J19
|
WCP012
|
Offset Imposed First Month N/H
Receives DIB and WC and/or
Other Disability Payment
|
REQUESTED
(Some fill-ins generated)
|
J20
|
WCP028
|
Benefits Offset N/H May File For Reduced RIB
|
REQUESTED
(Some fill-ins generated)
|
J21
|
WCP010
|
Total Or Partial WC Offset N/H Only
|
REQUESTED
(Some fill-ins generated)
|
J22
|
WCP048
|
Total Or Partial Offset Aux. Only
|
REQUESTED
(Some fill-ins generated)
|
J23
|
WCP049
|
Amount Of Benefit Received After Offset
|
REQUESTED
(Fill-ins manually completed)
|
J25
|
WCPR07
|
Amount Of Offset Based On Estimate For One Or More Years High 5
|
REQUESTED
(Some fill-ins generated)
|
J26
|
WCPR13
|
Offset Imposed After Date Of Notice
|
REQUESTED
(All fill-ins are System generated)
|
J27
|
WCP018
|
Removal Of Offset WC Or Other Disability Payments Terminated
|
REQUESTED
(Some fill-ins generated)
|
J28
|
WCP019
|
Removal Of Offset N/H Age 62 Or 65
|
REQUESTED
(Some fill-ins generated)
|
J29
|
WCP029
|
WC Or Other Disability Claim Pending N/H Only
|
REQUESTED
(All fill-ins generated)
|
J30
|
WCP008
|
WC Or Other Disability Claim Pending - Aux. Only
|
REQUESTED
(All fill-ins are System generated)
|
J31
|
WCP015
|
Increase In Benefits Due To A Redetermination
|
REQUESTED
(All fill-ins are System generated)
|
J32
|
WCP017
|
Increase In Benefits After WC Offset First Imposed
|
REQUESTED
(Some fill-ins generated)
|
J33
|
WCP021
|
Possible Excludable Expenses WC
|
REQUESTED
(Some fill-ins generated)
|
J36
|
WCPR20
|
Offset Based On Lump Sum Ending Date Of Proration
|
REQUESTED
(All fill-ins are System generated)
|
J37
|
WCP005
|
Offset Determined By ACE
|
REQUESTED
(Some fill-ins generated)
|
J38
|
WCP009
|
N/H Appealing WC Decision - N/H Only
|
REQUESTED
(Some fill-ins generated)
|
J39
|
WCPR02
|
N/H Appealing WC Decision - Aux. Only
|
REQUESTED
(All fill-ins are System generated)
|
J40
|
WCPR31
|
N/H Appealing WC Decision - N/H And Aux
|
REQUESTED
(All fill-ins are System generated)
|
J41
|
WCPR27
|
Offset Based On Unverified Allegation
|
REQUESTED
(All fill-ins are System generated)
|
J42
|
WCPR22
|
WC Excludable Amounts Deducted
|
REQUESTED
(Some fill-ins generated)
|
J43
|
WCP032
|
All Letters Involving Receipt Of WC Or Other Disability Payments N/H
|
GENERATED
|
J44
|
WCP004
|
N/H Receiving WC Or Other Disability Payments No Offset
|
REQUESTED
(Some fill-ins generated)
|
J45
|
WCPR23
|
Offset Based On Lump Sum Proration Method A
|
REQUESTED
(Some fill-ins generated)
|
J46
|
WCPR24
|
Offset Based On Lump Sum Proration Method B
|
REQUESTED
(Some fill-ins generated)
|
J47
|
WCPR25
|
Offset Based On Lump Sum Proration Method C
|
REQUESTED
(All fill-ins are System generated)
|
J48
|
WCP003
|
Definition Of WC Offset
|
REQUESTED
(No fill-ins)
|
J49
|
WCPR06
|
Amount Of Offset Based On Estimate For One Or More Years High 1
|
REQUESTED
(Some fill-ins generated)
|
J57
|
WCPR09
|
Interim Notice Pending ACE Determination
|
REQUESTED
(All fill-ins are System generated)
|
J59
|
WCP001
|
N/H Expressed Intent To File For WC and/or Another Disability Payment
|
REQUESTED
(All fill-ins are System generated)
|
J75
|
WCP050
|
Subsequent Adjustment To Proration Period Based On New Evidence
|
REQUESTED
(Some fill-ins generated)
|
J76
|
WCP051
|
Change In Amount Of The Average Current Earnings (ACE)
|
REQUESTED
(Some fill-ins generated)
|
J77
|
WCP052
|
Resumption Of Offset N/H Only
|
REQUESTED
(Some fill-ins generated)
|
J78
|
WCP053
|
Resumption Of Offset Auxiliaries Only
|
REQUESTED
(Some fill-ins generated)
|
J79
|
ENT075
|
New Beneficiary Entitled To Benefits
|
REQUESTED
(Some fill-ins generated)
|
J80
|
WCP026
|
Beneficiary No Longer Entitled To Benefits
|
REQUESTED
(Some fill-ins generated)
|
J81
|
WCP058
|
Change In WC Rate and/or Other Disability Payment And Offset Adjusted N/H Only
|
REQUESTED
(Some fill-ins generated)
|
J82
|
WCPR15
|
Change In WC Rate and/or Other Disability Payment And Offset Adjusted Auxiliary Only
|
REQUESTED
(Some fill-ins generated)
|
J83
|
WCP054
|
Verified Rate Of WC and/or Other Disability Payment
|
REQUESTED
(Some fill-ins generated)
|
J84
|
WCP055
|
Third Party Involvement
|
REQUESTED
(All fill-ins are System generated)
|
J85
|
WCP013
|
Change In Reduction Of Workers' Compensation Benefits (Because Of Change In State
Law)
|
REQUESTED
(Some fill-ins generated)
|
J91
|
WCP057
|
Removal Of Offset Lump-Sum Proration Ended
|
REQUESTED
(All fill-ins are System generated)
|
N/A
|
WCP060*
|
WC/PDB Removal of Offset – NH Attains Full Retirement Age (FRA)
|
REQUESTED
(Some fill-ins generated)
|
N/A
|
WCP061*
|
Benefits Offset to FRA- NH May File for Reduced RIB
|
REQUESTED
(Some fill-ins generated)
|