TN 7 (09-17)

DI 60099.080 Benefit Offset National Demonstration (BOND) Notices

A. Document Processing System (DPS)

The BOND work continuing disability review (CDR) unit uses the document processing system (DPS) to generate the following BOND notices:

  • Substantial gainful activity (SGA) cessation due process notice;

  • Continuance decision notice (trial work period (TWP) completed, but no SGA)(used prior to August 2013);

  • TWP determination notice (used prior to August 2013); and

  • SGA cessation notice (FINAL).

B. BOND stand-alone system (BSAS) notice

The BSAS generates the start and stop participation notice when a beneficiary is randomly assigned to the project. The notice provides an overview of the BOND project and provides the start and end dates of participation if the BOND participant completed the TWP. If the BOND participant did not complete the TWP, the notice explains the requirement that a TWP must be completed by September 30, 2017, to qualify for the BOND participation period. If the beneficiary completed the TWP and his or her benefits ceased due to SGA, the notice explains that the BOND offset is applicable if the beneficiary earns more than the BOND yearly amount.

C. MACADE ENB coding

For cases that the BSAS cannot process, the Office of Central Operations (OCO) centralized unit codes the enclosure notice block (ENB) field on the history (HST) screen with the BOND paragraphs. The manual adjustment credit and award data entry (MACADE) system generates the following notices:

  • The initial and revised BOND offset notice;

  • The auxiliary suspense and reinstatement notice;

  • The BOND BRI adjustment notice

  • The beneficiary and MEF end of year reconciliation (EOYR) notice; and

  • The EOYR appeal notice.

NOTE: The ENB field begins with “G” for a complete BOND notice or “F” for an incomplete BOND notice.

D. BOND universal text identifiers (UTI)

1. BEN101

a. Description

The BEN101 paragraph is an introductory paragraph, letting beneficiaries know they have been selected to participate in the BOND Project.

b. Language or fill-ins for BEN101

*F1 (1) been selected to participate in the Benefit Offset National Demonstration (BOND) project.

  1. Fill-in (1)

  2. You have, Name has

2. WDS017

a. Description

The WDS017 paragraph provides general description of BOND project. Use on all BOND notices. Use under caption CAP 56.

b. Language or fill-ins for WDS017:

The BOND project offers qualified individuals a more generous treatment of earnings than under the current rules. Provide a qualified individual an opportunity to work and earn over $(1) and benefit from having only $1 of benefits withheld for every $2 earned over this amount. Under current Social Security rules, the same qualified individual working and earning over $(2) generally has his or her benefits stopped.

1. Fill-in (1)

BOND yearly Amount, displayed in $$$$.cc format

2. Fill-in (2)

BOND yearly Amount, displayed in $$$$.cc format

3. WDS017

a. Description

This UTI in a general paragraph.

b. Language or fill-ins for WDS017

The BOND project offers qualified individuals a more generous treatment of earnings than under the current rules. A qualified individual is provided an opportunity to work and earn over $(1) and benefit from having only $1 of benefits withheld for every $2 earned over this amount. Under current Social Security rules, the same qualified individual working and earning over $(2) generally has his or her benefits stopped.

1. Fill-in (1)

BOND yearly amount, displayed in $$$$.cc format

2. Fill-in (2)

BOND yearly amount, displayed in $$$$.cc format

4. ERN084

a. Description of UTI

Use this UTI when the beneficiary’s earnings estimate is an initial estimate of earnings. (Do not use ERN084 if the estimated earnings is based on a revised estimate). Use under caption: CAP 1

b. Language or Fill-ins for ERN084

(1) current estimate of total earnings for (2) offset period this year is $(3).

  1. Fill-ins (1) and (2) will be systems generated. (Your, Name)

  2. Fill-in (3)

Estimated earnings amount displayed in $$$$.cc format

5. ERN085

a. Description of UTI

Use this UTI when the beneficiary’s offset period is for the entire calendar year and for revised estimates. Use under caption: CAP 1.

b. Language or fill-ins for ERN085

(1) revised estimate of total earnings for (2) offset period this year is $(3). (4) previously estimated total earnings of $(5) for this period.

  1. Fill-ins (1), (2), and (4) will be systems generated. (Your, Name)

  2. Fill-in (3)

Revised estimate of total earnings for the offset period in $$$$.cc format.

Fill-in (5)

Previously estimated total earnings for the offset period displayed in $$$$.cc format.

6. ALS190

a. Description

Use this UTI when the BOND beneficiary has requested a review.

b. Language or fill-ins for ALS190

If you think this information is not correct or you want to report any changes in (1) work plans or earnings, please get in touch with (2) benefits counselor at Abt Associates. Please call their toll-free number at 1-877-726-6309 (877-7BOND09) to report any changes. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90).

  1. Fill-ins (1) and (2) will be systems generated. (your, name possessive)

7. BRR078

a. Description of UTI

Use this UTI to advise an auxiliary beneficiary that benefits are not payable due to the BOND participant’s work and earnings. Use under caption: CAP 33.

b. Language or Fill-ins for BRR078

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

1.    Fill-in (1)

Name of beneficiary, possessive

2.    Fill-in (2)

Name of beneficiary, possessive

8. BRR079

a. Description of UTI

Use this UTI to advise an auxiliary beneficiary that benefits are now payable due to the BOND participant’s work and earnings. Use under caption CAP 35.

b. Language or Fill-ins for BRR079

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

1.  Fill-in (1)

Name of beneficiary, possessive

2.  Fill-in (2)

Name of beneficiary, possessive

9. WDS018

a. Description of UTI

Use this UTI when the beneficiary’s offset period is for the entire calendar year. Use under caption CAP 1.

b. Language or Fill-ins for WDS018

(1) offset period this year is the entire calendar year.

We determine how much to reduce (2) benefit payments for each month in the year under the $1 for $2 offset based on an estimate of BOND countable earnings for the year. To get this estimate, we use the estimate of total earnings for the year and subtract the estimate of the amount of allowable deductions for the year. The resulting amount is the estimate of BOND countable earnings for the year. Some allowable deductions include the following:

  • The amount of any sick or vacation pay,

  • The amount of any subsidy paid by an employer who pays more in wages than the actual value of the work, and

  • Amounts paid for items or services related to (3) disability that are needed to work. Some examples are prescription drugs, personal attendant, job coach, or a wheelchair.

After allowable deductions, (4) (5) of BOND countable earnings for this year is $(6).

Next, we subtract the BOND yearly amount from the estimate of the BOND countable earnings for the year and divide the remaining amount by two. We then divide that amount by 12 to determine the monthly offset amount. The monthly offset amount is the amount that we reduce benefits for each month in the year under the benefit offset. Based on the (7) of (8) BOND countable earnings and the computations above, (9) monthly offset amount this year is (10).

  1. Fill-in (1), (2), (3), (4), (8), (9) will be systems generated (Fill-in (1): Your, Name possessive; Fill-ins (2), (3), (4), (8), (9): your, his, her).

  2. Fill-in (5)

    • Choice A: estimate

    • Choice B: revised estimate

  3. Fill-in (6)

Previously estimated total earnings for the offset period in $$$$.cc format.

  1. Fill-in (7)

    • Choice A: estimate

    • Choice B: revised estimate

  2. Fill-in (10)

Monthly offset amount in $$$$.cc format.

10. WDS016

a. Description of UTI

Use this UTI when the beneficiary’s offset period is for partial year. Use under caption CAP 1.

b. Language or fill-ins for WDS016

(1) offset period this year is (2).

We determine how much to reduce (3) benefit payments for each month in the offset period under the $1 for $2 offset based on an estimate of BOND countable earnings for that period. To get this estimate, we use the estimate of total earnings for the offset period and subtract the estimate of the amount of allowable deductions for that period. The resulting amount is the estimate of BOND countable earnings for the offset period. Some allowable deductions include the following:

  • The amount of any sick or vacation pay,

  • The amount of any subsidy paid by an employer who pays more in wages than the actual value of the work, and

  • Amounts paid for items or services related to (4) disability needed to work. Some examples are prescription drugs, personal attendant, job coach, or a wheelchair.

After allowable deductions, (5) (6) of BOND countable earnings for the offset period this year is $(7).

Since the offset period is less than the calendar year, we prorate the BOND yearly amount based on the number of months in the offset period and use that prorated amount to figure the benefit offset. We subtract the prorated BOND yearly amount from the estimate of BOND countable earnings for the offset period and divide the remaining amount by two. We then divide that amount by the number of months in the offset period to determine the monthly offset amount. The monthly offset amount is the amount that we reduce benefits for each month in the offset period under the benefit offset. Based on the (8) of the BOND countable earnings and the computations above, (9) monthly offset amount for the offset period this year is $(10).

1. Fill-in (1), (3), (4), (5), and (9) will be systems generated (Your, Name).

2. Fill-in (2)

  • Choice 1: MM/YYYY

  • Choice 2: MM/YYYY through MM/YYYY

3.  Fill-in (6)

  • Choice A: estimate

  • Choice B: revised estimate

4.  Fill-in (7)

Amount of estimate or revised estimate in $$$$.cc format.

5.  Fill-in (8)

  • Choice A: estimate

  • Choice B: revised estimate

6.  Fill-in (10)

Amount of estimate or revised estimate in $$$$.cc format.

11. RCT053

a. Description of UTI

Use this UTI to remind the beneficiary to report any changes that may affect the BOND calculation. Use under caption CAP 15.

b. Language or fill-ins for RCT053

You must promptly report any changes that may affect (1) benefits. Failure to do so could mean you may have to repay any benefits not due. Let us know if:

  • (2) went to work since your last report or (3) to work in the future, or

  • You already reported (4) work, but duties or pay changed. (Remember to keep records of work and earnings such as pay statements from the employer, or

  • (5) doctor says (6) condition has improved even if (7) (8) work now, or

  • You applied for, start getting or have a change in the amount of (9) workers compensation or another public disability benefit, or

  • You start paying for work expenses related to (10) disability such as special transportation or the amount paid for these work expenses changes or you no longer pay for such expenses. (Remember to keep records and proof of payment for any work expenses.)

Fill-ins (1), (2), (3), (4), (5), (6), (7), (8), (9), and (10) are systems generated. (Fill-ins (1), (6): your, name possessive; Fill-in (2): You, Name; Fill-in (3): you go, he goes, she goes; Fill-ins (4), (6), (9), (10): your, his, her; Fill-in (5): Your, Name possessive; Fill-in (7): you, he, she; Fill-in (8): return to, returns to).

12. OPT 179

a. Description

Use this UTI as a paid versus payable.

b. Language or fill-ins for OPT179

We paid (1) $(2) for (3). Since we should have paid (4) $(5) for (6), we paid (7) $(8) (9) than (10) due.

  1. Fill-in (1) is system generated. (You, Beneficiary’s Name)

  2. Fill-in (2) is the MBR Paid amount

  3. Fill-ins (3) and (6) are MM/CCYY, MM/CCYY through MM/CCYY (date bene became offset eligible through end of current year)

  4. Fill-ins (4) and (7) are systems generated. (you, him, her)

  5. Fill-in (5) is the MBC that should have been paid

  6. Fill-in (8) is the amount of the underpayment or overpayment.

  7. Fill-in (9) is systems generated (more, less)

  8. Fill-in (10) is systems generated (you were, he was, she was)

13. DIBC12, REFC05, REFC06

a. These are paragraph headers.

  1. DIBC12 – Benefit Offset National Demonstration (BOND)

  2. REFC05 – If You Have Questions About the BOND Project

  3. REFC06 – If You Have Questions That Are Not About the BOND Project

14. BEN105

a. Description of UTI

Use this UTI when a beneficiary is in BOND offset and a new BRI MBA is calculated.

b. Language or fill-ins for BEN105

We may have let (1) know earlier that we would increase (2) benefits to (3) per month due to the rise in the cost of living. We have refigured (4) benefits based on (5) participation in the benefit offset national demonstration project (BOND). This notice corrects the calculation to apply the cost of living increase to (6) original benefit before the reduction for BOND earnings. (7) new monthly amount (before deductions) is (8).

  1. Fill-ins (1), (2), (4), (5), (6), and (7) are automatically generated (Fill-in (1): you, your, Name; Fill-in (2), (4): your, Name possessive; Fill-in (5), (6): your, his, her; Fill-in (7): Your, Name possessive).

  2. Fill-in (3)

  3. BRI/MBR incorrect monthly benefit amount

  4. Fill-in (8)

New offset monthly benefit amount after BRI correctly computed.

15. BEN106

a. Description of UTI

Use this UTI when you have completed an End of Year Reconciliation and you need a paid versus payable.

b. Language or fill-ins for BEN106

Based on (1) earnings of $(2) for (3) we should have paid (4) $(5) that should have been paid for (6).

  1. Fill in (1) is automatically generated (your, Name possessive)

  2. Fill-in (2) is the end of year reconciliation BOND countable earnings amount.

  3. Fill-in (3) is the reconciliation year in CCYY format.

  4. Fill-in (4) is automatically generated (you, him, her)

  5. Fill-in (5) is the monthly benefit credited (MBC).

  6. Fill-in (6) is the dates of reconciliation (MM/CCYY, MM/CCYY through MM/CCYY).

16. BEN107

a. Description of UTI

Use this UTI when you have completed an End of Year Reconciliation and no adjustment has been made.

b. Language or fill-ins for BEN107

This means we paid *F1correctly based on the evidence *F2provided for the reconciliation year.

  1. Fill-in (1) and (2) are automatically generated (Fill-in (1): you, Name; Fill-in (2): you, he, she).

17. BEN108

a. Description of UTI

Use this UTI when you are explaining your End of year reconciliation calculation.

b. Language or fill-ins for BEN108

This (1) resulted from the difference in the yearly amount that (2) estimated *F3 would earn during (4) and the actual amount that (5) earned, during that year. We determined the (6) after we recalculated (7) offset amount based on (8) actual BOND countable earnings.

  1. Fill-ins (1) and (6) are A- overpayment or B – underpayment.

  2. Fill-ins (2), (3), (5), (7) and (8) are automatically generated (Fill-in (2): you, Name; Fill-in (3), (5): you, he, she; Fill-in (7), (8): your, his, her).

  3. Fill-in (4) is the reconciliation year in CCYY format.

18. BEN109

a. Description of UTI

Use this UTI when you need to notify a BOND beneficiary that his/her participation period is ending.

b. Language or fill-ins for BEN109

(1) been a participant in the benefit offset national demonstration (BOND) project. The special rules for the BOND project will no longer apply to (2) beginning (3). (4).

  1. Fill-ins (1) and (2) are automatically generated (Fill-in (1): You have, Name has; Fill-in (2): you, him, her).

  2. Fill-in (3) is the date their participation period ends in MM/CCYY format.

  3. Fill-in (4) is the reason their participation period is ending:

    1. You asked to be withdrawn from the project. If you are receiving benefit payments, your payments may stop the first month you do substantial gainful work

    2. He asked to be withdrawn from the project. If he is receiving benefit payments, his payments may stop the first month he does substantial gainful work.

    3. She asked to be withdrawn from the project. If she is receiving benefit payments, her payments may stop the first month she does substantial gainful work.

    4. You are no longer eligible for the project, because you have not completed the trial work period by September 30, 2017.

    5. He is no longer eligible for the project, because he has not completed the trial work period by September 30, 2017.

    6. She is no longer eligible for the project, because she has not completed the trial work period by September 30, 2017.

    7. Null (use BEN110 or BEN 111)

19. BEN110

a. Description of UTI

Use this UTI when explaining why a beneficiary is ineligible for BOND. (Only used if F4 = A, B, C, D, E, or F requested in BEN 109)

b. Language or fill-ins for BEN110

(1) no longer eligible for the project because (2) (3). If (4) (you are, he is, she is) receiving benefit payments based on disability, (5) payments may stop the first month (6) substantial gainful work.

  1. Fill-ins (1), (2), (4), (5) and (6) are automatically generated (Fill-in (1): You are, Name is; Fill-in (2): you have, he has, she has; Fill-in (4): you are, he is, she is; Fill-in 5:your, his, her; Fill-in 6:you do, he does, she does)

  2. Fill-in (3) is the reason why the beneficiary is ineligible (A – F)

    1. A-had benefits terminated prior to the BOND start date of participation,

    2. B-participated in another demonstration project before,

    3. C-moved to a foreign country,

    4. D-received benefits paid by the railroad,

    5. E-elected to receive benefits not based on a disability,

    6. F-no longer met the BOND eligibility criteria

20. BEN111

a. Description of UTI

Use this UTI when explaining why a beneficiary is ineligible for BOND. (Only used if F4 = G requested in BEN 109)

b. Language or fill-ins for BEN111

(1) participation period ends (2). Payments will end with the month (3) substantial gainful work after (4).

  1. Fill-ins (1) and (3) are automatically generated (Fill-in (1): Your, Name; Fill-in (3): you do, he does, she does).

  2. Fill-ins (2) and (4) are the month their participation period ends in MM/CCYY format.

21. BEN112

a. Description of UTI

Use this UTI when explaining why a beneficiary is ineligible for BOND. (Only used if F4 = A, B, C, D, E, or F requested in BEN 109)

b. Language or fill-ins for BEN112

(1) participation period ends (2). Since (3) not demonstrated an ability to perform work at a substantial gainful activity (SGA) level, payments may end with in the second month following the month (4) an ability to perform work at an SGA level.

  1. Fill-ins (1), (3) and (4) are automatically generated. (Fill-in (1):Your- Name; Fill-in (3): you have, he has, she has; Fill-in (4): you demonstrate, he demonstrates, she demonstrates).

  2. Fill-in (2) is the month the participation period ends in MM/CCYY format.

22. BEN113

a. Description of UTI

Use this UTI when you have done the final reconciliation on a BOND beneficiary.

b. Language or fill-ins for BEN113

The special rules for the BOND project will no longer apply to (1) after (2) participation period ends. If (3) benefit payments based on disability after that month, (4) payments will stop the first month (5) substantial gainful work.

  1. Fill-ins (1) – you, Name, (2) – your, his, her, (3) – you receive, he receives, she receives, (4) – your, his, her, and (5) – your do, he does, she does) are all automatically generated.

23. BEN114

a. Description of UTI

Use this UTI when an auxiliary is not payable for the reconciliation period.

b. Language or fill-ins for BEN114

We cannot pay (1) benefits for (2) under the rules of the Benefit Offset National Demonstration (BOND) project. This is due to (3) work and earnings. This does not change any current benefits (4).

  1. Fill-ins (1) – you, Name; (3) – BOND beneficiary name possessive; and (4) – you receive, he receives, she receives; are automatically generated.

  2. Fill-in (2) is the sole month of offset in the reconciliation year (MM/CCYY) or the first and last month of offset period in the reconciliation year (MM/CCYY through MM/CCYY).

24. BEN115

a. Description of UTI

Use this UTI when an auxiliary is payable for the reconciliation period.

b. Language or fill-ins for BEN115

(1) will soon receive a check for (2). This check is for benefits due to (3) for (4) under the rules of the Benefit Offset National Demonstration (BOND) project. (5) are due this check because of (6) work and earnings. This does not change any current benefits (7).

  1. Fill-ins (1) – You, Name; (3) – you, him, her; (5) – You, Name; (6) – BOND beneficiary name possessive; and (7) – you receive, he receives, she receives; are automatically generated.

  2. Fill-in (2) is the amount of the refund after reconciliation.

  3. Fill-in (4) is the sole month of offset in the reconciliation year (MM/CCYY) or the first and last month of offset period in the reconciliation year (MM/CCYY through MM/CCYY).

25. BEN116

a. Description of UTI

Use this UTI to remind a BOND beneficiary to report current year estimate of earnings.

b. Language or fill-ins for BEN116

If (1) working and (2) not given us an estimate of (3) expected yearly earnings, please contact Abt Associates immediately. We show their contact information under the heading, “If You Have Questions About the BOND Project”. If (4) not give us an estimate, we may pay (5) incorrect benefit payments.

  1. Fill-ins (1-5) are automatically generated. (Fill-in (1): you are, Name is; Fill-in (2): have, has; Fill-in (3): your, his, her; Fill-in (4): you do, he does, she does; Fill-in (5): you, him, her)

26. BEN117

a. Description of UTI

Use this UTI if a BOND beneficiary submits documentation for end of year reconciliation and there is no change in the benefit amount.

b. Language or fill-ins for BEN117

Thank you for providing us with information about (1) earnings for last year. (2) asked us to determine if there has been a change in the amount of benefits payable to (3) under BOND because of this information. Based on this evidence we have determined that there is no change to (4) monthly benefit amount for this period. This decision does not change any benefits (5) may be currently receiving.

Fill-ins (1-5) are automatically generated. (Fill-in (1): you are, Name is; Fill-in (2): have, has; Fill-in (3): your, his, her; Fill-in (4): you do, he does, she does; Fill-in (5): you, him, her)

27. BEN118

a. Description of UTI

Use this UTI if a BOND beneficiary submits documentation for end of year reconciliation and an overpayment or underpayment applies.

b. Language or fill-ins for BEN118

Thank you for providing us with information about (1) earnings for the last year. (2) asked us to determine if there has been a change in the amount of benefits payable to (3) under BOND because of this information.

  1. Fill-ins (1-3) are automatically generation. (Fill-in (1): your, Name possessive; Fill-in (2): You, He, She; Fill-in (3): you, him, her)

28. BEN119

a. Description of UTI

Use this UTI if a BOND beneficiary submits a Request for Reconsideration.

b. Language or fill-ins for BEN118

We received a request (1).

  1. Fill-in (1) has five options:

A = for an explanation.

B = that we not collect the overpayment.

C = that we review our decision.

D = that we review our decision and not collect the overpayment.

E = that we withhold a different amount.

29. INFC50

This caption states: What Happens When The Special Rules for BOND No Longer Apply?

E. Sample Notices

1. BOND Offset – Initial or Revised Earnings Estimate

Social Security Administration

Retirement, Survivors and Disability Insurance

Date:

Claim Number:

Name and address

[G52—approved] . INTRODUCTORY STATEMENT A20, A21, A 22 ADJUSTMENT NOTICE

We are writing to give you new information about the   (Computer. Generated.)  benefits which  (Computer. generated)   on this Social Security record.

[BEN101]

*F1 (You have, Name has) been selected to participate in the Benefit Offset National Demonstration (BOND) project.

[BOND Caption 1] Benefit Offset National Demonstration (BOND)

[WDS017]

The BOND project offers qualified individuals a more generous treatment of earnings than under the current rules. A qualified individual is provided an opportunity to work and earn over $*F1 (BOND non-blind yearly amount) or $*F2 (BOND blind yearly amount) ,and benefit from having only $1 of benefits withheld for every $2 earned over this amount. Under current Social Security rules, the same qualified individual working and earning over $*F3 (BOND non-blind yearly amount) or $*F4 (BOND blind yearly amount), generally has his or her benefits stopped.

[CAP1--approved] Your Benefits

Choose between BOND UTI 14 or 15 depending on whether this is an initial estimate or revised estimate of earnings for the months for which the beneficiary is eligible for the offset in the year.

[ERN084] *F1 (Your, Name possessive) current estimate of total earnings for *F2 (your, Name possessive) offset period this year is $*F3 (estimated total earnings for the offset period).

OR

[ERN085] *F1 (Your, Name possessive) revised estimate of total earnings for *F2 (your, his, her) offset period this year is $*F3 (revised estimate of total earnings for the offset period). *F4 (You, Name) previously estimated total earnings of $*F5 (previous estimate of total earnings for same period) for this period.

[Use either WSD018 or WSD016 depending on whether partial or full offset year]

[WSD018 – Offset period is entire calendar year]

*F1 (Your, Name possessive) offset period this year is the entire calendar year.

  

We determine how much to reduce *F2 (your, Name possessive) benefit payments for each month in the year under the $1 for $2 offset based on an estimate of *F3 (your, Name possessive) BOND countable earnings for the year. To get this estimate, we use *F4 (your, Name possessive) estimate of total earnings for the year and subtract *F5 (your, Name possessive his, her) estimate of the amount of allowable deductions for the year. The resulting amount is the estimate of *F6 (your, Name possessive) BOND countable earnings for the year. Some allowable deductions include the following:

  • The amount of any sick or vacation pay,

  • The amount of any subsidy paid by an employer who pays more in wages than the actual value of the work, and

  • Amounts *F7 (you pay, Name pays) for items or services related to *F8 (your, Name possessive) disability that are needed to work. Some examples are prescription drugs, personal attendant, job coach, or a wheelchair.

After allowable deductions, *F9 (your, Name possessive) *F10 (estimate, revised estimate) of BOND countable earnings for this year is $*F11 (estimate/revised estimate of BOND countable earnings for this year).

  

Next, we subtract the BOND yearly amount from the estimate of *F12 (your, Name possessive) BOND countable earnings for the year and divide the remaining amount by two. We then divide that amount by twelve to determine the monthly offset amount. The monthly offset amount is the amount by which *F13 (your, Name possessive) benefits for each month in the year are reduced under the benefit offset. Based on the *F14 (estimate, revised estimate) of *F15 (your, Name possessive) BOND countable earnings and the computations above, *F16 (your, Name possessive) monthly offset amount this year is $*F17 (monthly offset amount).

  

[WDS016 – Offset period is less than the calendar year]

*F1 (Your, Name possessive) offset period this year is *F2 (mm/yyyy) (first month of offset period in the year, sole month of offset period in the year) *F3 (through (mm/yyyy) (last month of offset period in the year), Null).

  

We determine how much to reduce *F4 (your, Name possessive) benefit payments for each month in the offset period under the $1 for $2 offset based on an estimate of *F5 (your, Name possessive) BOND countable earnings for that period. To get this estimate, we use *F6 (your, Name possessive) estimate of total earnings for the offset period and subtract *F7 (your, Name possessive) estimate of the amount of allowable deductions for that period. The resulting amount is the estimate of *F8 (your, Name possessive) BOND countable earnings for the offset period. Some allowable deductions include the following:

  • The amount of any sick or vacation pay,

  • The amount of any subsidy paid by an employer who pays more in wages than the actual value of the work, and

  • Amounts *F9 (you pay, Name pays) for items or services related to *F10 (your, Name possessive) disability that are needed to work. Some examples are prescription drugs, personal attendant, job coach, or a wheelchair.

   

After allowable deductions, *F11 (your, Name possessive) *F12 (estimate, revised estimate) of BOND countable earnings for *F13 (your, name possessive) offset period this year is $*F14 (estimate/revised estimate of BOND countable earnings for offset period this year).

   

Since *F15 (your, Name possessive) offset period is less than the calendar year, we prorate the BOND yearly amount based on the number of months in *F16 (your, Name possessive) offset period and use that prorated amount to figure the benefit offset. We subtract the prorated BOND yearly amount from the estimate of *F17 (your, Name possessive) BOND countable earnings for the offset period and divide the remaining amount by two. We then divide that amount by the number of months in *F18 (your, Name possessive) offset period to determine the monthly offset amount. The monthly offset amount is the amount by which *F19 (your, Name possessive) benefits for each month in the offset period are reduced under the benefit offset. Based on the *F20 (estimate, revised estimate) of *F21 (your, Name possessive) BOND countable earnings and the computations above, *F22 (your, Name possessive) monthly offset amount for *F23 (your, Name possessive) offset period this year is $*F24 (monthly offset amount).

   

   

[BOND UTI 23]

*F1 (You, Name) *F2 (will be, should have been) paid $*F3 (offset monthly benefit amount (MBA)) a month beginning *F4 (first month of offset period) *F5 (A, B, C, or D). The new monthly benefit amount is the amount before any deduction for Medicare premiums.

   

F5= Alpha character(s):

A= because of the offset under the BOND project

B= because of the offset under the BOND project and the receipt of workers' compensation payments or public disability benefits

C= because of the offset under the BOND project and the government pension offset provision

D= Null (if D is selected the *M31 (NOT screen) will be used to further explain the reason)

   

[CAP 02-approved] What We Will Pay

   

[UTI G01—approved] (computer generated fill-ins) NOTE: Automated fill-ins for this paragraph.

  • The next check you receive will be for $*F1 which is the money you are due through *F2.

  • Your next scheduled payment of $*F4 which is for *F5, will be receive on or about the *F6 of *F7.

  • After that, you will receive $*F8 on or about the *F9 of each month.

    

[CAP 16--approved] Do You Think We are Wrong

[ALS190]

If you think this information is not correct or you want to report any changes in *F1 (your, Name possessive) work plans or earnings, please get in touch with *F2 (your, Name possessive) benefits counselor at Abt Associates. Please call their toll-free number at 1-877-726-6309 (877-7BOND09) to report any changes. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90).

  

Optional paragraph--Use CAP07 and HIB187 if Medicare Part B premiums are being deducted from disability benefits

[CAP07--approved] Information About Medicare

[HIB187—approved]

We will continue to deduct Medicare premiums from your monthly checks.

   

[CAP15--approved] Things To Remember

[RCT033—approved]

*F1 (You, Name) must promptly report any changes that may affect your benefits. Failure to do so could mean *F2 (you, Name) may have to repay any benefits not due. Let us know if:

  • *F3 (You, Name) went to work since *F4 (your, Name possessive) last report or *F5 (you, Name) return to work in the future; or

  • *F6 (You, Name) already reported your work, but *F7 (your, Name possessive) duties or pay changed. (Remember to keep records of *F8 (your, Name possessive) work and earnings such as pay statements from *F9 (your, Name possessive) employer.); or

  • *F10 (Your, Name possessive) doctor says *F11 (your, Name possessive) condition has improved (even if *F12 (you don’t, Name doesn’t) work now); or

  • *F13 (You apply for, start getting or have a change; Name applies for, starts getting, or has a change) in the amount of workers' compensation or another public disability benefit; or

  • *F14 (You start, Name starts) paying for work expenses related to *F15 (your, Name possessive) disability (for example, *F16 (you, Name) may need special transportation) or the amount paid for these work expenses changes or *F17 (you, Name) no longer pay for such expenses. (Remember to keep records and proof of payment for any work expenses.)

   

[BOND Caption 17 ] -- If You Have Questions About the BOND Project

  

[REF137]

Please visit our website at www.socialsecurity.gov/disabilityresearch/offsetnational.htm

for general information about the Benefit Offset National Demonstration (BOND) project. If you have any questions about the BOND project, you may call our partner Abt Associates. Their toll-free number is 1-866-611-EARN (3276). They will help you by phone or they will set up an appointment with the Abt local office that serves your area. If you have a hearing or speech impairment, you may call their TTY number, 1-800-222-2222. When you call, please have this letter with you. It will help the counselors at Abt answer your questions.

[BOND Caption 6]--If You Have Questions that Are Not About the BOND Project

[REF108—approved] If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local Social Security office at *F2 (Local FO#). We can answer most questions over the phone. You may also write or visit any Social Security office. The office that serves your area is located at:

                   *F3 (FO Address)
                   *F4 (FO Address)
                   *F5 (FO Address)
                   *F6 (FO Address)

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

2. BOND BRI Adjustment Notice

Social Security Administration

Retirement, Survivors and Disability Insurance

Date:

Claim Number:

Name and address

[LIS004] Introductory Paragraph for A20, A21, and A22 Adjustment Notices

We are writing to give you new information about the   (Computer generated.)   benefits which   (Computer generated)   on this Social Security record.

[BEN105]

We may have let *F1 (you, Name) know earlier that we would increase *F2 (your, Name possessive) benefits to *F3 (BRI/MBR incorrect monthly benefit amount) per month due to the rise in the cost of living. We have refigured *F4 (your, Name possessive) benefits based on *F5 (your, Name possessive) participation in the benefit offset national demonstration project (BOND). This notice corrects the calculation to apply the cost of living increase to *F6 (your, Name possessive) original benefit before the reduction for BOND earnings. *F7 (Your, Name possessive) new monthly amount (before deductions) is *F8 (new offset monthly benefit amount).

   

[ALSC01] Do You Think We Are Wrong

  

[ALS190]

If you think this information is not correct or you want to report any changes in *F1 (your, Name possessive) work plans or earnings, please get in touch with *F2 (your, Name possessive) benefits counselor at Abt Associates. Please call their toll-free number at 1-877-726-6309 (877-7BOND09) to report any changes.

  

[INFC08] Things To Remember

  

[RCT053]

You must promptly report any changes that may affect *F1 (your, Name possessive) benefits. Failure to do so could mean you may have to repay any benefits not due. Let us know if:

  • *F2 (You, Name) went to work since your last report or *F3 (return, returns) to work in the future; or

  • You already reported *F4 (your, Name possessive) work, but duties or pay changed. (Remember to keep records of work and earnings such as pay statements from the employer); or

  • *F5 (Your, Name possessive) doctor says *F6 (his, her, your) condition has improved even if *F7 (he, she, you) *F8 (doesn’t, don’t) work now; or

  • You applied for, start getting or have a change in the amount of *F9 (your, Name possessive) workers compensation or another public disability benefit; or

  • You start paying for work expenses related to *F10 (your, Name possessive) disability such as special transportation or the amount paid for these work expense changes or you no longer pay for such expenses. (Remember to keep records and proof of payment for any work expenses.)

[REFC05]-- If You Have Questions About The Bond Project

  

[REF137]

Please visit our website at www.socialsecurity.gov/disabilityresearch/offsetnational.htm

for general information about the Benefit Offset National Demonstration (BOND) project. If you have any questions about the BOND project, you may call our partner Abt Associates. Their toll-free number is 1-877-726-6309 (877-7BOND09). They will help you by phone or they will set up an appointment with the Abt local office that serves your area. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90). When you call, please have this letter with you. It will help the counselors at Abt answer your questions.

3. EOYR – BOND End of Year Reconciliation – Notice of Overpayment/underpayment

Social Security Administration

Retirement, Survivors and Disability Insurance

  

Date:

Claim Number:

  

Name and address

  

  

[LIS004] (Use for an underpayment)

We are writing to give you new information about the (Computer generated) benefits which (Computer generated) on this Social Security record.

  

[OPT161] (Use for an overpayment)

We are writing to give you new information about the disability benefits which you receive on this Social Security record. In the rest of this letter, we will tell you:

How we paid you (amount of the overpayment) too much in benefits; and

What to do if you think we are wrong about the overpayment.

   

[CHKC09] Your Benefits

  

[BEN118] (Use when the beneficiary requests a reconciliation based on evidence they submit)

Thank you for giving us information about your earnings for the last year. You asked us to determine if there has been a change in the amount of benefits payable to you under BOND because of this information.

  

[BEN106] (Use when the beneficiary has an overpayment or an underpayment) Note: Fill-ins 5 and 6 are repeatable-enter a comma after F6 to add more iterations of these two fill-ins.

Based on *F1 (your, Name possessive) earnings of $*F2 (end of year reconciliation BOND countable earnings amount) for *F3 (ccyy) (reconciliation year) we should have paid *F4 (you, him, her) $F5 (monthly benefit credited (MBC) that should have been paid) for *F6 (mm/ccyy, mm/ccyy through mm/ccyy).

  

Use OPT179 immediately after BEN106

  

[OPT179]

We paid *F1 (you, Beneficiary’s Name) $*F2 (MBC Paid) for *F3 (mm/ccyy, mm/ccyy through mm/ccyy). Since we should have paid *F4 (you, him, her) $*F5 (MBC should have been paid) for *F6 (mm/ccyy, mm/ccyy through mm/ccyy), we paid *F7 (you, him, her) $*F8 (amount of overpayment/underpayment) *F9 (more, less) than *F10 (you were, he was, she was) due.

  

[BEN107] (Use for a beneficiary requested reconciliation when there is no change in benefits)

This means we paid *F1 (you, Name) correctly based on the evidence *F2 (you, he, she) provided for the reconciliation year.

  

[BEN108] (Use after OPT179)

This *F1 (A=overpayment, B=underpayment) resulted from the difference in the yearly amount that *F2 (you, Name) estimated *F3 (you, he, she) would earn during *F4 (ccyy (reconciliation year)) and the actual amount that *F5 (you, he, she) earned during that year. We determined the *F6 (A=overpayment, B=underpayment) after we recalculated *F7 (your, his, her) offset amount based on *F8 (your, his, her) actual countable earnings.

  

[BEN116]

If you are working and have not given us an estimate of your expected yearly earnings, please contact Abt Associates immediately. We show their contact information under the heading, “If You Have Questions About the BOND Project”. If you do not give us an estimate, we may pay you incorrect benefit payments.

  

[BEN109] (Use when the reconciliation period includes the last month of the participation period)(Do not use when BEN113 is being used – these UTIs are mutually exclusive)

*F1 (You have, Name has) been a participant in the benefit offset national demonstration project (BOND). The special rules for the BOND project will no longer apply to *F2 (you, him, her) beginning *F3 (mm/dd/ccyy). *F4 (A-G).

F4-A: You asked to be withdrawn from the project. If you are receiving benefit payments, your payments may stop the first month you do substantial gainful work

F4-B: He asked to be withdrawn from the project. If he is receiving benefit payments, his payments may stop the first month he does substantial gainful work.

F4-C: She asked to be withdrawn from the project. If she is receiving benefit payments, her payments may stop the first month she does substantial gainful work.

F4-D: You are no longer eligible for the project, because you have not completed the trial work period by September 30, 2017.

F4-E: He is no longer eligible for the project, because he has not completed the trial work period by September 30, 2017.

F4-F: She is no longer eligible for the project, because she has not completed the trial work period by September 30, 2017.

F4-G: Null (use BEN110 or BEN111)

   

[BEN110] (Use when fill-in 4= A,B,C,D, E, or F in BEN109)

*F1 (You are, Name is) no longer eligible for the project because *F2 (you have, he has, she has) *F3 (A-had benefits terminated prior to the BOND start date of participation, B-participated in another demonstration project before, C-moved to a foreign country, D-received benefits paid by the railroad, E-elected to receive benefits not based on a disability, F-no longer met the BOND eligibility criteria). If *F3 (you are, he is, she is) receiving benefit payments based on disability, *F4 (your, his, her) payments may stop the first month *F5 (you do, he does, she does) substantial gainful work.

  

[BEN111] (Use when fill-in 4= G (Null) is used in BEN109)

*F1 (Your, Name) participation period ends *F2 (mm/ccyy). Payments will end with the month *F3 (you do, he does, she does) substantial gainful work after *F4 (mm/ccyy).

  

[INFC50]—What Happens When The Special Rules For BOND No Longer Apply (Use for final reconciliation- after BEN110 or BEN111)

  

[BEN113] (Do not use when BEN109 is being used. These UTI’s are mutually exclusive)

The special rules for the BOND demonstration project will no longer apply to you after your participation period ends. If you receive benefit payments after that month, your payments will stop the first month you do substantial gainful work.

  

[OPTC05]—How You Can Pay Us Back (Use for overpayment situations)

  

[RFU001 for E32]

You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Always include your claim number (as indicated above) on the check or money order. If you cannot refund the full $ Computer Generated now, you should submit: (a) a partial payment; (b) an explanation of your financial circumstances; and (c) a definite plan for repaying the balance.

  

[RFU012 for E31]

You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Always include your claim number (as indicated above) on the check or money order. If you cannot refund the full amount now, you should submit: (a) a partial payment; (b) an explanation of your financial circumstances; and (c) a definite plan for repaying the balance.

If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding your full benefit each month beginning with the payment you would normally receive about (comp. gen.).We will continue to withhold your benefit until the overpayment has been fully recovered.

  

[OPT165-when RFU012 generated]

We will pay you a monthly check of (Computer Generated) until we start to collect the overpayment.

  

[ALSC06] Do You Think We Are Wrong About The Overpayment (Use with notice E31 or E32)

  

[WAV002 for E32]

You have certain rights with respect to this overpayment and its recovery.

1.  Right to Appeal: If you disagree in any way with this overpayment determination, you have the right, within 60 days of the date you receive this notice, to request that the determination be reconsidered. If you request this independent review of the overpayment determination, please submit any additional information you have which pertains to the overpayment.

2.  Right to Request Waiver: You also have the right to request a determination concerning the need to recover the overpayment. An overpayment must be refunded or withheld from benefits unless both of the following are true:

  1. The overpayment was not your fault in any way; and

  2. You could not meet your necessary living expenses if we recovered the overpayment, or recovery would be unfair for some other reason.

If you request waiver, we may need a statement of your assets and monthly income and expenses.

If you request reconsideration and/or waiver within 30 days, the overpayment will not have to be recovered until the case is reviewed. This review is described in more detail on the attached Form SSA-3105, Important Information About Your Appeal and Waiver Rights. The people in any Social Security office will be glad to help you complete the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration) and/or waiver (SSA-632-F4, Overpayment Recovery Questionnaire).

Even if you do not want to request reconsideration or waiver, please call, write or visit any Social Security office if you have any questions or need more information. Please take this letter with you if you do visit an office.

   

[WAV002 for E31]

You have certain rights with respect to this overpayment and its recovery.

1.  Right to Appeal: If you disagree in any way with this overpayment determination, you have the right, within 60 days of the date you receive this notice, to request that the determination be reconsidered. If you request this independent review of the overpayment determination, please submit any additional information you have which pertains to the overpayment.

2.  Right to Request Waiver: You also have the right to request a determination concerning the need to recover the overpayment. An overpayment must be refunded or withheld from benefits unless both of the following are true:

  1. The overpayment was not your fault in any way; and

  2. You could not meet your necessary living expenses if we recovered the overpayment, or recovery would be unfair for some other reason.

If you request waiver, we may need a statement of your assets and monthly income and expenses.

If you request reconsideration and/or waiver within 30 days, the planned withholding of your benefit to recover the overpayment will not take place until your case is reviewed. This review is described in more detail on the attached Form SSA-3105, Important Information About Your Appeal and Waiver Rights. The people in any Social Security office will be glad to help you complete the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration) and/or waiver (SSA-632-F4, Overpayment Recovery Questionnaire).

Even if you do not want to request reconsideration or waiver, please call, write or visit any Social Security office if the planned withholding of your monthly payment would cause hardship. Please take this letter with you if you do visit an office. Unless we hear from you within 30 days, we will withhold your payment as shown above.

  

[ALSC27] If You Want To Appeal

   

[ALS120]

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision which you believe are wrong and will look at any new facts you have. We may also review those parts which you believe are correct and may make them unfavorable or less favorable to you.

  

[REFC05] If You Have Questions About The BOND Project

  

[REF137]

Please visit our website at www.bond.ssa for general information about the Benefit Offset National Demonstration (BOND) project. If you have any questions about the BOND project, you may call our partner Abt Associates. Their toll-free number is 1-877-726-6309 (877-7BOND09). They will help you by phone or they will set up an appointment with the Abt local office that serves your area. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90). When you call, please have this letter with you. It will help the counselors at Abt answer your questions.

  

[REFC06] If You Have Questions That Are Not About The BOND Project

  

[REF008 — approved]

We invite you to visit our website at www.social security.gov on the Internet to find general information about Social Security. If you have any specific questions, call us toll-free at 1-800-772-1213. We can answer most questions over the phone. If you prefer to visit one of our offices, please check the local telephone directory for the office nearest you. Or call us and we can give you the office address. Please have this letter with you if you call or visit an office. It will help us answer your questions.

4. EOYR – Auxiliary notice – benefits are not payable (BSAS to MACADE/MADCP)

*This notice is used to explain to the auxiliary that benefits were not payable during the reconciliation year because proven earnings resulted in total offset of the BOND participant’s monthly DIB (previous estimate allowed payment).

   

Social Security Administration

Retirement, Survivors and Disability Insurance

   

  

Date:

Claim Number:

  

Name and address

  

  

[LIS004]

We are writing to give you new information about the (Computer generated) benefits which (Computer generated) on this Social Security record.

  

[OPT169]

Since we paid you ($comp. gen) for (mm/ccyy-comp. gen), we paid you ($comp gen) more than you were due.

  

[CHKC01--approved] Why We Cannot Pay You

  

[BEN114]

We cannot pay you benefits from *F2 ((mm/yyyy) (sole month of offset in the reconciliation year), (mm/yyyy through mm/yyyy) (first and last month of offset period in the reconciliation year)) under the rules of the Benefit Offset National Demonstration (BOND) project. This is due to *F1 (BOND beneficiary name possessive) work and earnings. This does not change any current benefits you receive.

  

  

[OPTC05]—How You Can Pay Us Back

  

[RFU001 for E32]

You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Always include your claim number (as indicated above) on the check or money order. If you cannot refund the full $ (comp. gen.) now, you should submit: (a) a partial payment; (b) an explanation of your financial circumstances; and (c) a definite plan for repaying the balance.

  

[RFU012 for E31]

You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Always include your claim number (as indicated above) on the check or money order.

If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding your full benefit each month beginning with the payment you would normally receive about (comp. gen.).We will continue to withhold your benefit until the overpayment has been fully recovered.

  

[OPT165-when RFU012 generated]

We will pay you a monthly check of ($ comp. gen.) until we start to collect the overpayment.

  

[ALSC06] Do You Think We Are Wrong About The Overpayment

  

[WAV002 for E32]

You have certain rights with respect to this overpayment and its recovery.

1.  Right to Appeal: If you disagree in any way with this overpayment determination, you have the right, within 60 days of the date you receive this notice, to request that the determination be reconsidered. If you request this independent review of the overpayment determination, please submit any additional information you have which pertains to the overpayment.

2.  Right to Request Waiver: You also have the right to request a determination concerning the need to recover the overpayment. An overpayment must be refunded or withheld from benefits unless both of the following are true:

  1. The overpayment was not your fault in any way; and

  2. You could not meet your necessary living expenses if we recovered the overpayment, or recovery would be unfair for some other reason.

If you request waiver, we may need a statement of your assets and monthly income and expenses.

If you request reconsideration and/or waiver within 30 days, the overpayment will not have to be recovered until the case is reviewed. This review is described in more detail on the attached Form SSA-3105, Important Information About Your Appeal and Waiver Rights. The people in any Social Security office will be glad to help you complete the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration) and/or waiver (SSA-632-F4, Overpayment Recovery Questionnaire).

Even if you do not want to request reconsideration or waiver, please call, write or visit any Social Security office if you have any questions or need more information. Please take this letter with you if you do visit an office.

   

[WAV002 for E31]

You have certain rights with respect to this overpayment and its recovery.

1.  Right to Appeal: If you disagree in any way with this overpayment determination, you have the right, within 60 days of the date you receive this notice, to request that the determination be reconsidered. If you request this independent review of the overpayment determination, please submit any additional information you have which pertains to the overpayment.

2.  Right to Request Waiver: You also have the right to request a determination concerning the need to recover the overpayment. An overpayment must be refunded or withheld from benefits unless both of the following are true:

  1. The overpayment was not your fault in any way; and

  2. You could not meet your necessary living expenses if we recovered the overpayment, or recovery would be unfair for some other reason.

If you request waiver, we may need a statement of your assets and monthly income and expenses.

If you request reconsideration and/or waiver within 30 days, the planned withholding of your benefit to recover the overpayment will not take place until your case is reviewed. This review is described in more detail on the attached Form SSA-3105, Important Information About Your Appeal and Waiver Rights. The people in any Social Security office will be glad to help you complete the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration) and/or waiver (SSA-632-F4, Overpayment Recovery Questionnaire).

Even if you do not want to request reconsideration or waiver, please call, write or visit any Social Security office if the planned withholding of your monthly payment would cause hardship. Please take this letter with you if you do visit an office. Unless we hear from you within 30 days, we will withhold your payment as shown above.

  

[ALSC27] If You Want To Appeal

  

[ALS023]

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision, which you believe are wrong and will look at any new facts you have. We may also review those parts, which you believe are correct and may make them unfavorable or less favorable to you.

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show you did not get it within the 5-day period.

  • You must have a good reason for waiting more than 60 days to ask for an appeal.

  • You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2, called “Request for Reconsideration”. Contact one of our offices if you want help.

Please read the enclosed pamphlet: Your Right to Question the Decision Made on Your Social Security Claim”. It contains more information about the appeal.

  

[REFC01] If You Have Any Questions

  

[REF137]

Please visit our website at www.socialsecurity.gov/disabilityresearch/offsetnational.htm

for general information about the Benefit Offset National Demonstration (BOND) project. If you have any questions about the BOND project, you may call our partner Abt Associates. Their toll-free number is 1-877-726-6309 (877-7BOND09). They will help you by phone or they will set up an appointment with the Abt local office that serves your area. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90). When you call, please have this letter with you. It will help the counselors at Abt answer your questions.

5. EOYR – Auxiliary notice – benefits are payable (BSAS to MACADE/MADCP)

*This notice is used to explain to the auxiliary that benefits were payable to them in the reconciliation year since the BOND beneficiary was due partial benefits based on proven earnings (previous estimate put the BOND beneficiary in full suspense – LAF SQ). Use Notice A18.

   

  

Social Security Administration

Retirement, Survivors and Disability Insurance

  

  

  

Date:

Claim Number:

  

Name and address

  

[LIS004]. INTRODUCTORY STATEMENT A20, A21, A 22 ADJUSTMENT NOTICE

We are writing to give you new information about the *F1 (auxiliary) benefits which *F2 (you receive, Name receives) on this Social Security record.

  

[BEN115]

You will soon receive a check for *F1 (amount of the refund). This check is for benefits due to you for *F2 ((mm/yyyy) (sole month of offset in the reconciliation year), (mm/yyyy through mm/yyyy) (first and last month of offset period in the reconciliation year)) under the rules of the Benefit Offset National Demonstration (BOND) project. You are due this check because of *F1 (BOND beneficiary name possessive) work and earnings. This does not change any current benefits you receive.

  

[ALSC27] If You Want To Appeal

  

[ALS023]

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision, which you believe are wrong and will look at any new facts you have. We may also review those parts, which you believe are correct and may make them unfavorable or less favorable to you.

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show you did not get it within the 5-day period.

  • You must have a good reason for waiting more than 60 days to ask for an appeal.

  • You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2, called “Request for Reconsideration”. Contact one of our offices if you want help.

Please read the enclosed pamphlet: Your Right to Question the Decision Made on Your Social Security Claim”. It contains more information about the appeal.

  

[REFC01] If You Have Any Questions

  

[REF137]

Please visit our website at www.socialsecurity.gov/disabilityresearch/offsetnational.htm

for general information about the Benefit Offset National Demonstration (BOND) project. If you have any questions about the BOND project, you may call our partner Abt Associates. Their toll-free number is 1-877-726-6309 (877-7BOND09). They will help you by phone or they will set up an appointment with the Abt local office that serves your area. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90). When you call, please have this letter with you. It will help the counselors at Abt answer your questions.

6. EOYR – No adjustment in benefits for beneficiary initiated reconciliation

*This notice explains that benefits for the closed year will not change based on proven earnings submitted by the beneficiary.

  

  

Social Security Administration

Retirement, Survivors and Disability Insurance

  

  

  

Date:

Claim Number:

  

Name and address

  

[BEN117]

Thank you for giving us information about your earnings for last year. You asked us to determine if there has been a change in the amount of benefits payable to you under BOND because of this information. Based on this evidence we have determined that there is no change to your monthly benefit amount for this period. This decision does not change any benefits you may be currently receiving.

  

[BEN107]

This means we paid you correctly based on the evidence you provided for the reconciliation year.

  

[ALSC01] Do You Think We Are Wrong

  

[ALS190]

If you think this information is not correct or you want to report any changes in *F1 (your, Name possessive) work plans or earnings, please get in touch with *F2 (your, Name possessive) benefits counselor at Abt Associates. Please call their toll-free number at 1-877-726-6309 (877-7BOND09) to report any changes. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90).

  

[ALSC27] If You Want To Appeal

  

[ALS023]

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision, which you believe are wrong and will look at any new facts you have. We may also review those parts, which you believe are correct and may make them unfavorable or less favorable to you.

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show you did not get it within the 5-day period.

  • You must have a good reason for waiting more than 60 days to ask for an appeal.

  • You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2, called “Request for Reconsideration”. Contact one of our offices if you want help.

Please read the enclosed pamphlet: Your Right to Question the Decision Made on Your Social Security Claim”. It contains more information about the appeal.

  

[REFC05] If You Have Questions About The BOND Project

  

[REF137]

Please visit our website at www.BONDSSA.org for general information about the Benefit Offset National Demonstration (BOND) project. If you have any questions about the BOND project, you may call our partner Abt Associates. Their toll-free number is 1-877-726-6309 (877-7BOND09). They will help you by phone or they will set up an appointment with the Abt local office that serves your area. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90). When you call, please have this letter with you. It will help the counselors at Abt answer your questions.

7. EOYR – Reconsideration overpayment Determination

Social Security Administration

Retirement, Survivors and Disability Insurance

Notice of Reconsideration

(nonpay or current pay status)

  

Date:

Claim Number:

  

Name and address

  

  

[BEN119]

We received your request *F1.

Fill-Ins:

*F1-A for an explanation
*F1-B that we not collect the overpayment
*F1-C that we review our decision
*F1-D that we review our decision and not collect the overpayment
*F1-E that we withhold a different amount

[CHKC09] Your Benefits

  

[BEN118]

Thank you for giving us information about your earnings for the last year. You asked us to determine if there has been a change in the amount of benefits payable to you under BOND because of this information.

  

[BEN106] (Use when the beneficiary has an overpayment or an underpayment) Note: Fill-ins 5 and 6 are repeatable-enter a comma after F6 to add more iterations of these two fill-ins.

Based on *F1 (your, Name possessive) earnings of $*F2 (end of year reconciliation BOND countable earnings amount) for *F3 (ccyy) (reconciliation year) we should have paid *F4 (you, him, her) $F5 (monthly benefit credited (MBC) that should have been paid) for *F6 (mm/ccyy, mm/ccyy through mm/ccyy).

  

Use OPT179 immediately after [BEN106]

  

  

[OPT179]

We paid *F1 (you, Beneficiary’s Name) $*F2 (MBC Paid) for *F3 (mm/ccyy, mm/ccyy through mm/ccyy). Since we should have paid *F4 (you, him, her) $*F5 (MBC should have been paid) for *F6 (mm/ccyy, mm/ccyy through mm/ccyy), we paid *F7 (you, him, her) $*F8 (amount of underpayment or overpayment) *F9 (more, less) than *F10 (you were, he was, she was) due.

  

[BEN107] (Use for a beneficiary requested reconciliation when there is no change in benefits. Should not appear with BEN108 and OPT179.)

This means we paid *F1 (you, Name) correctly based on the evidence *F2 (you, he, she) provided for the reconciliation year.

[BEN108] (Use after OPT179)

This *F1 (A-overpayment, B-underpayment) resulted from the difference in the yearly amount that *F2 (you, Name) estimated *F3 (you, he, she) would earn during *F4 (ccyy (reconciliation year)) and the actual amount that *F5 (you, he, she) earned during that year. We determined the *F6 (A-overpayment, B-underpayment) after we recalculated *F7 (your, his, her) offset amount based on *F8 (your, his, her) actual countable earnings.

  

[BEN116]

If you are working and have not given us an estimate of your expected yearly earnings, please contact Abt Associates immediately. We show their contact information under the heading, “If You Have Questions About the BOND Project”. If you do not give us an estimate, we may pay you incorrect benefit payments.

  

[BEN109] (Use when the reconciliation period includes the last month of the participation period. Do not use when BEN113 is requested-BEN109 and BEN113 are mutually exclusive.)

*F1 (You have, Name has) been a participant in the benefit offset national demonstration project (BOND). The special rules for the BOND project will no longer apply to *F2 (you, him, her) beginning *F3 (mm/dd/ccyy). *F4 (A-G).

F4-A: You asked to be withdrawn from the project. If you are receiving benefit payments, your payments may stop the first month you do substantial gainful work

F4-B: He asked to be withdrawn from the project. If he is receiving benefit payments, his payments may stop the first month he does substantial gainful work.

F4-C: She asked to be withdrawn from the project. If she is receiving benefit payments, her payments may stop the first month she does substantial gainful work.

F4-D: You are no longer eligible for the project, because you have not completed the trial work period by September 30, 2017.

F4-E: He is no longer eligible for the project, because he has not completed the trial work period by September 30, 2017.

F4-F: She is no longer eligible for the project, because she has not completed the trial work period by September 30, 2017.

F4-G: Null (use BEN110 or BEN111)

  

[BEN110] (Use when fill-in 4= A,B,C,D,E, or F is used in BEN109)

*F1 (You are, Name is) no longer eligible for the project because *F2 (you have, he has, she has) *F3 (A-had benefits terminated prior to the BOND start date of participation, B-participated in another demonstration project before, C-moved to a foreign country, D-received benefits paid by the railroad, E-elected to receive benefits not based on a disability, F-no longer met the BOND eligibility criteria). If *F3 (you are, he is, she is) receiving benefit payments based on disability, *F4 (your, his, her) payments may stop the first month *F5 (you do, he does, she does) substantial gainful work.

  

[BEN111] (Use when fill-in 4= G (Null) is used in BEN109)

*F1 (Your, Name) participation period ends *F2 (mm/ccyy). Payments will end with the month *F3 (you do, he does, she does) substantial gainful work after *F4 (mm/ccyy).

  

[INFC50]—What Happens When The Special Rules For BOND No Longer Apply (Optional - Use for final reconciliation- after BEN110 or BEN111)

  

[BEN113]—optional (Do not use when BEN109 is requested-BEN109 and BEN113 are mutually exclusive)

The special rules for the BOND demonstration project will no longer apply to you after your participation period ends. If you receive benefit payments after that month, your payments will stop the first month you do substantial gainful work.

  

[OPTC05]—How You Can Pay Us Back

  

[RFU001 for E32]

You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Always include your claim number (as indicated above) on the check or money order. If you cannot refund the full $ Computer Generated now, you should submit: (a) a partial payment; (b) an explanation of your financial circumstances; and (c) a definite plan for repaying the balance.

  

[OCO001 for E31]

You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Always include your claim number (as indicated above) on the check or money order.

If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding your full benefit each month beginning with the payment you would normally receive about (comp. gen.).We will continue to withhold your benefit until the overpayment has been fully recovered.

  

[OPT165-use when OCO001 generated]

We will pay you a monthly check of (Computer Generated) until we start to collect the overpayment.

  

[ALSC06] Do You Think We Are Wrong About The Overpayment

  

[RCN021]

We changed our earlier decision because of new facts we received.

If you think we are wrong, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. In the rest of our letter, we will call this person an ALJ. The ALJ will review those parts of the decision, which you believe are wrong. The ALJ will look at any new facts you have and correct any mistakes. The ALJ may also review those parts, which you believe are correct and make them unfavorable or less favorable to you.  

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you get this letter.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. If you want to make a request, please contact one of our offices. We can help you complete the required form.

Please read the enclosed pamphlet, "Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case." It contains more information about the hearing.

  

[REFC05] If You Have Questions About The BOND Project

  

[REF137—approved]

Please visit our website at www.BONDSSA.gov for general information about the Benefit Offset National Demonstration (BOND) project. If you have any questions about the BOND project, you may call our partner Abt Associates. Their toll-free number is 1-877-726-6309 (877-7BOND09). They will help you by phone or they will set up an appointment with the Abt local office that serves your area. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90). When you call, please have this letter with you. It will help the counselors at Abt answer your questions.

  

[REFC06] If You Have Questions That Are Not About The BOND Project

  

[REF008—approved]

 We invite you to visit our website at www.social security.gov on the Internet to find general information about Social Security. If you have any specific questions, call us toll-free at 1-800-772-1213. We can answer most questions over the phone. If you prefer to visit one of our offices, please check the local telephone directory for the office nearest you. Or call us and we can give you the office address. Please have this letter with you if you call or visit an office. It will help us answer your questions.

8. EOYR – End date of BOND Participation Notice

Social Security Administration

Retirement, Survivors and Disability Insurance

(MACADE action to revise MBA or demo stop dates)

   

Date:

Claim Number:

  

Name and address

[LIS004—approved] Introductory Paragraph for A20, A21, and A22 Adjustment Notices

We are writing to give you new information about the   (Computer generated.)   benefits which   (Computer generated)   on this Social Security record.

  

[BEN109] (Use when the reconciliation period includes the last month of the participation period. Do not use when BEN113 is requested-BEN109 and BEN113 are mutually exclusive.)

*F1 (You have, Name has) been a participant in the benefit offset national demonstration project (BOND). The special rules for the BOND project will no longer apply to *F2 (you, him, her) beginning *F3 (mm/dd/ccyy). *F4 (A-G).

F4-A: You asked to be withdrawn from the project. If you are receiving benefit payments, your payments may stop the first month you do substantial gainful work

F4-B: He asked to be withdrawn from the project. If he is receiving benefit payments, his payments may stop the first month he does substantial gainful work.

F4-C: She asked to be withdrawn from the project. If she is receiving benefit payments, her payments may stop the first month she does substantial gainful work.

F4-D: You are no longer eligible for the project, because you have not completed the trial work period by September 30, 2017.

F4-E: He is no longer eligible for the project, because he has not completed the trial work period by September 30, 2017.

F4-F: She is no longer eligible for the project, because she has not completed the trial work period by September 30, 2017.

F4-G: Null (use BOND UTI 3B or 3C)

[BEN110] (Use when fill-in 4= A,B,C,D,E,or F is used in BEN109)

*F1 (You are, Name is) no longer eligible for the project because *F2 (you have, he has, she has) *F3 (A-had benefits terminated prior to the BOND start date of participation, B-participated in another demonstration project before, C-moved to a foreign country, D-received benefits paid by the railroad, E-elected to receive benefits not based on a disability, F-no longer met the BOND eligibility criteria). If *F3 (you are, he is, she is) receiving benefit payments based on disability, *F4 (your, his, her) payments may stop the first month *F5 (you do, he does, she does) substantial gainful work.

  

[BEN111] (Use when fill-in 4= G (Null) is used in BEN109)

*F1 (Your, Name) participation period ends *F2 (mm/ccyy). Payments will end with the month *F3 (you do, he does, she does) substantial gainful work after *F4 (mm/ccyy).

  

[ALSC01] Do You Think We are Wrong

  

[ALS190]

If you think this information is not correct or you want to report any changes in *F1 (your, Name possessive) work plans or earnings, please get in touch with *F2 (your, Name possessive) benefits counselor at Abt Associates. Please call their toll-free number at 1-877-726-6309 (877-7BOND09) to report any changes. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90).

  

[INFC50]—What Happens When The Special Rules For BOND No Longer Apply

[BEN113] (Do not use with BEN109-BEN109 and BEN113 are mutually exclusive)

The special rules for the BOND demonstration project will no longer apply to you after your participation period ends. If you receive benefit payments after that month, your payments will stop the first month you do substantial gainful work.

  

[INFC08] Things To Remember

  

[RCT053]

*F1 (You, Name) must promptly report any changes that may affect your benefits. Failure to do so could mean *F2 (you, Name) may have to repay any benefits not due. Let us know if:

  

*F3 (You, Name) went to work since *F4 (your, Name possessive) last report or *F5 (you, Name) return to work in the future; or

  

*F6 (You, Name) already reported your work, but *F7 (your, Name possessive) duties or pay changed. (Remember to keep records of *F8 (your, Name possessive) work and earnings such as pay statements from *F9 (your, Name possessive) employer.); or

  

*F10 (Your, Name possessive) doctor says *F11 (your, Name possessive) condition has improved (even if *F12 (you don’t, Name doesn’t) work now); or

  

*F13 (You apply for, start getting or have a change; Name applies for, starts getting, or has a change) in the amount of workers' compensation or another public disability benefit; or

  

*F14 (You start, Name starts) paying for work expenses related to *F15 (your, Name possessive) disability (for example, *F16 (you, Name) may need special transportation) or the amount paid for these work expenses changes or *F17 (you, Name) no longer pay for such expenses. (Remember to keep records and proof of payment for any work expenses.)

  

[REFC05] If You Have Questions About The BOND Project

  

[REF137]

Please visit our website at www.BONDSSA.gov for general information about the Benefit Offset National Demonstration (BOND) project. If you have any questions about the BOND project, you may call our partner Abt Associates. Their toll-free number is 1-877-726-6309 (877-7BOND09). They will help you by phone or they will set up an appointment with the Abt local office that serves your area. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90). When you call, please have this letter with you. It will help the counselors at Abt answer your questions.

  

[REFC06] If You Have Questions That Are Not About The BOND Project

  

[REF008]

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, call us toll-free at 1-800-772-1213. We can answer most questions over the phone. If you prefer to visit one of our offices, please check