20 CFR 411.200(b)--SSA-1375 Internet Version (State ENs)

‘MAXIMUS
Request for Important Information
MAXIMUS Ticket to Work
P.O. Box 1433
Alexandria, Virginia 22313

Ticket Number:

Notice Code:
We recently wrote to you about your progress with work and earnings, education, or
technical training from through . After every 12 months that you work with an Employment Network (EN)
or State vocational rehabilitation (VR) agency, we must decide if you are making the
expected progress. The 12 months only include months that your ticket was assigned to an
EN and active or you were working with a State VR agency and active. We either
received no response or the information did not show that you met the requirements for
making the expected progress. If we do not hear from you in writing within 30 days of the
date of this notice, you will no longer be excused from medical reviews as of .
Why Social Security Does Progress Reviews
As long as you are working with an EN or a State VR agency and making the expected
progress toward your work-related goals, Social Security will not conduct a medical
review to see if you are still disabled under their rules. A Progress Review is the means
used to decide if you are making enough progress with work and earnings, education, or
technical training to continue to be excused from a medical review.
If you aren’t meeting the progress review requirements you are not making the expected
progress, and you will not be excused from a medical review. However, you may
continue to work with your EN or State VR agency toward your goals.
What You Should Do
You have three options at this time:
EIN:
SSN:
SSA-L1374 (EF 4/08)

Notice Code: F0001000
Page 1 of 3

1. To Continue Making Progress
In the past, we requested your response to the attached Progress Review Form. This letter is
your second chance to provide information about your progress with work and earnings,
education, or technical training. If you have met the requirements for your 12-month
Progress Review, please complete the attached Progress Review Form, sign and date it, and
return it to us within 30 days. If you have not met the requirements for this period, you may
contact < INSERT name of EN/state VR agency> to help you continue making progress
toward your goals.

2. To Request Inactive Status
At any time that you believe you are not able to make the expected progress, you may
request Inactive Status. To do this, you may write MAXIMUS a letter asking for Inactive
Status. MAXIMUS will notify your EN or State VR agency of this. However, you may
continue to work with your EN or State VR agency toward your work goals.
The months that you are in Inactive Status do not count against the time limit for making
progress toward self-supporting employment so we will not review your progress during
this period. However, while you are in Inactive Status, you are not excused from medical
reviews.

3. To Ask Social Security to Review Our Decision
If you would like Social Security to review our decision, you must send a written request
within 30 days and explain why you disagree with our decision. Please provide evidence
to show how you met the requirements for this Progress Review period. You must
include evidence of your work and earnings or education or technical training. We
require an original pay slip or school transcript, or statement from an employer or school.
You may keep a copy of what you send us for your records. In place of this, we accept
two pieces of evidence, such as photocopies of pay slips or transcripts, and a signed
statement from you certifying that you met the required work or education or training.
You may complete the enclosed Progress Review Form, sign it and return it to us in place
of a signed statement. Please write your ticket number on each document you send us.
The evidence must be clear and legible.

EIN:
SSN:
SSA-L1374 (EF 4/08)

Notice Code: F0001000
Page 2 of 3

We will send your written request to Social Security. Once they review your evidence, they
will send you a letter to tell you about their final decision.
If You Have Questions
If you have any questions regarding the Ticket to Work Program, please contact us at
1-866-968-7842 or TDD 1-866-833-2967. All written requests should be sent to the
following address:

MAXIMUS Ticket to Work
P.O. Box 1433
Alexandria, VA 22313

For help with general questions, you may call SSA at 1-800-772-1213, or you may write
or visit any Social Security office. SSA can also give you more information about other
employment
support policies that help people with disabilities go to work. If you visit a Social
Security office, please bring this letter with you.
Sincerely,
MAXIMUS Ticket to Work Program

EIN:
SSN:
SSA-L1374 (EF 4/08)

Notice Code: F0001000
Page 3 of 3