TN 32 (04-26)

NL 00705.221 Reopening Notice 5 – Allowance to Closed Period – Title XVI

 

Use one of the following lead-in paragraphs:

Reopening To Closed Period - Medical Improvement - Title XVI

We are writing to you about (1) Supplemental Security Income payments. We recently looked at (2) claim again to see if our decision was correct. After reviewing all of the information carefully, we are changing our decision. We now find that (3) disabled from (4) to (5). This means that (6) payments will stop.

 

Fill-ins:

(1) your/recipient’s name (possessive)

(2) your/his/her

(3) you were/recipient's name was

(4) Established onset date (MM/DD/YYYY)

(5) Closed period end date (MM/DD/YYYY)

(6) your/his/her

 

OR

 

Reopening To Closed Period - Group I Exception - Title XVI

We are writing to you about (1) Supplemental Security Income payments. We recently looked at (2) claim again to see if our decision was correct. After reviewing all of the information carefully, we are changing that decision. We have decided that (3) now able to work. This means that (4) payments will stop.

 

Fill-ins:

(1) your/recipient’s name (possessive)

(2) your/his/her

(3) you are/he is/she is

(4) your/his/her

 

OR

 

Reopening to Closed Period – Group II Exception – Title XVI

We are writing to you about (1) Supplemental Security Income payments. We recently looked at (2) claim again to see if our decision was correct. After reviewing all of the information carefully, we are changing that decision. Based on our rules, we have decided that (3) no longer eligible for payments.

 

Fill-ins:

(1) your/recipient’s name (possessive)

(2) your/his/her

(3) you are/he is/she is

 

The Decision

See the enclosed Explanation.

Attach 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.

 

If concurrent claims are involved, include the following paragraph:

This decision refers only to (1) Supplemental Security Income payments. You will get a separate letter about (2) Social Security Disability Insurance benefits.

Fill-ins:

(1) your/recipient’s (possessive)

(2) your/his/her

 

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.

 

(Universal text identifiers (UTIs) ALSC12/ALS023 - modified to show SSA-789 instead of SSA-561)

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 the 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 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 must ask for an appeal in writing. Please use our "Request for Reconsideration - Disability Cessation -Right to Appear", form SSA-789. You may go to our website at https://www.ssa.gov/forms to locate the form. You can also contact us to request the form, or if you need help filling out the form.

If there is a determination of FSF, or if the revision is due to a non-medical reason, use:

 

 

Do not send the following caption and paragraph 4061 if there is a determination of fraud or similar fault, 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 the payment of SBC (see DI 27540.030).

Include Goldberg/Kelly payment continuation language in the decision notice.

 

(UTI 4059)

Appeal In 10 Days 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.

• •

  With this form, you can choose to continue or not continue getting benefits during your appeal. If applicable, you can also choose to continue only Medicare and for your family to keep getting their benefits if they are also receiving benefits on your record.

• •

  We must receive your appeal request with the SSA-792 form within 10 days to continue your benefits.

• •

  If you lose the appeal, you might have to pay back some or all of this money. If you are receiving Medicare, you will not have to pay back Medicare.

(UTIs 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.

 

Do not send the following caption and paragraph if the revision is due to a non-medical reason, such as work.

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:

• •

  The DHO will write you about the time and place for the meeting.

• •

  You can look at your file before the meeting.

• •

  You can tell the DHO why you think you are still (1). You can give the DHO more facts and you can bring people to say why you are (2).

• •

  You can have the DHO ask people to come to the meeting and bring important papers. You can question these people at the meeting.

• •

  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.

 

Fill-ins:

(1) disabled/blind

(2) disabled/blind

 

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-1694 "Claimant's Appointment of Representative" at www.ssa.gov/forms, or contact us to request a form. You can also log into your mySocialSecurity account for information and online service options regarding your representation.

 

(UTI 4070)

If Your Health Gets Worse

If (1) health gets worse and you feel that (2) disabled again, please get in touch with us. (3) may be able to get payments again.

Fill-ins:

(1) your/recipient’s name (possessive)

(2) you are/he is/she is

(3) You/recipient’s name

 

(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 deaf or hard of hearing, call TTY (866) 501-2101.

 

Need More Help?

• •

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

• •

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

• •

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

              (2) [Field Office Address

               City, State, ZIP]

Fill-ins:

(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.

 

If a determination of FSF is not involved, use:

Enclosure:

SSA Pub. No. 05-10090