TER001 – TERMINATION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF AGE
               18 TERMINATION (A18TRM)
         (1) (2) no longer entitled to Social Security benefits beginning (3). (4) benefits
            are stopping because in that month (5)
         
         
            - 
               
            
 
            - 
               
            
 
            - 
               
                  •
                  
                     not a full-time elementary or secondary level school student.
                     
                   
                
             
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         You 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3)  
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         His 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         Her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         Your 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (6)  
                        
                      | 
                     
                     
                         18 
                        
                      | 
                     
                  
               
            
          
         TER002 – TERMINATION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF CHILD
               NO LONGER A STUDENT (CNLFTS)
         (1) (2) no longer entitled to Social Security benefits beginning (3). (4) benefits
            are stopping in that month because:
         
         
            - 
               
                  •
                  
                     (5) not a full-time elementary or secondary level school student, and
                     
                   
                
             
            - 
               
            
 
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         You 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3)  
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         His 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         Her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         Your 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (6)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
               
            
          
         TER003 – TERMINATION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF AGE
               19 STUDENT PROVISIONS (STUD19), EFFECTIVE DATE > AGE 19
         (1) (2) no longer entitled to student benefits beginning (3). Student benefits normally
            end with the payment before the month the student turns 19. But, (4) met an exception
            which allowed benefits to continue past that month. The exception allows benefits
            to continue
         
         
            - 
               
                  •
                  
                     for 2 months after the student turns 19, or
                     
                   
                
             
            - 
               
                  •
                  
                     until the end of the school term, whichever comes first.
                     
                   
                
             
         
         However, if the school requires a student to reenroll each quarter or semester, benefits
            may continue until that quarter or semester ends. (5) no longer (6) the exception
            beginning (7), so (8) student benefits end that month.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         You 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3)  
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         He 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         She 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         You 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (6)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         meets 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         meet 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (7)  
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (8)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         his 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         your 
                        
                      | 
                     
                  
               
            
          
         TER010 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF LAST
               CHILD AGE ATTAINMENT (CHDAGE) OR LAST CHILD’S DIB TERMINATION (CHDNLD)
         (1) no longer entitled to Social Security benefits beginning (2). To be entitled,
            (3) must be taking care of a child who is entitled to benefits. That child must be
            under age 16 or disabled. In (4), (5) child (6).
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is” 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         You are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         they 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4) 
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         their 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         your 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (6) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         became age 16 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         is no longer disabled 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         no longer qualifies for Social Security disability benefits 
                        
                      | 
                     
                  
               
            
          
         TER011 - AUXILIARY TERMINATES – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST)
               OF CLAIM WITHDRAWAL (CLMWTH) DUE TO NUMBER HOLDER CLMWTH
         We can no longer pay (1) benefits because (2) withdrew (3) claim for Social Security
            benefits. This withdrawal cancels (4) entitlement as of (5). We can only pay (6) if
            (7) is also entitled to benefits.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2)  
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         his 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4)  
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5)  
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (6)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (7)  
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
               
            
          
         TER012 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF MARRIAGE
               OF CHILD BENEFICIARY (CMARRY), REMARRIAGE (REMARR), MARRIAGE (MARRGE)
         We can no longer pay (1) benefits because of (2) marriage in (3).
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1)  
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         his 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         your 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                         MARR-BEGIN date 
                        
                      | 
                     
                  
               
            
          
         TER013 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF DIVORCE
               (DIVORC)
         We can no longer pay you benefits because you and your spouse were divorced in (1).
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
               
            
          
         TER014 - LEAD IN TERMINATION - FOLLOWED BY SPECIFIC TERMINATION UTI
         (1) no longer (2) for Social Security benefits beginning (3).
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         You 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         qualifies 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         qualify 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
               
            
          
         TER015 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF LAST
               CHILD’S MARRIAGE (CHDTRM)
         We can no longer pay you benefits because (1) is no longer entitled to benefits due
            to (2) marriage in (3). We can only pay you if you are caring for a child who is entitled
            to benefits.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         his 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
               
            
          
         TER016 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF DIVORCE
               BETWEEN PARENT AND NUMBER HOLDER (STEPDV)
         We can no longer pay (1) because (2) and (3) were divorced in (4).
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         your father 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her father 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         his father 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 4 
                        
                      | 
                     
                     
                         your mother 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 5 
                        
                      | 
                     
                     
                         her mother 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 6 
                        
                      | 
                     
                     
                         his mother 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3)  
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4)  
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
               
            
          
         TER017 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF ANNULMENT
               OF PARENT’S MARRIAGE TO NUMBER HOLDER (PMRANL), END OF PUTATIVE MARRIAGE (PUTMAR),
               (ANNULMENT OF MARRIAGE (ANNULM), VOID OR VOIDED MARRIAGE (VOIDMR), BENEFICIARY TERMINATION
               WITH DATE OF ENTITLEMENT (NOTENT)
         We have determined that (1) not (2) spouse and therefore (3) not entitled to spouse
            benefits.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is” 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         are 
                        
                      | 
                     
                  
               
            
          
         TER018 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF BENEFICIARY
               TERMINATION WITH DATE OF ENTITLEMENT (NOTENT) AND CHILD IN CARE OCCURRENCE DELETED
         We have determined that (1) not have a child of (2) in (3) care. As a result, (4)
            not entitled to benefits on (5) record.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “does” 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you do 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         his 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         your 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
               
            
          
         TER019 – TERMINATION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF BENEFICIARY
               TERMINATION WITH DATE OF ENTITLEMENT (NOTENT) AND STUDENT ENTITLEMENT (SRD) OCCURRENCE
               DELETED
         We have determined that (1) not attending school and, therefore, (2) not entitled
            to benefits on (3) record.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is” 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
               
            
          
         TER020 – BENEFICIARY TERMINATION WITH DATE OF ENTITLEMENT (NOTENT) CREL DATA DELETED
               OR ANNULMENT OF ADOPTION (ADPANL) CICENDRSN = O
         We have determined that (1) not the child of (2). As a result, (3) not entitled o
            benefits on (4) record.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is” 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
               
            
          
         TER022 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF AGE
               19 STUDENT PROVISIONS (STUD19), EFFECTIVE DATE = AGE 19
         (1) no longer (2) for monthly payments beginning (3). Our records show that (4) (5)
            not attending elementary or secondary level school in the month (6) became age 19.
            Please contact us if this isn’t true. Because, if (7) (8) in school at that time,
            benefits may continue:
         
         
            - 
               
                  •
                  
                     for 2 months after the month (9) became age 19, or
                     
                   
                
             
            - 
               
                  •
                  
                     through the month that the school term ends, whichever is first.
                     
                   
                
             
         
         However, if (10) school requires (11) to reenroll each quarter or semester, benefits
            may continue through the last month of the quarter or semester in which (12) (13)
            (19). This is so even if that quarter or semester ends more than 2 months after (14)
            (15) (19).
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         You 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         qualifies 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         qualify 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) in the last occurrence of
                           BCLM data on the post-MBR
                         
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         was 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         were 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (6) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (7) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (8) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         were 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         was 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (9) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (10) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         his 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         your 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (11) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         him 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (12) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (13) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         turns 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         turn 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (14) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (15) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         turns 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         turn 
                        
                      | 
                     
                  
               
            
          
         TER025 – TERMINATION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF DEATH
               (CLMDTH)
         (1) is not entitled to monthly benefits beginning (2) because (3) died in that month.
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in value: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                         Beneficiary’s Date of Death (BDOD) in the format Month CCYY 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
               
            
          
         TER026 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF LAST
               CHILD’S MARRIAGE (CHDTRM) CIC-END REASON DEATH
         (1) for Social Security benefits starting (2) because of the loss of (3) child (4).
            To qualify, (5) must be taking care of a child who is entitled to benefits. That child
            must be under age 16 or disabled.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         You no longer qualify 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “no longer
                           qualifies”
                         
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                         Beneficiary’s Date of Death (BDOD) in the format Month CCYY 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         your 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4) 
                        
                      | 
                     
                     ORSIS 2014-0014 Subchapter NL 00730
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) for the first CIC-CHDPIC
                           with the CIC-ENDRSN = Death (D)
                         
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         he 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         she 
                        
                      | 
                     
                  
               
            
          
         TER027 – TERMINATION - BENEFICIARY BORN ON FIRST DAY OF THE MONTH
         Because (1) born on the first day of the month, we consider (2) to be age (3) the
            month before.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is” 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you were 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         him 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         her 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
               
            
          
         TER028 – TERMINATION – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF ERRONEOUS
               DEATH TERMINATION (ERRDTH)
         (1) been receiving benefits on (2) record based on erroneous information that (3)
            had died. Since this information was not correct, (4) no longer entitled to benefits
            on (5) account.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “has” 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         You have 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
               
            
          
         TER029 – PIC C TERMINATION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST)
               OF ANNULMENT OF PARENT’S MARRIAGE TO NUMBER HOLDER (PMRANL)
         We can no longer pay (1) because the marriage between (2) and (3) (4) was annulled
            in (5).
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         you 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                         NH-NAME 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         your 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (4) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         mother 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         father 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (5) 
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) in the last occurrence of
                           BCLM data on the post-MBR in the format Month CCYY
                         
                        
                      | 
                     
                  
               
            
          
         TER031 – DISABLED BENEFICIARY'S BENEFITS TERMINATE DUE TO DISABILITY CESSATION
               
         (1) not entitled to Social Security benefits beginning (2). Based on our rules, we
            have determined that (3) no longer disabled.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | 
                         Fill-in values: 
                        
                      | 
                     
                  
               
               
                  
                  
                     
                     | 
                         Fill-in (1) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is” 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         You are 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (2) 
                        
                      | 
                     
                     
                         Historical Date of Entitlement Termination (BCLM-DOETERM) 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Fill-in (3) 
                        
                      | 
                     
                     
                           
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 1 
                        
                      | 
                     
                     
                         he is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 2 
                        
                      | 
                     
                     
                         she is 
                        
                      | 
                     
                  
                  
                     
                     | 
                         Choice 3 
                        
                      | 
                     
                     
                         you are 
                        
                      |