TN 1 (06-24)

DI 28055.055 Model Language: Auxiliary (EPE) Cessation Notice - Exhibit

We are writing to tell you that we have looked at (W/E's name, possessive) case to see if (their) health problems are still disabling. After looking at all of the information carefully, we found that (W/E's name) is not disabled under our rules as of (month/year).

If You Are Receiving Payments

If you are receiving payments, they will end. We will write you later if we owe you back payments or you are overpaid.

Do You Think We Are Wrong?

If you think we are wrong, you have the right to appeal. We will review this decision if you appeal.

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  You have 60 days to appeal.

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  The 60 days start the day after you get this letter.

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  You will have to have a good reason for waiting more than 60 days.

Contact Us In 10 Days To Keep Receiving Your Payment

You have only 10 days to ask us to continue your payments during your appeal. The 10 days start the day after you receive this letter.

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  Both you and (W/E's name) must ask for your payments to continue.

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  And either you or (W/E's name) must file an appeal.

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  If the appeal is lost, you might have to pay back some or all of the money you received.

If You Have Any Questions

If you have any questions, you should call, write,or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.