TN 4 (09-21)
DI 28080.015 Example of Notice for a Title II Continuing Disability Review (CDR) Pre-determination
SSA reviewed your record to see if you are still entitled for Social Security disability
insurance benefits. To get benefits, you must be unable to do any substantial gainful
activity (SGA). Substantial gainful activity is physical or mental work you can do
for pay or profit. It can be full-time or part-time work.
A State agency, Disability Determination Services (DDS), rather than the persons or
agencies that gave us reports, made this determination. Based on the information in
file, DDS plans to decide that you are no longer disabled and can do SGA starting
in (date). You will be entitled to receive benefits for (date) and for the next 2 months.
What You Should Do
Please write to us within 10 days if you have more information that you want us to consider. You can write to us at
this address: DDS Name, Street, City and State, Zip Code
If We Do Not Hear From You
If we do not hear from you within 10 days, we will make our determination about your disability benefits based on the information
we have. We will send you another letter when we make our final decision.
The Information We Have
We considered the following reports in addition to the evidence you gave us when you
first filed for benefits:
Sawyer Memorial Hospital, report of hospitalization 01/10/2018 to 02/06/2018; outpatient
records of 03/03/2018 to 06/17/2018.
Greg Sweeney, M.D., report of 07/05/2018.
Dr. Michael Parker, report of 05/10/2018 for period 10/12/2015 to 05/10/2018.
The information showed (1).
(1) Include a brief statement describing the basis for the most recent favorable
medical determination and the reason for the current review.
You say you still cannot work because (2).
(2) Include a brief statement outlining the reasons the individual gave for
believing he or she is still disabled and whether or not he or she is engaging
Current reports show (3).
(3) Describe current medical severity, medical improvement, or exceptions to the
medical improvement review standard and ability to work.
Describe the work the individual can do. (4)
(4) Include a brief statement, if appropriate, outlining the past job the
individual can do, or a statement that although the individual cannot do past
work, considering age, education, and past work experience, he or she has the
capacity to do other kinds of work requiring less physical exertion.
If You Have Any Questions
Insert contact information including telephone number.
NOTE: In ceased prisoner cases, because we cannot consider the original impairment, the
notice must include the Rider W message. See NL 00705.540, Prisoner Model Letter “W” – Felony and Non-Felony Related Impairments – DIB, CDB,