Pension Medical Evidence

addressee
street
city
state/zip

Dear addressee:

We have your claim for a pension. Our laws require us to ask you for more information. The information you give us will help us decide whether we can pay you a pension.

What We Need

Send us a medical report from a doctor or clinic that you visited in the past six months. The report should show why you can't work. Please take this letter and the enclosed Doctor's Guide to your doctor.

When We Need It

We need the doctor's report by [date]. We'll have to turn down your claim if we don't get the report by that date.

Your Right to Privacy

The information you give us is private. We might have to give out this information in a few special cases. But we will not give it out to the general public without your permission. We've attached a form which explains your privacy rights. If you have any questions, call us toll-free by dialing 1-800-827-1000. Our TDD number for the hearing impaired is 1-800-829-4833. If you call, please have this letter with you.

Sincerely

Enclosures:
Your Privacy Rights
Doctor's Guide