TN 32 (04-26)

NL 00705.211 Reopening Notice 3 – Auxiliary – Title II

Use one of the following lead-in paragraphs:

Auxiliary – Lead-In -- Allowance to Denial

We are writing to you about your Social Security benefits. We recently looked at (1) disability case again to make sure our decision was correct. After reviewing all of the information carefully, we are changing our decision. We now find that (2) is not disabled. Therefore, based on our rules, we are denying your claim for benefits. When (3) benefits stop, your benefits will also stop.

Fill-ins:

(1) number holder’s name (possessive)

(2) number holder's name

(3) number holder's name (possessive)

OR

Auxiliary – Lead-In – Closed Period

We are writing to let you about your Social Security benefits. We recently looked at (1) disability case again to make sure our decision was correct. After reviewing all of the information carefully, we are changing our decision. We now find that (2) is no longer disabled. When (3) benefits stop, your benefits will also stop.

Fill-ins:

(1) number holder’s name (possessive)

(2) number holder's name

(3) his/her

 

(Universal text identifier (UTI) ALSC12/ALS023)

If You Disagree With The Decision

If you do not agree with this decision, you have the right to appeal. A person who did not make the first decision will decide the case. We will review the case and look at any new facts you have. We will review the parts of the decision that you think are wrong and correct any mistakes. We may also review the parts of our decision that you think are right. We will make a decision that may or may not be in your favor.

• •

  You have 60 days to ask for an appeal.

• •

  The 60 days start the day after you receive 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 must ask for an appeal in writing. Please use our “Request for Reconsideration” form, SSA-561. You can go to our website at www.ssa.gov/forms to locate this form. Or, you can submit your appeal request online at www.ssa.gov/disability/appeal. You can also contact us to request the form or if you need help filling out the form.

 

Do not send the following caption and paragraph (4060) if there is a determination of fraud or similar fault (FSF), since FSF precludes the payment of statutory benefit continuation. Do not send the following caption and paragraph if the revision is due to a non-medical reason, such as work, or other reason that precludes statutory benefit continuation (SBC) payments (see DI 27540.025). However, a predetermination due process notice is needed.

(UTI 4060)

Appeal in 10 Day To Keep Getting Your Benefits

You have only 10 days to ask us in writing to continue your benefits during your appeal. The 10 days start the day after you get this letter.

• •

  To continue benefits, complete our SSA-792 Statutory Benefit Continuation Election Statement form. Submit the form with your appeal request to your local Social Security office within 10 days. You can go to our website at https://www.ssa.gov/forms to locate this form. You can also contact us to request the form or if you need help filling out the form.

• •

  Both you and (1) must ask for your payments to continue, and (2) must file an appeal within 10 days.

• •

  If (3) loses the appeal, you might have to pay back some or all of this money.

Fill-ins:

(1) number holder’s name

(2) he/she

(3) number holder's name

 

(UTI ALSC23/ALS099)

You May Not Have To Pay Back The Money You Get During Your Appeal

If you ask us to continue your benefits during your appeal, and your appeal is not approved, we will start collecting the money you and your family received during your appeal. You can request to not pay the money back by asking for a waiver. We may approve your waiver if the overpayment was not your fault AND paying us back would mean that you cannot afford to meet your daily living expenses, or it would be unfair for some other reason. We may find you are not at fault for the overpayment of the benefits you received during your appeal if all the following are true:

• •

  You asked for an appeal because you believe you still have a disability.

• •

  You provided the requested evidence.

• •

  You attended all requested examinations.

 

(UTI REPC01/REP002)

If You Want Help With Your Appeal

You may choose to have a representative help you with your case. We will work with this person just as we would work with you. If you decide to have a representative, you should find one quickly so that person can start preparing your case.

Many representatives charge a fee only if you win your case. Others may represent you for free. Generally, your representative cannot charge a fee unless we approve it. Your local Social Security office can give you a list of groups that can help you find a representative.

If you get a representative, you or that person must notify us in writing. You can go to https://secure.ssa.gov/ssa1696/front-end/ to complete the form with your representative online, download the form SSA-1696 "Claimant's Appointment of Representative" at www.ssa.gov/forms, or contact us to request a form.

You can also log into your mySocial Security account for information and online service options regarding your representation.

 

(UTI CTDO)

Suspect Social Security Fraud?

Please visit https://oig.ssa.gov/report or call the Inspector General's Fraud Hotline at (800) 269-0271. If you are a person who is deaf or hard of hearing, call TTY (866) 501-2101.

 

Need More Help?

1. Visit www.ssa.gov for fast, simple, and secure online services.

2. Call us at 1-800-772-1213, weekdays from 8:00am to 7:00pm. If you are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention this letter when you call.

3. You may also call your local office at (1).

 

             (2)  [Field Office Address

                City, State, Zip code]

 

Fill-ins (per DOORS):

(1) Local field office public line phone number

(2) Local field office address

 

If you contact us, please refer to this letter. It will help us answer your questions.

 

How Are We Doing? Go to www.ssa.gov/feedback to tell us.

 

Enclosure:

SSA Pub. No. 05-10058