48 lines
3.0 KiB
Markdown
48 lines
3.0 KiB
Markdown
**Jason Dewaine Davis**
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737 Summit Ridge
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Lewisville TX 75077
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(940) 340-9369
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**Date:** 02/12/2026
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**RE:** Jason Davis
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**SSN:** 441-74-0923
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**Claim/File Number:** [if known]
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**Subject:** Additional Information for SSA‑821 – Work Activity Report
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To the Social Security Administration Claims Representative,
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I am writing to provide additional context for the SSA‑821 Work Activity Report I am submitting. I want to be certain that my situation is clearly understood.
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**I did not work at all during the period from March 15, 2024, to the present.**
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I was laid off from my last job on [insert date you last actually worked]. After my separation, I received a severance/lay‑off payment from my employer. This is the income reported in Question 2 of the SSA‑821. I did not perform any work—not a single day—for that money, nor did I seek or obtain any other employment during this time.
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**The reason I did not work is that I was completely disabled by severe major depressive disorder with catatonic features.**
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During this period I experienced prolonged episodes where I was essentially non‑functional. I would lie on the couch for hours—often an entire day—unable to move, speak, or initiate even the smallest task. I vividly recall staring at the clock and perceiving the hour hand moving as quickly as a second hand; time itself had lost all meaning for me. I felt utterly alone, trapped in my own body, and I struggled daily with suicidal ideation. I could not concentrate, could not interact with others, and could not have sustained even a simple, sedentary job.
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I have not worked since my layoff because my condition made it impossible to search for work, attend interviews, or perform any job duties. I remained at home, often isolated, and relied on my severance pay to survive.
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I am under the care of [doctor’s name, if you have one] and my medical records document this period of disability. I have authorized SSA to obtain those records.
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I hope this statement helps clarify why no work activity appears on the SSA‑821 and why I am unable to engage in substantial gainful activity. Please contact me if you need any further information.
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Sincerely,
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**Jason Davis**
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[Signature]
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[Printed Name]
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---
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## ✅ **What to do with this statement**
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1. **Type it** (or print it clearly) on a blank sheet of white paper.
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2. **Attach it** behind your completed SSA‑821 form, **before** you mail or fax.
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3. **Keep a copy** for yourself.
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This statement does **not** replace medical records or the formal function report—but it gives the person reading your file a human connection to your case. Many disability examiners have said that a well‑written claimant statement can make a real difference.
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If you don’t have a doctor’s name yet, simply remove that sentence. If you want to add more details (e.g., specific dates, how you spent your days), you can expand it.
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Would you like me to adjust the tone, shorten it, or add any other specific details you haven’t shared yet? |