gainful work, your monthly payments based on disability
can be started again without a new application. Contact any Social Security office
right away if this happens.
Fill-ins
(1) mm/yyyy, mm/yyyy and mm/yyyy, mm/yyyy and later (choice)
(Mandatory Choice 3 of 3 (If benefits were previously
suspended during IRP due to SGA and SGA has now ceased))
Your reinstated disability benefits were stopped because you were working. Your disability
benefits can be started again because you are no longer doing substantial gainful
work. Your benefit checks will start beginning the month of __(1)__. They can continue
as long as you have a disabling medical condition and do not perform substantial gainful
work.
Fill-ins
(1) mm/yyyy (custom)
INFORMATION ABOUT MEDICARE
(Mandatory Choice 1 of 2 (Medicare Notice when benefits
are suspended during IRP))
If __(1)__ __(2)___ Medicare, __(3)___ coverage will continue after ___(4)___ __(5)___
___(6)___last monthly payment. If __(7)__ __(8)___ supplementary medical insurance
(Medicare “Part B”), ___(9)___ will be billed for ___(10)___ medical insurance premiums
every 3 months. Please pay the premiums promptly to avoid losing coverage. If ___(11)___
no longer __(12)___ this coverage, please let us know right away. {HIB116}
Fill-ins
(1) you/beneficiary’s full name
(2) have/has
(3) your/his/her
(4) you/he/she
(5) receive/receives
(6) your/his/her
(7) you/he/she
(8) have/has
(9) you/he/she
(10) your/his/her
(11) you/he/she
(12) want/wants
(Mandatory Choice 2 of 2 (Medicare Notice when IRP payments
are resumed))
If you have Medicare and are disabled, that protection continues without change except
that if you were billed every 3 months for your insurance premiums they will now be
deducted monthly from your check beginning with the month of __(1)__. {DIB038}
Fill-ins
(1) mm/yyyy (custom)
IF YOU RETURN TO WORK
Generally, we consider work to be substantial and gainful if the monthly earnings
are over __(1)__ per month (for the year __(2)___.) In deciding whether your work
is substantial and gainful, we consider how much you actually earn, the nature of
your job duties, the skills and experience you need to do the job, and expenses related
to your disability. If you are self-employed, we may give more consideration to the
kind and value of your work, including your part in the management of the business,
than to your actual income alone.
As long as your medical condition(s) still meets our definition of a disabling impairment(s),
we can pay reinstated benefits for each month your work is not substantial and gainful
until you have been eligible for 24 months of payable benefits. Benefits will not
be payable for a month in which your work is substantial and gainful, if that month
occurs during the 24 month initial reinstatement period. These 24 payable months do
not have to be in a row. Even if you are not receiving payments because of work, your
Medicare coverage will continue.
At the end of these 24 months, you may be eligible for additional work incentives,
such as a trial work period, and another extended period of eligibility for Medicare.
Please see the enclosed pamphlet, “Working While Disabled,” for more information about
work incentives.
Fill-ins
(1) Custom
(2) Custom- yyyy
Optional Paragraph (Notice of completed IRP months)
You have had __(1)__ payable months of your 24-month initial reinstatement benefit period. You were
eligible for payable benefits in the following month(s): __(2)__.
Fill-ins
(1) Custom
Custom-mm/yyy
YOUR REPORTING RESPONSIBILITIES
You must tell us right away about any changes that may affect your benefits. You should
tell us if:
-
•
You change your mailing address;
-
•
You return to work or you increase your work hours;
-
•
Your doctor says your condition has improved;
-
•
You plan to leave the United States for 30 days or more;
-
•
You have been convicted of a criminal offense; or
-
•
You marry and your benefits have been reinstated as either a disabled widow/widower
or a disabled adult child.
IF YOU DISAGREE WITH THE DECISION
If you disagree with the decision, you have the right to appeal. We will review your
case again and consider any new facts you have. A person who did not make the first
decision will decide your case.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason if you wait more than 60 days to ask for an appeal.
-
•
You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2,
called "Request for Reconsideration." Contact one of our offices if you want help.
Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your
Social Security Claim." It contains more information about the appeal.
IF YOU WANT HELP WITH YOUR APPEAL
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it. And if you hire a lawyer, we will
withhold up to 25 percent of any past due benefits to pay toward the fee.
IF YOU HAVE ANY QUESTIONS
We invite you to visit our website at www.socialsecurity.gov on the Internet to find
general information about Social Security. If you have any specific questions, you
may call us toll-free at 1-800-772-1213, or call your local Social Security office
at __(1)__ . We can answer most questions over the phone. If you are deaf or hard
of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit
any Social Security office. The office that serves your area is located at:
__ (2) __
__ (3) __
__ (4) __
__ (5) __
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment.
This will help us serve you more quickly when you arrive at the office.
Fill-ins
(1) Field Office phone number
(2) First line of Field Office address
(3) Second line of Field Office address
(4) Third line of Field Office address
(5) Fourth line of Field Office address
(6) Fifth line of Field Office address
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly when you arrive at
the office.
Regional
Commissioner
Enclosure(s)
__(1)__
Fill-ins
(1) Publication Number of Enclosure