TN 31 (04-94)

SI 01130.672 Manual Notices - Victims' Compensation Payments and State or Local Relocation Assistance

A. Procedure

 

 

1. When to Issue a Notice

Issue a manual notice only in cases where:

  • receipt of a victims' compensation payment or State or local relocation assistance payment is established and developed per SI 01130.665 or SI 01130.670, respectively; and

  • there is at least 1 month remaining in the exclusion period.

2. How to Issue a Notice

  1. Issue the manual notice on a Form SSA-L8166-U2.

  2. See NL 00801.010 E. on sending manual notices and NL 00804.100 ff. for the appropriate standard notice paragraphs.

  3. Include the appropriate language in B. below.

    NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

B. Exhibit - insert paragraph for manual notices

 

  1   received   2   of   3   in   4   . We will not count this money toward   5   resource limit for 9 months after   6   . On   7   , we will then count any money that is left over as part of   8   resources. But things   9   with the money may count as resources the month after    10   . You can ask us which things count as resources.   11   cannot get SSI if the resources we count are worth over   12   .

 

Fill-ins

 

  1. Choice 1: You

    Choice 2: She

    Choice 3: He

    Choice 4: Your spouse

    Choice 5: Her spouse

    Choice 6: His spouse

    Choice 7: You and your spouse

    Choice 8: She and her spouse

    Choice 9: He and his spouse

    Choice 10: Your parent

    Choice 11: Her parent

    Choice 12: His parent

    Choice 13: You and your parent

    Choice 14: She and her parent

    Choice 15: He and his parent

    Choice 16: Your parents

    Choice 17: Her parents

    Choice 18: His parents

    Choice 19: You and your parents

    Choice 20: She and her parents

    Choice 21: He and his parents

     

  2. Money amount

     

  3. Choice 1: State/local relocation assistance (use “State” and/or “local”, as applicable)

    Choice 2: victims' compensation payment(s)

     

  4. Month/Year

     

  5. Choice 1: your

    Choice 2: her

    Choice 3: his

     

  6. Choice 1: you receive it

    Choice 2: she receives it

    Choice 3: he receives it

    Choice 4: you received it

    Choice 5: she received it

    Choice 6: he received it

    Choice 7: they receive it

    Choice 8: they received it

    Choice 9: it is received

    Choice 10: it was received

     

  7. Month/Day/Year

     

  8. Choice 1: your

    Choice 2: her

    Choice 3: his

     

  9. Choice 1: you buy

    Choice 2: bought

     

  10. Choice 1: you buy them

    Choice 2: they are bought

     

  11. Choice 1: You

    Choice 2: She

    Choice 3: He

     

  12. Choice 1: $2,000

    Choice 2: $3,000


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501130672
SI 01130.672 - Manual Notices - Victims' Compensation Payments and State or Local Relocation Assistance - 10/07/2014
Batch run: 10/07/2014
Rev:</