Effective Dates: 10/11/1995 - Present Previous | Next

TN 26 (07-95)

NL 00804.105 Captions for SSI Paragraphs

A. INTRODUCTION

Each caption is listed by its paragraph number. The captions are listed in the order in which they should appear on the notice. Captionsnever appear alone. For a caption to be used, at least one paragraph must be generated under it. Captions for AONS are found in NL 00804.260, (part of paragraph).

B. INITIAL CLAIMS SITUATIONS

The following captions are used on SSA-L8025's, Notice of Award (some of the captions are also used on other notices).

  ​ ​

1901.

How Much We'll Pay

1919.

Our Decision About How We'll Pay (1)

 

(1)

Choice 1 - You
Choice 2 -(Recipient's Name)

1905.

Information About (1) Payments

 

(1)

Choice 1 - Your
Choice 2 -(Recipient's Name With Apostrophe)

1907.

(1) (2) Is Based On These Facts

 

(1)

Choice 1 - Your
Choice 2 -(Recipient's Name With Apostrophe)

 

(2)

Choice 1 - Payment
Choice 2 - SSI

NOTE: Use Choice 1 if recipient is C01 in CCM or later. Use Choice 2 if recipient is not C01 in CCM or later.

1929.

How You May Be Able to Receive SSI

1908.

Information About (1) Back Payments

 

(1)

Choice 1 - Your
Choice 2 -(Recipient's Name with Apostrophe)

1918.

Information About (1) Disability

 

(1)

Choice 1 - Your
Choice 2 -(Recipient's Name with Apostrophe)

1909.

About (1) Overpayment

 

(1)

Choice 1 - Your
Choice 2 -(Recipient's Name with Apostrophe)

1911.

If You Think (1) Shouldn't Have To Pay Us Back

 

(1)

Choice 1 - You
Choice 2 -(Recipient's Name)

1915.

Information About Medicaid (1)

 

(1)

Choice 1 - And Other Benefits
Choice 2 - Null

1928.

Where You Can Apply For Medicaid

1927.

We Will Review (Your) Case

1926.

(1) Things to Remember

 

(1)

Choice 1 - Other
Choice 2 -Null

C. DENIAL SITUATION

The following captions are used on SSA-L8030's, Notice of Disapproved Claim (some of the captions are also used on other forms).

  ​ ​

1903.

Why We Can't Pay (1)

 

(1)

Choice 1 - You
Choice 2 -(Recipient's Name)

1906.

Our Decision Is Based On These Facts

1909.

About (1) Overpayment

 

(1)

Choice 1 - Your
Choice 2 -(Recipient's Name with Apostrophe)

1911.

If You Think (1) Shouldn't Have To Pay Us Back

 

(1)

Choice 1 - You
Choice 2 -(Recipient's Name)

1915.

Information About Medicaid (1)

 

(1)

Choice 1 - And Other Benefits
Choice 2 - Null

NOTE: Select Choice 1 if a paragraph is being issued; otherwise select Choice 2.

D. PE SITUATIONS

The following captions are used on PE notices (some of the captions are also used on IC notices).

  ​ ​

2016.

(1) Will Be (2) As Follows:

From Through Amount Due Each Month
(3) (4) (5) (6) (7)
 

(1)

Choice 1 - Your Payments
Choice 2 - The Payments of (Recipient's Name)

 

(2)

Choice 1 - Changed
Choice 2 - Null

 

(3)

(Month/Day/Year)
 

(4)

Choice 1 - (Month/Year)
Choice 2 - Continuing

 

(5)

$$$.¢¢ 
 

(6)

Choice 1 - This includes ($$$.¢¢)
Choice 2 - Null

 

(7)

Choice 1 - from the State of (Name State)
Choice 2 - from the District of Columbia
Choice 3 - Null

1919.

Our Decision About How We'll Pay (1)

 

(1)

Choice 1 - You
Choice 2 - (Recipient's Name)

1904.

Why (1)    (2) Changed

 

(1)

Choice 1 - Your
Choice 2 - (Recipient's Name with Apostrophe)

 

(2)

Choice 1 - Payments
Choice 2 - Record

NOTE: If there is a due amount change, use Choice 1; if there is no due amount change, use Choice 2.

1930.

Why (Your) Payments Are Stopping

1905.

Information About (1) Payments

 

(1)

Choice 1 - Your
Choice 2 - (Recipient's Name with Apostrophe)

1916.

Information About Medicaid

NOTE: This caption is used with computer matching paragraphs.

1907.

(1) (2) Is Based On These Facts

 

(1)

Choice 1 - Your
Choice 2 - (Recipient's Name with Apostrophe)

 

(2)

Choice 1 - Payment
Choice 2 - SSI

NOTE: Use Choice 1 if recipient is C01 in CCM or later. Use Choice 2 if recipient is not C01 in CCM or later.

1908.

Information About (1) Back Payments

 

(1)

Choice 1 - Your
Choice 2 - (Recipient's Name with Apostrophe)

1912.

Our Decision On Your Waiver Request

1913.

About Your Request For Direct Deposit

1915.

Information About Medicaid (1)

 

(1)

Choice 1 - And Other Benefits
Choice 2 - Null

NOTE: When paragraph number 1311 is used, use Choice 1. When paragraph number 1311 is not used, use Choice 2.

1928.

Where You Can Apply For Medicaid

1925.

Please Remember This

1927.

We Will Review (Your) Case

2298.

This paragraph consists of two captions:
 
  1. 1. 

    If You Still Have Some of (Recipient's Name with Apostrophe) SSI
 
  1. 2. 

    Uncashed Checks Should Be Returned

NOTE: For the paragraphs used under these captions see NL 00804.185.

1918.

Information About (1) Disability

 

(1)

Choice 1 - Your
Choice 2 - (Recipient's Name with Apostrophe)

1926.

(1) Things To Remember

 

(1)

Choice 1 - Other
Choice 2 - Null

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900804105
NL 00804.105 - Captions for SSI Paragraphs - 10/11/1995
Batch run: 08/14/2006
Rev:10/11/1995