Current SSA-L1374

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

Claim Account Number:

We wrote to you about your progress with work and education from through . You either did not respond or your response
did not show that you made 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 Progress Reviews are Important
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 way Social Security decides if you
are making enough progress with work and education 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:

1. To Continue Making Progress
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.
EIN: <#>
SSN:
SSA-L1374 (EF 04/08)

Notice Code: F0001000

Page 1 of 3

MAXIMUS
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 education. We require an original pay slip or school transcript, or statement from an
employer or school. 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 keep a copy of what you send us for your records. 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.
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

EIN:
SSN:
SSA-L1374 (EF 04/08)

Notice Code: F0001000

Page 2 of 3

MAXIMUS
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 04/08)

Notice Code: F0001000

Page 3 of 3