CDR001 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD - MEDICAL EXAM IN 3
YEARS
Doctors and other trained staff decided that (1) (2) disabled under our rules.
But, this decision must be reviewed at least once every 3 years. We will send you
a letter before we start the review. Based on that review, (3) benefits will continue
if (4) still disabled, but will end if (5) no longer disabled.
Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
|
you
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Fill-in (2)
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Choice 1
|
is
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Choice 2
|
are
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Fill-in (3)
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Choice 1
|
his
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Choice 2
|
her
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Choice 3
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your
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Fill-in (4)
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Choice 1
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he is
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Choice 2
|
she is
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Choice 3
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you are
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Fill-in (5)
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Choice 1
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he is
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Choice 2
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she is
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Choice 3
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you are
|
CDR002 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD - MEDICAL EXAM IN 5–7
YEARS
Doctors and other trained staff decided that (1) (2) disabled under our rules.
However, we must review all disability cases. Therefore, we will review (3) case in
5 to 7 years. We will send you a letter before we start the review.
Based on that review, (4) benefits will continue if (5) still disabled, but will end
if (6) no longer disabled.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
you
|
Fill-in (2)
|
|
Choice 1
|
is
|
Choice 2
|
are
|
Fill-in (3)
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Choice 1
|
his
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Choice 2
|
her
|
Choice 3
|
your
|
Fill-in (4)
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Choice 1
|
his
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Choice 2
|
her
|
Choice 3
|
your
|
Fill-in (5)
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Choice 1
|
he is
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Choice 2
|
she is
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Choice 3
|
you are
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Fill-in (6)
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Choice 1
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he is
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Choice 2
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she is
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Choice 3
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you are
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CDR004 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD – DISABILITY NOT
PERMANENT
The doctors and other trained personnel who decided that (1) (2) disabled expect (3)
health to improve. Therefore, we will review (4) case in the future.
We will send you a letter before we start the review. Based on that review, (5) benefits
will continue if (6) (7) still disabled, but will end if (8) (9) no longer disabled.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
you
|
Fill-in (2)
|
|
Choice 1
|
is
|
Choice 2
|
are
|
Fill-in (3)
|
|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
Fill-in (4)
|
|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
Fill-in (5)
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|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
Fill-in (6)
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|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (7)
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Choice 1
|
is
|
Choice 2
|
are
|
Fill-in (8)
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|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (9)
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Choice 1
|
is
|
Choice 2
|
are
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CDR063 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED
WIDOW(ER) BENEFITS (DWB) SUSPENDED - FAILURE TO COOPERATE
We cannot pay (1) benefits because our records show that (2) did not return information
we asked for concerning (3) disability.
Fill-in values:
|
Fill-in (1)
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|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
you
|
Fill-in (2)
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|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (3)
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|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
CDR065 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED
WIDOW(ER) BENEFITS (DWB) SUSPENDED - FAILURE TO COOPERATE
If we stop (1) Social Security disability benefits and you do not give us the information
we asked for before (2), (3) will have to file a new application to get Social Security
disability benefits again. If we do not hear from you by this date, we will send you
another letter which will give you the information about (4) appeal rights.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
your
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Fill-in (2)
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Add 12 months to the first effective date in History data that corresponds to the
ongoing Continuing Disability Review (CDR) Failure to Cooperate (FTC) suspension
and display in the format Month CCYY
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Fill-in (3)
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Choice 1
|
he
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Choice 2
|
she
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Choice 3
|
you
|
Fill-in (4)
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Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
CDR066 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED
WIDOW(ER) BENEFITS (DWB) TERMINATED FOR FAILURE TO COOPERATE
(1) no longer (2) for Social Security disability benefits beginning (3) because our
records show that (4) did not return information we asked for during (5) continuing
disability review.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
You
|
Fill-in (2)
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|
Choice 1
|
qualifies
|
Choice 2
|
qualify
|
Fill-in (3)
|
Historical Date of Entitlement Termination (BCLM-DOETERM-REL) - this date corresponds to the first effective date in History (HIST) data on the post-MBR of the Continuing Disability Review (CDR) Failure to Cooperate (FTC) for
PIC A or W or the CDR FTC for PIC C in the format Month CCYY)
|
Fill-in (4)
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|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (5)
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|
Choice 1
|
his
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Choice 2
|
her
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Choice 3
|
your
|
CDR067 – BENEFITS ARE TERMINATED DUE TO THE NUMBER
HOLDER'S FAILURE TO COOPERATE OR DISABILITY CESSATION
We can no longer pay (1) benefits because (2) no longer qualifies for Social Security
disability benefits beginning (3).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
you
|
Fill-in (2)
|
NH-NAME
|
Fill-in (3)
|
Historical Date of Entitlement Termination (BCLM-DOETERM-REL) that corresponds to the first effective date in History (HIST) data for the Disability
Insurance Benefits Cessation (DIBCES) termination which is used for an auxiliary when the Number Holder fails to cooperate
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CDR083 – REQUEST FOR MEDICARE ONLY STATUTORY BENEFIT CONTINUATION FOR A
BENEFICIARY WITH A FUTURE DATED DISABILITY CESSATION DATE (DBC)
In an earlier letter, we told (1) that (2) disability benefits would end. (3) no longer
entitled to benefits as of (4). However, during the appeals process (5) requested
to have Medicare coverage continued.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
you
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Fill-in (2)
|
|
Choice 1
|
your
|
Choice 2
|
his |
Choice 3 |
her |
Fill-in (3)
|
|
Choice 1
|
You are
|
Choice 2
|
He is |
Choice 3 |
She is |
Fill-in (4)
|
|
Choice 1
|
Future dated DBC in Month CCYY format |
Fill-in (5)
|
|
Choice 1
|
you
|
Choice 2
|
he |
Choice 3
|
she |
CDR084 – FAVORABLE REVERSAL OF THE MEDICAL CESSATION DECISION FOR A BENEFICIAIRY
WITHOUT STATUTORY BENEFIT PAYMENT CONTINUATION
In an earlier letter, we told (1) that (2) disability benefits would end. Now, we
decided that (3) still disabled and our previous notice should be disregarded.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
you
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (not possessive)
|
Fill-in (2)
|
|
Choice 1
|
your
|
Choice 2
|
his |
Choice 3 |
her |
Fill-in (3)
|
|
Choice 1
|
you are
|
Choice 2
|
he is |
Choice 3 |
she is |
CDR701 – PAYMENTS WILL CONTINUE AT THE SAME RATE AFTER A FAVORABLE REVERSAL OF
THE MEDICAL CESSATION DECISION
We previously advised (1) that (2) disability benefits would terminate because (3)
no longer entitled to benefits. However, during the appeals process (4) monthly benefit
check(s) continued. It has been determined that (5) still disabled and our previous
notice should be disregarded.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
you
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Fill-in (2)
|
|
Choice 1
|
your
|
Choice 2
|
his |
Choice 3 |
her |
Fill-in (3)
|
|
Choice 1
|
you are
|
Choice 2
|
he is |
Choice 3 |
she is |
Fill-in (4)
|
|
Choice 1
|
your |
Choice 2
|
his
|
Choice 3
|
her |
Fill-in (5)
|
|
Choice 1
|
you are
|
Choice 2
|
he is |
Choice 3
|
she is |