TN 25 (08-23)
NL 00705.354 Continuing Disability Review (CDR) Come-In Notice
Social Security Administration
Supplemental Security Income
Notice of Continuing Disability Review
Street Address
City, State, ZIP
Phone:
Office Hours:
Date:
Claim Number: xxx-99-xxxxxDC
John Smith for
Jane Smith
Street Address
City ST ZIP
IMPORTANT NOTICE
YOU MUST CONTACT US OR JANE SMITH'S SSI MAY STOP
We must review the cases of children who are receiving Supplemental Security Income
(SSI) based on disability to make sure they are still disabled under our rules. Our
rules require us to review, at least once every three years, the cases of children
whose health we think may improve. We may also review cases at other times, even if
we do not think that a child's health may improve.
We are writing to let you know that we are starting to review Jane Smith's SSI case.
We have enclosed a pamphlet, “How We Decide If You Are Still Disabled,” that will
tell you more about the review.
What You Need To Do Now
Choice 1
Please call us and ask for.
See Next Page
999-99-9999D Page 2 of 4
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.
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.
-
-
•
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 they use.
-
•
Any information that shows their 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;
-
•
counseling and/or therapy;
-
•
schools and/or special classes or tutoring; and
-
•
teachers and/or counselors who have knowledge of their condition.
We may ask for other information later.
***(NOTE: Do NOT use the following language if the child is their own payee.)
We May Ask You To Show That Jane Smith Receives
Treatment
Before we review Jane Smith's case, we may also ask you to show proof that they are
and have been receiving treatment that is medically necessary and available for their
condition. Before we ask for this proof, we will consider the nature of their condition.
If you do not show proof of treatment when we ask you, and you do not have a good
reason why they are not receiving treatment, we may stop making payments to you and
select another payee if it is in their best interests. If they are old enough, we
may pay them directly.
See Next Page
999-99-9999DC Page 3 of 4
How We Decide If
They
Are Disabled
Doctors and other trained staff will decide for us if:
-
•
their condition has improved, and if
-
•
they are still disabled under our rules.
We Will Let You Know What We Decide
When we decide, we will write and let you know our decision. Our letter will tell
you whether they are still disabled under our rules.
We may find that they are no longer disabled under our rules and their SSI could stop.
If this happens, you can appeal our decision. If you appeal our decision, you can
also choose to have us continue to pay you until we decide the appeal.
If
We Do Not Hear From You
We may stop Jane Smith's SSI if you do not answer this letter by
(Month/Day/Year) or contact us by this date to tell us why we have not heard from you. Before we
stop their 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 payments
during the appeal.
Information About Medical Assistance
If Jane Smith's SSI stops, any medical assistance they have that is based on SSI may
also stop. If this happens, your medical assistance agency should contact you, or
you can call them to see if you qualify for continued medical assistance. You should
know that children do not have to be disabled to qualify for medical assistance. Many
children may still qualify for medical assistance if they live in households that
meet the income and resource rules for SSI.
You may also be able to receive help to pay Jane Smith's medical bills through the
Children's Health Insurance Program (CHIP) in your State. For more information about
CHIP in your State, call toll-free 1-877-KIDS NOW or 1-877-543-7669.
If You Have Any Questions
We will be glad to answer any questions that you have. Whether we talk to you by telephone
or in person, 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
See Next Page
999-99-9999DC Page 4 of 4
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 telephone, please
call us right away. Our telephone number is shown on the first page of this letter.
Field Office Manager
Enclosure(s)
SSA Pub. No. 05-10053
[The enclosures may include and of the following:
Form SSA-3881, Questionnaire for Children Claiming SSI Benefits
Form SSA-827, Authorization for Source to Release Information to the Social
Security Administration]
Notice Language
Fill-ins
IMPORTANT NOTICE
YOU MUST CONTACT US OR (1) SSI MAY STOP
We must review the cases of children who are receiving Supplemental Security Income
(SSI) based on disability to make sure they are still disabled under our rules. Our
rules require us to review the cases of children whose health we think may improve
at least once every three years. We may also review cases at other times, even if
we do not think that a child's health may improve.
We are writing to let you know that we are starting to review (2) SSI case. We have
enclosed a pamphlet, “How We Decide If You Are Still Disabled,” that will tell you
more about the review.
Fill-ins:
-
(1)
Choice 1: Recipient's name (possessive)
Choice 2: Your
-
(2)
Choice 1: Recipient's name (possessive)
Choice 2: your
What You Need To Do Now
Fill-ins:
-
(1)
Choice 1:
Please call us and ask for (name of FO employee).
-
(2)
Choice 2:
We would like you to come to our office on (date and time of
appointment).
When you come in, please ask for (name of FO employee).
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.
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.
-
-
•
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 (1).
-
•
Any information that shows (2) 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;
-
•
counseling and/or therapy;
-
•
schools and/or special classes or tutoring; and
-
•
teachers and/or counselors who have knowledge of (3) condition.
We may ask for other information later.
-
(1)
Choice 1: they use
Choice 2: you use
-
(2)
Choice 1: their
Choice 2: your
-
(3)
Choice 1: their
Choice 2: your
***(NOTE: Do NOT use the following language if the child is their own payee.)
We May Ask You To Show That (1) Receives Treatment
Before we review (2) case, we may also ask you to show proof that (3) are and have
been receiving treatment that is medically necessary and available for (4) condition.
Before we ask for this proof, we will consider the nature of (5) condition. If you
do not show proof of treatment when we ask you, and you do not have a good reason
why (6) are not receiving treatment, we may stop making payments to you and select
another payee if it is in (7) best interests. If (8) are old enough, we may pay (9)
directly.
-
(1)
Choice 1: Recipient's name
-
(2)
Choice 1: Recipient's name (possessive)
-
-
-
-
-
-
-
How We Decide If (1) Disabled
Doctors and other trained staff will decide for us if:
-
•
(2) condition has improved, and if
-
•
(3) still disabled under our rules.
-
(1)
Choice 1: They Are
Choice 2: You Are
-
(2)
Choice 1: their
Choice 2: your
-
(3)
Choice 1: they are
Choice 2: you are
We Will Let You Know What We Decide
When we decide, we will write and let you know our decision. Our letter will tell
you whether (1) still disabled under our rules.
We may find that (2) no longer disabled under our rules and (3) SSI could stop. If
this happens, you can appeal our decision. If you appeal our decision, you can also
choose to have us continue to pay you until we decide the appeal.
-
(1)
Choice 1: they are
Choice 2: you are
-
(2)
Choice 1: they are
Choice 2: you are
-
(3)
Choice 1: their
Choice 2: your
If We Do Not Hear From You
We may stop (1) SSI if you do not answer this letter by (Month/Day/Year) or contact
us by this date to tell us why we have not heard from you. Before we stop (2) 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 payments during the
appeal.
-
(1)
Choice 1: Recipient's name (possessive)
Choice 2: your
-
(2)
Choice 1: their
Choice 2: your
Information About Medical Assistance
If (1) SSI stops, any medical assistance (2) that is based on SSI may also stop. If
this happens, your medical assistance agency should contact you, or you can call them
to see if you qualify for continued medical assistance. You should know that children
do not have to be disabled to qualify for medical assistance. Many children may still
qualify for medical assistance if they live in households that meet the income and
resource rules for SSI.
You may also be able to receive help to pay (3) medical bills through the Children's
Health Insurance Program (CHIP) in your State. For more information about CHIP in
your State, call toll-free 1-877-KIDS NOW or 1-877-543-7669.
-
(1)
Choice 1: Recipient's name (possessive)
Choice 2: your
-
(2)
Choice 1: they have
Choice 2: you have
-
(3)
Choice 1: Recipient's name (possessive)
Choice 2: your
If You Have Any Questions
We will be glad to answer any questions that you have. Whether we talk to you by telephone
or in person, 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. 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 telephone, please
call us right away. Our telephone number is shown on the first page of this letter.
Field Office Manager
Enclosure(s)
SSA Pub. No. 05-10053
[The enclosures may include and of the following:
Form SSA-3881, Questionnaire for Children Claiming SSI Benefits
Form SSA-827, Authorization for Source to Release Information to the Social
Security Administration]