I-2-8-103.Exhibit - Response to Inquiry by Individual/Representative Regarding Title XVI Payment Continuation

Refer to

Memorandum

Date:

From:

HO

Subject:

Response to Inquiry by Individual/Representative Regarding Title XVI Payment Continuation

To:

DO/BO _______________________

RE:

____________________________    _______________________

Individual's Name                                   SSN

1.

a. ___

Individual initiated action on _________________(date)

or

b. ___

Representative of individual initiated action on _________________(date)

__________________________________

Name of Representative

2.

a. ___

Do not reinstate continued payments -- a final decision or dismissal order has already been issued for this remanded case on _________________(date)

or

b. ___

The remand is still pending without a final action. The individual has been referred to your office to complete a written request for continued payments. Please perform SSI queries to determine whether or not the individual received continued payments before at the ALJ level and follow the instructions in POMS DI 12027.065ff.

_____________ Date of prior decision or dismissal order

_____________ Date of Appeals Council remand order

NOTE TO DO/BO:

The HO will not send a notice to the individual regarding continued payments, since the individual/representative initiated the process.