AGENCY LETTERHEAD

Date: [Fill-in]

Case ID: [Fill-in]

 

Addressee Name

Address Line 1

Address Line 2

City, State, Zip code

 

CALL IN LETTER

 

We are the office that makes disability decisions for the Social Security Administration. It is very important that we speak to you by [10 calendar days].

[Free form/Canned text]

If you do not respond by [10 calendar days], we may decide your case based on the information we already have in file. This means that we could find that you are not disabled based on our rules or that your disability has ended if you are already getting benefits.

Please call the phone number(s) show below Monday-Friday between [DDS office open] and [DDS office close]. When you call or leave a message, please provide the Case ID: [case ID number], your name, and a call back number.

Thank you for your help.

[Name]

[Phone Number]

[Fax Number]

 

Enclosure:

Multi-Language Insert (if enclosed)

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  DI 22505.014 Requesting Evidence or Action from the Claimant or Third Party

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  DI 22510.016 Claimant Consultative Examination (CE) Notice and Confirmation Procedures

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  DI 22510.019 Consultative Examination (CE) Appointment Notice Follow Up and Reminder

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  DI 23007.005 Contacting the Claimant, Appointed Representative, or Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence