NL 00701.000 Form Notices

Subchapter Table of Contents
Section   Latest
Transmittal
NL 00701.001 Usage Chart for RSDI Authorization and General Use Form Notices TN 18 02-21
NL 00701.003 Usage Chart for Form Notices Relating Specifically to Disability Issues
NL 00701.005 Usage Chart for HI/SMI Form Notices
NL 00701.007 Usage Chart for Benefit Adjustment Form Notices
NL 00701.024 Form SSA-L51 — Determination of One-Half Support (At Time N/H's Disability Began — Disapproved) TN BASIC 11-81
NL 00701.036 Form SSA-L223 — Auxiliary Disapproval — N/H Not Entitled
NL 00701.060 Form SSA-L236 — CDB Disapproval — Not Disabled Before Age 22 TN BASIC 11-81
NL 00701.063 Form SSA-L236A — CDB Disapproval — Not Disabled Through Point of Decision (Not Yet Age 22) TN BASIC 11-81
NL 00701.066 Form SSA-L237 — DIB Denial — Miscellaneous (Fill-In Letter) TN BASIC 11-81
NL 00701.069 Form SSA-L237B — DIB Denial — Death Before End of 5-Month Waiting Period TN BASIC 11-81
NL 00701.093 Form SSA-L250 — Approval of Withdrawal
NL 00701.114 Form SSA-L412 — Reconsideration — Initial Interim Notice — Additional Evidence is Being Obtained TN BASIC 11-81
NL 00701.116 Form SSA-L445-U2 — Notice to Spouse in Separate Household
NL 00701.117 Form CMS-L457 — Acknowledgement of Request for Medicare Part B Termination
NL 00701.120 Form CMS-L458 — Acknowledgement of Request for Premium Hospital Insurance Termination
NL 00701.126 Form SSA-L467 — Disability Benefit Suspension Notice (Miscellaneous)
NL 00701.135 SSA-L501 Home Visit Letter TN 15 06-10
NL 00701.136 SSA-L502 Telephone Interview Letter TN 15 06-10
NL 00701.137 SSA-L503 Centenarian Project -- Representative Payee Notice of Interview TN 15 06-10
NL 00701.138 SSA-L504 Centenarian Project -- Nursing Home Notice of Interview TN 15 06-10
NL 00701.139 SSA-L505 Residence Address Request Letter TN 15 06-10
NL 00701.205 SSA-L725, Employer Verification of Monthly Wages TN 13 09-06
NL 00701.237 Form SSA-L761 — Miscellaneous Adjustment Notice
NL 00701.255 Form SSA-L795-U2 — Reconsideration — Affirmation of DIB or CDB Cessation
NL 00701.267 Form SSA-L800-U2 — Reconsideration — Affirmation of DIB Denial
NL 00701.270 Form SSA-L801-U2 — Reconsideration — Affirmation of DWB Cessation TN BASIC 11-81
NL 00701.354 Form SSA-L823 — Auxiliary Denial — N/H Not Entitled
NL 00701.360 Form SSA-L829-U2-Disapproval -- Miscellaneous Fill-In Letter TN BASIC 11-81
NL 00701.387 Form SSA-L850 — Approval of Request for Withdrawal (Disability) TN BASIC 11-81
NL 00701.390 Form SSA-L917 — Reconsideration — DIB Earnings Requirement Not Met TN BASIC 11-81
NL 00701.391 Form SSA-L928 – Reconsideration -- Affirmation of DIB, DWB, or CDB Denial TN 14 09-07
NL 00701.425 Form SSA-L1013 — DIB Continuance — Title II
NL 00701.430 Form SSA-L1014 — DIB Continuance — Title XVI
NL 00701.435 Form SSA-L1016 (Formerly SSA-L368) — DIB Cessation (T21) No OPA/UPA — No HI/SMI TN BASIC 11-81
NL 00701.440 Form SSA-L1017 (Formerly SSA-L368A) — DIB Cessation (T21) — No DIB OPA/UPA HI/SMI Arrearage TN BASIC 11-81
NL 00701.445 Form SSA-L1018 (Formerly SSA-L368B) — DIB Cessation (T21) — No DIB OPA/UPA — SMI Refund TN BASIC 11-81
NL 00701.450 Form SSA-L1019 (Formerly SSA-L368C) — DIB Cessation (T21) — DIB Underpayment — SMI Premium Arrearage TN BASIC 11-81
NL 00701.455 Form SSA-L1020 (Formerly SSA-L368D) — DIB Cessation (T21) — No DIB OPA/UPA HI/SMI With No Overage or Arrearage TN BASIC 11-81
NL 00701.460 Form SSA-L1021 (Formerly SSA-L369) — DIB Cessation (T20 and T28) — No DIB OPA/UPA — No HI/SMI TN BASIC 11-81
NL 00701.465 Form SSA-L1022 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI Premium Arrearage TN BASIC 11-81
NL 00701.470 Form SSA-L1023 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — SMI Premium Refund TN BASIC 11-81
NL 00701.475 Form SSA-L1024 — DIB Cessation (T20 and T28) — DIB Underpayment — SMI Premium Arrearage TN BASIC 11-81
NL 00701.480 Form SSA-L1025 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI With No Premium Overage or Arrearage TN BASIC 11-81
NL 00701.485 Form SSA-L1026 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — No HI/SMI Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.490 Form SSA-L1027 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI Premium Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.495 Form SSA-L1028 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — SMI Refund — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.500 Form SSA-L1029 — DIB Cessation (T20 and T28) DIB U/P Premium Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.505 Form SSA-L1030 — DIB Cessation (T20 and T28) — No DIB OPA/UPA — HI/SMI With No Overage or Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.515 Form SSA-L1032 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI Premium Arrearage TN BASIC 11-81
NL 00701.520 Form SSA-L1033 — Disability Cessation (T22) — No DIB OPA/UPA — SMI Refund TN BASIC 11-81
NL 00701.525 Form SSA-L1034 — Disability Cessation (T22) — DIB Underpayment SMI Arrearage TN BASIC 11-81
NL 00701.530 Form SSA-L1035 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI With No Premium Arrearage or Overage TN BASIC 11-81
NL 00701.535 Form SSA-L1036 — Disability Cessation (T22) — No DIB OPA/UPA — No HI/ SMI — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.540 Form SSA-L1037 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI Premium Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.545 Form SSA-L1038 — Disability Cessation (T22) — No DIB OPA/UPA — SMI, Refund — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.550 Form SSA-L1039 — Disability Cessation (T22) — DIB Underpayment — SMI Arrearage — Auxiliaries in NH's Household TN BASIC 11-81
NL 00701.555 Form SSA-L1040 — Disability Cessation (T22) — No DIB OPA/UPA — HI/SMI With No Premium Overage or Arrearage — Auxiliaries In NH's Household TN BASIC 11-81
NL 00701.600 Form SSA-L1064-C1 — Lump Sum Approval TN BASIC 11-81
NL 00701.612 Form SSA-L1157-U2 — DI Medical Requirements Met — Non Medical Requirements To Be Determined
NL 00701.615 Form SSA-L1221 — RIB Disapproval — Lack of Insured Status TN BASIC 11-81
NL 00701.620 Form SSA-L1222 — RIB Disapproval — Lack of Insured Status — Date of Birth Not Established TN BASIC 11-81
NL 00701.625 Form SSA-L1223 — RIB Disapproval — Not Retirement Age TN BASIC 11-81
NL 00701.630 Form SSA-L1224 — RIB Disapproval — Not Yet Age 62 TN BASIC 11-81
NL 00701.740 Form SSA-L4967-U2 — Reconsideration — Affirmation of Cessation
NL 00701.750 Form SSA-L5620 — One Check Only Adjustment — Reconsideration Paragraph Required — Beneficiary In Conditional Pay or Suspense Status After Action

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900701000
NL 00701.000 - Form Notices - Table of Contents - 02/17/2021
Batch run: 02/17/2021
Rev:02/17/2021