BRR004 RIGHTS AND RESPONSIBILITIES RSI, DOMESTIC OR FOREIGN (G34)

(System Generated)

Caption: Your Responsibilities

 (1)  benefits are based on the information  (2)  gave us. If this information changes, it could affect  (3)  benefits. For this reason, it is important that you report changes to us right away.

We have enclosed a pamphlet,  (4)  . It tells you what must be reported and how to report.  (5) 

BRR006 DISABILITY IMPROVEMENT INFORMATION (G12)

(System Generated)

Caption: Things To Remember

If  (1)  health gets worse and you think  (2)  disabled before  (3)  full retirement age,  (4)   (5)   (6)   (7)  , you should contact us about applying again for disability benefits. Also, please get in touch with us three months before  (8)  age 62 to find out whether  (9)  for retirement benefits.

BRRO06 INDIVIDUAL AGE 62-65 (NO RIB CLAIM FILED) (T26)

(Requested)

Caption: Things To Remember

If  (1)  health gets worse and you think  (2)  disabled before  (3)  full retirement age,  (4)   (5)   (6)   (7)  , you should contact us about applying again for disability benefits. Also, please get in touch with us three months before  (8)  age 62 to find out whether  (9)  for retirement benefits.

BRR016 RIGHTS AND RESPONSIBILITIES NON-DIB, RRB DOM. OR FOR (G35)

(System Generated)

Caption: Your Responsibilities

The decisions we made on your claim are based on information you gave us. If this information changes, it could affect your benefits. For this reason, it is important that you report changes to us or to the Railroad Retirement Board right away. We have enclosed a pamphlet which tells you what must be reported and how to report.

BRR026 REPORTING RESPONSIBILITIES - PROVISIONAL BENEFITS (P11)

(Requested)

Caption: Your Responsibilities

You must tell us right away about any changes that may affect  (1)  benefits. You should tell us if:

• •

   (2)  mailing address;

• •

   (3)  to work or  (4)  work hours;

• •

   (5)  doctor says  (6)  condition has improved;

• •

   (7)  to leave the United States for 30 days or more;

• •

   (8)  been convicted of a criminal offense; or

• •

   (9)  benefits have been reinstated as either a disabled widow/widower or a disabled adult child.

BRR040 FACILITY OF PAYMENT WORKER'S RESPONSIBILITIES (G36)

(System Generated)

Caption: Your Responsibilities

Please let us know if any of the following things happen:

• •

  The amount of money  (1)   (2)  to make changes; or

• •

  Another family member starts working; or

• •

  A family member moves out of the household.

The way we pay benefits could change if any of these things happen.

BRR057 RIB BENEFITS AT 62 MAY BE HIGHER FOR FAMILY THAN DIB (J72)

(Requested)

Caption: Things To Remember

You should get in touch with us about 3 months before  (1)   (2)  age 62. At that time, you can find out whether  (3)  family would receive higher benefits if  (4)  for retirement benefits.

BRR075 REMINDER TO INCLUDE CLAIM NUMBER ON CORRESPONDENCE (G80)

(System Generated)

Caption: If You Disagree With The Decision

Always give  (1)  Social Security claim number on any letter or notice you send about  (2)  claim.

BRR076 REMINDER TO KEEP LETTER AS PERMANENT RECORD (G81)

(System Generated)

Caption: If You Disagree With The Decision

KEEP AS A PERMANENT RECORD – DO NOT DESTROY

BRR078 (WB6) BOND

Caption:

(System Generated)

Because of  (1)  work and earnings, no benefits are payable to you at this time under the rules of the Benefit Offset National Demonstration (BOND) project. If  (2)  work or earnings change, we may be able to pay some benefits in the future.

BRR079 (WB7) BOND

Caption:

(System Generated)

Because of  (1)  work and earnings, benefits are payable to you at this time under the rules of the Benefit Offset National Demonstration (BOND) project. If  (2)  work or earnings change, some benefits may not be payable in the future.

BRR080 REMINDER TO REPORT CHANGES IN WORK OR EARNINGS (W67)

(Requested)

Caption: Your Responsibilities

Please be sure to let us know right away if  (1)  work or earnings change, because changes could affect the amount of  (2)  benefits.

BRR084 REPORTING RESPONSIBILITIES FOR SUPPLEMENTAL MEDICAL INSURANCE PREMIUM IMMUNOSUPPRESSIVE DRUG BENEFICIARIES

(Systems Generated)

Caption: Your Responsibilities

Call Social Security at 1-877-465-0355 between 8:30 a.m. – 6:00 p.m. EST, Monday through Friday, within 60 days of signing up for certain other health insurance coverage. You can’t keep the immunosuppressive drug benefit once your other coverage starts.

BRRR13 CURRENT YEAR S.E.I. USED PENDING RECEIPT OF TAX RETURN (C06)

(Requested)

Caption: Your responsibility

 (1)  benefits are partly based on self-employment income for  (2)  . As soon as the taxable year is over,  (3)  should report this income on a Federal tax return.

Then, you must send us a copy of the return. Also, send us a cancelled check or other proof to show that  (4)  filed the return. Otherwise, we will stop  (5)  benefits and ask you to return any money we have sent you.