TN 13 (06-09)
NL 00705.261 Reopening 13 - Change in Basis – Blind to Disabled – Title II
NOTE: This situation does not provide for statutory benefit continuation. Therefore, a
pre-determination notice would have to be sent first. Before sending a final determination
and this notice, follow the procedure in DI 27525.005.
4040 modified for blind to disabled
We are writing to you about your Social Security benefits. We recently looked at (1) claim again to see if our decision was correct. We did this because we got more information
on (2) case. After carefully reviewing all of the information, we find that (3) not meet our blindness requirements, but (4) meet our disability requirements.
Fill-ins:
(1) your/claimant’s name (possessive)
(2) your/his/her
(3) you do/he does/she does
(4) you do/he does/she does
This is a new paragraph:
Since you do not meet the blindness requirements, if (1) , we will use a lower monthly earnings amount to decide if (2) to be entitled to disability benefits.
Fill-ins:
(1) you work/he works/she works
(2) you continue/he continues/she continues
If the predetermination due process notice included complete and sufficient personalized
language and no changes are needed to the personalized explanation (e.g., no new evidence was
submitted that needed to be addressed), there is no need to repeat the personalized
language in this reopening determination notice. Otherwise, Enter the Personalized Disability Explanation (PDE) language per DI 26530.020 and DI 26530.055, including a list of the evidence, an explanation of what the evidence shows, and
the detailed, personalized reasons for the determination. For additional guidance,
see Reopening of Prior Determination DI 27536.015. Use paragraph 4041 (NL 00708.100) if merged text is not used.
If concurrent claims are involved, include paragraph 842:
This decision refers only to (1) Social Security Disability Insurance benefits. You will get a separate letter about
(2) Supplemental Security Income payments.
Fill-ins:
(1) your/claimant’s name (possessive)
(2) your/his/her
4054
Who Decided (1) Case
Fill-in:
(1) Your/His/Her
If DDS disability determination:
Doctors and other trained staff looked at this case and made this decision. They work
for the State but used our rules.
If Federal disability determination:
Our doctors and other trained staff looked at this case and made this decision.
ALS023 – modified to show 789 instead of 561
If You Disagree With The Decision
If you disagree with this decision, you have the right to appeal. We will review __
(1)__ case and consider any new facts you have. A person who did not make the first
decision will decide __ (2)__ case. We will review those parts of the decision that
you believe are wrong and will look at any new facts you have. We may also review
those parts that you believe are correct and may make them unfavorable or less favorable
to __(3)__.
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You have 60 days to ask for an appeal in writing.
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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.
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You must have a good reason for waiting more than 60 days to ask for an appeal.
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You have to ask for an appeal in writing. We will ask you to complete a Form SSA-789-U4,
called “Request for Reconsideration – Disability Cessation – Right to Appear.” Contact
one of our offices if you want help.
Fill-ins:
(1) your/claimant’s name (possessive)
(2) your/his/her
(3) you/him/her
Please read the enclosed pamphlet, “Your Right to Question the Decision Made on Your
Claim.” It contains more information about the appeal.
4067
How An Appeal Works
A Disability Hearing Officer (DHO) will decide your appeal. We will call this person
a DHO in the rest of our letter. The DHO will meet with you before making the decision
on your appeal. The meeting works like this:
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The DHO will write you about the time and place for the meeting.
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You can look at your file before the meeting.
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You can tell the DHO why you think you are still blind. You can give the DHO more
facts and you can bring people to say why they think you are still blind.
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You can have the DHO ask people to come to the meeting and bring important papers.
You can question these people at the meeting.
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You do not have to go to the meeting in person. If you do not want to go, you can
give the DHO more facts you may have. The DHO will decide your case using these facts
and what is now in your file. But if you go to the meeting, it may help the DHO decide
your case.
4069A
If You Want Help With Your Appeal
You can have a friend, representative, or someone else help you. There are groups
that can help you find a representative or give you free legal services if you qualify.
There also are representatives 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, please let us know. If you hire someone, we must approve
the fee before he or she can collect it. If you hire a representative who is eligible
for direct pay, we will withhold up to 25 percent of any past-due benefits to pay
toward the fee.
4078
If You Have Any Questions
If you have any questions please call us toll free at 1-800-772-1213, or call your local Social Security office at [FO phone number from DOORS. We can answer most questions over the phone. You can also write or visit any Social
Security office. The office that serves your area is located at:
Fill-in:
[Field Office Address
City, State, ZIP] per DOORS
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.
Enclosure:
SSA Pub. No. 05-10058