POMS Reference

NL 00701: Form Notices

BASIC (11-81)

A. Sample form

G-NL_00701.360A

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B. Preparation of form

If the disability examiner indicates this notice on Form SSA-3428-U2 or SSA-831-U5, use Form SSA-L829.

Fill-ins:

  1. for child benefits, the next sentence should be “Your claim for” and type the complete name of the child. If there are several children, each child will get a notice.

  2. type any additional paragraphs indicated in this space.