The number holder's name is a must-key, 40-position field. Key the name shown for the number holder as follows:

1. a. 

   First name or initial is a 15-position field (3-17). If less then 15 positions are keyed, depress the “ENTER” key.

2. b. 

   Middle initial is a 1-position field (18). If middle initial is not shown, depress the “ENTER” key. If a middle initial is shown key the middle initial. The system will automatically enter field 19 to key the number holder's last name.

3. c. 

   Last name is a 20 position field (19 – 38). If less than 20 positions, depress the “Enter” key. The cursor automatically moves to the SN field.

4. d. 

   Suffix (if shown) is a 4 position field (39-42). If there is a suffix, shift + tab back to the suffix field. Key Jr., Sr., I, II, or III or IV.

5. e. 

   Do not key periods (.), hyphens (-), apostrophes (‘), or any information in parenthesis.

6. f. 

   If no "Name" is shown in Item 1 on the Form SSA-7004, or the name is incomplete, compare the "Name" shown in the address and the signature line.

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  Names Agree

  If the names agree, key the “Name” shown in the address in the NH field.

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  Names Do Not Agree

  If the names do not agree, delete all program levels keyed for the record, and handle as indicated in RM 01340.029.

This is a must-key, must-fill, 9-position field (43 – 51).

1. a. 

   Key the Social Security number shown for the number holder.

2. b. 

   Do not key hyphens (-) if indicated.

3. c. 

   Key only one number in this field. If more than one number is shown, key the additional number(s) in the Other/Multiple Social Security Number(s) field.

4. d. 

   Do not make an entry if:

   • •

     The first three positions are "000" or greater than "728"

   • •

     Fourth and fifth positions are "00," or

   • •

     Last four positions are "0000."

5. e. 

   If the SSN is not present in item 2, but one appears in item 4, key the first complete valid “SSN” that appears in item 4 in item 2 only.

6. f. 

   If the SSN is not present anywhere on the request and a telephone number is shown on the form, obtain an alphadent query and contact the number holder to verify the necessary information to process the request. If a telephone number is not available, contact directory assistance for a number.

This is a must-key, must-fill, 8-position field (52 – 59).

1. a. 

   Key the date of birth shown for the number holder. An entry is invalid if the month is greater than "12" or the day is greater than "31." If the day of birth is not shown, key 02 as the day. The system will automatically generate the century in fields 56 and 57.

   NOTE: If the current date is keyed an error message, "CURRENT YEAR IN DB FIELD," will appear, delete the SSA-7004-SM-OP1/OP2 and/or facsimile of form SSA-7004.

2. b. 

   When keying the date of birth and the century is something other than “19”, you must field back and key the century.

3. c. 

   If no date of birth is provided and a telephone number is available, contact the number holder to verify the date of birth information. A numident query is needed before contacting the number holder. If the telephone number is missing, contact directory assistance.

4. d. 

   If a telephone number is not available, mail the request back to the number holder using your current processing procedures.

This is a 45-position field (MA 1) 60 - 68, (MA 2) 69 - 77, (MA 3) 78 - 86, (MA 4) 87 - 95 and (MA 5) 96 - 104. The system automatically skips this field. If an entry is required follow the instructions indicated.

1. a. 

   Depress the SHIFT key + the TAB key and tab back five times to enter the other social security number(s) or depress the "F2" key before keying the date of birth. By depressing the "F2" key this allows the system to turn the "ASD" off.

2. b. 

   Key no more than five 9-digit multiple social security numbers.

3. c. 

   If less than five SSN"s are entered, depress the "ENTER" key once to blank fill the remaining positions in the field.

4. d. 

   Do not make an entry if:

   • •

     a multiple number is the same as the social security number (SSN) keyed,

   • •

     a multiple number is the same as the multiple number already keyed in this field,

   • •

     the first three positions of a number are “000” or greater than “728”,

   • •

     the fourth and fifth positions of a number are "00," or,

   • •

     the last four positions of a number are “0000.”

5. e. 

   If the SSN is not present in item 2, but one appears in item 4, key the first complete valid “SSN” that appears in item 4 in item 2 only.

6. f. 

   If the SSN is not present anywhere on the request and a telephone number is shown on the form, view the alphadent query and contact the number holder to verify the necessary information to process the request. If a telephone number is not available, contact directory assistance for a number.

This is a 1-position field (105). Key the

1-character designation of the number holder's sex as follows:

• •

  "F" for female

• •

  "M" for male

• •

  If no sex is shown, depress the ENTER key.

• –

  If No Entry is Provided

  Depress the ENTER key to zero-fill the field.

• –

  If An Entry is Provided

  Key the 6-digit dollar amount provided (No cents are required.)

• –

  If Less Than 6 Digits Are Provided

  Depress the ENTER key to zero-fill the remaining Positions in the field.

• –

  If More Than 6 Digits Are Provided

  Key six nines (999999).

• –

  If More Than One Entry is Provided

  Key the first entry.

• –

  If Such Words As “Maximum” or “Max” Are Written On The Form

  Key six nines (999999).

This is a 2-position field (118 – 119). Key the field as follows:

• •

  Key the 2-position age provided.

• •

  If no age is provided, depress the ENTER key to zero-fill the field.

• •

  If more than one age is given, key one form for each age requested.

• •

  Depress the ENTER key to exit the field.

• –

  No Entry is Provided

  Depress the ENTER key to zero-fill the field.

• –

  An Entry is Provided

  Key the 6-digit dollar amount provided (No cents are required.)

• –

  Less Than 6 Digits Are Provided

  Depress the ENTER key to zero-fill the remaining positions in the field.

• –

  More Than 6 Digits Are Provided

  Key six nines (999999.)

• –

  More Than One Entry is Provided

  Key the first entry.

• –

  If Such Words as “Maximum” or “Max” Are Written On The Form

  Key six nines (999999).