TN 12 (08-00)

SI 01150.151 Exhibits of Notice Language

This section lists all of the paragraphs for the manual notices for transfer of resources cases.

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

Paragraph TRF001 (INELIGIBLE DUE TO TRANSFERRED RESOURCE)

When Used: This paragraph is used to inform an individual that the transfer of a resource will result in a period of ineligibility for SSI. This paragraph is not used for cash transfers.

1 gave away ___2____ or sold it for less than it was worth in ___3_____. Based on the value of the ____4____, we determined that ___5___ may not be eligible for SSI from __6____ through ___7_____ . A person who gives away a resource or sells it for less than it is worth may be ineligible for SSI for up to 36 months.

TRF001 Example:

You gave away a house or sold it for less than it was worth in May 2000. Based on the value of the house, we determined that you may not be eligible for SSI from June 2000 through February 2002. A person who gives away a resource or sells it for less than it is worth may be ineligible for SSI for up to 36 months.

TRF0O1 Fill-Ins:

  1. Choice 1: You

    Choice 2: He

    Choice 3: She

  2. Type of resource transferred (e.g., a house, a car)

  3. Month/year (the month the transfer occurred)

  4. Type of resource transferred (e.g., house, car)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Month/year (first month of period of ineligibility)

  7. Month/year (final month of period of ineligibility)

TRF002 (INELIGIBLE DUE TO TRANSFERRED CASH)

When Used: This paragraph is used to inform the individual that giving away cash will result in a period of ineligibility for SSI.

__1___ gave away __2___ cash in __3___. Based on the amount of money given away, we determined that __4___ may not be eligible for SSI from __5___ through __6___. Giving away cash can make a person ineligible for SSI for up to 36 months.

TRF002 Example:

You gave away $8,000 cash in May 2000. Based on the amount of money given away, we determined that you may not be eligible for SSI from June 2000 through January 2001. Giving away cash can make a person ineligible for SSI for up to 36 months.

TRF002 Fill-Ins:

  1. Choice 1: You

    Choice 2: He

    Choice 3: She

  2. Dollar amount of the cash transferred

  3. Month/year that cash was transferred (if cash was transferred in several months it will be necessary to expand fill-ins 2 and 3, e.g., “You gave away $4,000 cash in May 2000 and $3,000 cash in June 2000.)

  4. Choice 1: you

    Choice 2: he

    Choice 3: she

  5. Month/year (first month of period of ineligibility)

  6. Month/year (final month of period of ineligibility)

TRF003 (UNDUE HARDSHIP DEFINITION)

When Used: This paragraph is used to inform the individual that, despite the resource transfer, he or she may be eligible for SSI if not getting SSI would cause undue hardship. This paragraph also explains the term “undue hardship.”

However, __1___ may be eligible for SSI if not getting SSI would cause __2___ undue hardship. Undue hardship means that __3___ would not be able to pay for __4___ food and shelter without SSI.

TRF003 Example:

However, you may be eligible for SSI if not getting SSI would cause you undue hardship. Undue hardship means that you would not be able to pay for your food and shelter without SSI.

TRF003 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: you

    Choice 2: him

    Choice 3: her

  3. Choice 1: you

    Choice 2: he

    Choice 3: she

  4. Choice 1: your

    Choice 2: his

    Choice 3: her

TRF004 (UNDUE HARDSHIP DETERMINATION)

When Used: This paragraph is used to inform the individual whether he or she is eligible or ineligible for SSI based on undue hardship.

Based on the information __1___ provided, we determined that __2___ __3___ eligible for SSI starting in __4___. This is because __5___ gave away a resource or sold it for less than it was worth but __6___ __7___ pay for food and shelter without SSI.

TFR004 Examples:

Based on the information you provided, we determined that you are eligible for SSI starting in July 2000. This is because you gave away a resource or sold it for less than it was worth but you could not pay for food and shelter without SSI.

Based on the information you provided, we determined that you are not eligible for SSI starting in July 2000 because you transferred a resource for less than it was worth but you could pay for food and shelter without SSI.

TRF004 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: you

    Choice 2: he

    Choice 3: she

  3. Choice 1: are

    Choice 2: is

    Choice 3: are not

    Choice 4: is not

  4. Month/year (that benefits will start or stop)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Choice 1: you

    Choice 2: he

    Choice 3: she

  7. Choice 1: could

    Choice 2: could not

TRF005 (PERIOD OF INELIGIBILITY ENDING DATE)

When Used: This paragraph informs the individual when the period of ineligibility due to the transferred resource will end (e.g., the period was 5 months long and the 5 months have passed).

___1__ ____2____ eligible for SSI starting in ___3_____ because ____4___ is the last month ___5___ __6___ not eligible because of the ___7___ ____8____ transferred.

TRF005 example:

You are eligible for SSI starting in August 2000 because July 2000 is the last month you are not eligible because of the house you transferred.

TRF005 Fill-Ins:

  1. Choice 1: You

    Choice 2: He

    Choice 3: She

  2. Choice 1: are

    Choice 2: is

  3. Month/year (that benefits will start)

  4. Month/year (final month of period of ineligibility)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Choice 1: are

    Choice 2: is

  7. Type of resource transferred (e.g., house, car)

  8. Choice 1: you

    Choice 2: he

    Choice 3: she

TRF006 (SSA WILL RECONTACT YOU ABOUT UNDUE HARDSHIP)

When Used: This paragraph informs an individual who is currently eligible for SSI based on undue hardship that he or she will be contacted in a future month to find out whether eligibility for SSI based undue hardship continues.

__1___ may continue to be eligible for SSI if not getting SSI would cause __2___ undue hardship. We will contact __3___ in __4___ to find out if __5___ still __6___ SSI in order to pay for __7___ food and shelter.

TRF006 Example:

You may continue to be eligible for SSI if not getting SSI would cause you undue hardship. We will contact you in December 2000 to find out if you still need SSI in order to pay for your food and shelter.

TRF006 Fill-Ins:

  1. Choice 1: You

    Choice 2: He

    Choice 3: She

  2. Choice 1: you

    Choice 2: him

    Choice 3: her

  3. Choice 1: you

    Choice 2: him

    Choice 3: her

  4. Month/year (that individual will be contacted)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Choice 1: need

    Choice 2: needs

  7. Choice 1: your

    Choice 2: his

    Choice 3: her

TRF007 (CONTACT SSA ABOUT FUTURE UNDUE HARDSHIP)

When Used: This paragraph is issued to individuals who are ineligible because they transferred a resource and do not qualify for SSI based on undue hardship. We notify them that they should contact SSA if they cannot afford to pay for food and shelter in a future month.

__1____ may qualify for SSI payments in future months if not getting SSI causes undue hardship. Contact Social Security right away if __2___ cannot pay for __3___ food and shelter.

TRF007 example:

You may qualify for SSI payments in future months if not getting SSI causes undue hardship. Contact Social Security right away if you cannot pay for your food and shelter.

TRF007 Fill-Ins:

  1. Choice 1: You

    Choice 2: He

    Choice 3: She

  2. Choice 1: you

    Choice 2: he

    Choice 3: she

  3. Choice 1: your

    Choice 2: his

    Choice 3: her

TRF008 (CONTACT SSA WHEN PERIOD OF INELIGIBILITY ENDS)

When Used: This paragraph is used when an individual is found ineligible for SSI because of a resource transfer and is not being paid SSI based on undue hardship. We tell the individual to contact SSA when the period of ineligibility is over to find out whether he or she can be eligible for SSI.

The last month __1___ __2___ not eligible for SSI because of the transferred __3___ is __4____ . __5___ may be eligible for SSI starting in __6___. Contact Social Security before __7___ to find out if __8___ __9___ eligible beginning in that month.

TRF008 example:

The last month you are not eligible for SSI because of the transferred house is October 2000. You may be eligible for SSI starting in November 2000. Contact Social Security before November 2000 to find out if you are eligible beginning in that month.

TRF008 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: are

    Choice 2: is

  3. Type of resource transferred (e.g., house, car)

  4. Month/year (final month of period of ineligibility)

  5. Choice 1: You

    Choice 2: He

    Choice 3: She

  6. Month/year (month after the final month of the period of ineligibility)

  7. Month/year (month after the final month of the period of ineligibility)

  8. Choice 1: you

    Choice 2: he

    Choice 3: she

  9. Choice 1: are

    Choice 2: is

TRF009 (INELIGIBLE DUE TO TRANSFER—RECONSIDERATION)

When Used: This paragraph is used for reconsiderations and revised determinations when the individual was determined to be ineligible due to a resource transfer. This paragraph explains SSA's initial determination on the issue. It is not used for transfers of cash.

Previously, we determined that __1___ __2___ not eligible for SSI from ___3____ through __4____ because __5___ gave away __6___ or sold it for less than it was worth in __7___. A person who gives away a resource or sells it for less than it is worth may be ineligible for SSI for up to 36 months.

TRF009 example:

Previously, we determined that you were not eligible for SSI from June 2000 through February 2002 because you gave away a house or sold it for less than it was worth in May 2000. A person who gives away a resource or sells it for less than it is worth may be ineligible for SSI for up to 36 months.

TRF009 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: were

    Choice 2: was

  3. Month/year (first month of period of ineligibility)

  4. Month/year (final month of period of ineligibility)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Type of resource transferred (e.g., a house, a car)

  7. Month/year (the month the transfer occurred)

TRF010 (INELIGIBLE DUE TO CASH TRANSFER—RECONSIDERATION)

When Used: This paragraph is used for reconsiderations and revised determinations when the individual was determined to be ineligible due to a transfer of cash. It explains SSA's initial determination on the issue.

Previously, we determined that __1___ gave away __2___ cash in __3___. Based on the amount of money given away, we determined that __4___ __5___ not eligible for SSI from __6___ through __7___ . Giving away cash can make a person ineligible for SSI for up to 36 months.

TRF010 Example:

Previously, we determined that you gave away $8,000 cash in May 2000. Based on the amount of money given away, we determined that you were not eligible for SSI from June 2000 through October 2000 . Giving away cash can make a person ineligible for SSI for up to 36 months.

TRF010 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Dollar amount of the cash transferred

  3. Month/year that the cash was transferred (if cash was transferred in several months, fill-ins 2 and 3 will need to be expanded, e.g., “you gave away $4,000 cash in May 2000 and $2,000 cash in June 2000.”

  4. Choice 1: you

    Choice 2: he

    Choice 3: she

  5. Choice 1: were

    Choice 2: was

  6. Month/year (first month of period of ineligibility)

  7. Month/year (final month of period of ineligibility)

TRF011 (EXPLANATION OF PRIOR UNDUE HARDSHIP DETERMINATION)

When Used: This paragraph is used for reconsiderations and revised determinations when SSA determined that the individual was ineligible due to a resource transfer and did not qualify for SSI based on undue hardship. This paragraph explains SSA's initial determination.

Previously, we determined that __1___ __2___ not eligible for SSI starting in __3___. This is because __4___ gave away a resource or sold it for less than it was worth and __5___ could pay for __6___ food and shelter without getting SSI for that month.

TRF011 Example:

Previously, we determined that you were not eligible for SSI starting in June 2000. This is because you gave away a resource or sold it for less than it was worth and you could pay for your food and shelter without getting SSI for that month.

TRF011 fill-ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: were

    Choice 2: was

  3. Month/year (that individual did not qualify for SSI based on undue hardship)

  4. Choice 1: you

    Choice 2: he

    Choice 3: she

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Choice 1: your

    Choice 2: his

    Choice 3: her

TRF012 (DETERMINATION OF INELIGIBILITY—RECONSIDERATION)

When Used: This paragraph is used for a reconsideration when the individual appeals the period of ineligibility and SSA affirms the initial determination. This paragraph informs the individual that SSA still finds that he or she is ineligible. This paragraph is not used for transfers of cash.

Based on the information provided for this reconsideration, we now determine that __1___ __2____ not eligible for SSI from ___3____ through __4___ because __5___ gave away ___6___ or sold it for less than it is worth in __7___.

TRF012 example:

Based on the information provided for this reconsideration, we now determine that you are not eligible for SSI from June 2000 through February 2002 because you gave away a house or sold it for less than it is worth in May 2000.

TRF012 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: are

    Choice 2: is

  3. Month/year (first month of period of ineligibility)

  4. Month/year (final month of period of ineligibility)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Type of resource transferred (e.g., a house, a car)

  7. Month/year (the month the transfer occurred)

TRF013 (CASH TRANSFER DETERMINATION—RECONSIDERATION)

When Used: This paragraph is used for reconsiderations when an individual appeals the period of ineligibility and SSA affirms the initial determination. This paragraph informs the individual that SSA still finds the individual ineligible due to a transfer of cash.

Based on the information provided for this reconsideration, we now determine that __1___ __2___ not eligible for SSI from __3___ through __4___ because __5___ gave away __6___ cash in __7___ .

TRF013 Example:

Based on the information provided for this reconsideration, we now determine that you are not eligible for SSI from June 2000 through February 2001 because you gave away $8,000 cash in May 2000.

TRF013 Fill-Ins

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: are

    Choice 2: is

  3. Month/year (first month of period of ineligibility)

  4. Month/year (final month of period of ineligibility)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Dollar value of cash given away

  7. Month/year that cash was given away (it will be necessary to expand on fill-ins 6 and 7 if cash was transferred in several months, e.g., “you gave away $4,000 cash in May 2000 and $2,000 cash in June 2000.”

TRF014 (UNDUE HARDSHIP DETERMINATION—RECONSIDERATION)

When Used: This paragraph is used for a reconsideration when the individual appeals the period of ineligibility and SSA affirms the initial determination. This paragraph informs the individual that SSA still finds that he or she is ineligible for SSI because he or she does not qualify based on undue hardship.

Based on the information provided for this reconsideration, we now determine that __1___ __2___ not eligible for SSI from __3____ through __4___. This is because __5___ gave away a resource or sold it for less than it was worth and __6___could pay for __7___ food and shelter for that period of time without getting SSI.

TRF014 example:

Based on the information provided for this reconsideration, we determined that you are not eligible for SSI from June 2000 through the date of this determination. This is because you gave away a resource or sold it for less than it is worth and you could pay for your food and shelter for that period of time without getting SSI.

TFR014 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: are

    Choice 2: is

  3. Month/year (first month that the individual was not eligible for SSI, e.g., month of filing, or first month of period of ineligibility)

  4. Choice 1: the date of this determination

    Choice 2: Month/year (that the individual was not eligible for SSI)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Choice 1: you

    Choice 2: he

    Choice 3: she

  7. Choice 1: your

    Choice 2: his

    Choice 3: her

TRF015 (INDIVIDUAL IS ELIGIBLE—RECONSIDERATION)

When Used: This paragraph is used for reconsiderations when the individual appeals the period of ineligibility and SSA reverses the initial determination. This paragraph informs the individual that SSA now finds that he or she is eligible for SSI and explains the reason.

Based on the information provided for this reconsideration, we now determine that __1___ __2___ eligible for SSI starting in __3____ because __4___.

TRF015 example:

Based on the information provided for this reconsideration, we now determine that you are eligible for SSI starting in June 2000 because you gave away a resource or sold it for less than it was worth but you could not pay for your food and shelter without getting an SSI payment for that month.

TRF015 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: are

    Choice 2: is

  3. Month/year (that individual is eligible)

  4. Choice 1: you gave away a resource or sold it for less than it was worth but you could not pay for your food and shelter without getting an SSI payment for that month.

    Choice 2: he gave away a resource or sold it for less than it was worth but he could not pay for his food and shelter without getting an SSI payment for that month.

    Choice 3: she gave away a resource or sold it for less than it was worth but she could not pay for her food and shelter without getting an SSI payment for that month.

    Choice 4: the resource you transferred was returned to you.

    Choice 5: the resource he transferred was returned to him.

    Choice 6: the resource she transferred was returned to her.

    Choice 7: you intended to receive fair market value for the resource you transferred.

    Choice 8: he intended to receive fair market value for the resource he transferred.

    Choice 9: she intended to receive fair market value for the resource she transferred.

    Choice 10: you did not transfer the resource in order to get SSI payments.

    Choice 11: he did not transfer the resource in order to get SSI payments.

    Choice 12: she did not transfer the resource in order to get SSI payments.

    Choice 13: you did not transfer the resource for less than it was worth.

    Choice 14: he did not transfer the resource for less than it was worth.

    Choice 15: she did not transfer the resource for less than it was worth.

    Choice 16: the resource you transferred was not worth enough to make you ineligible for SSI.

    Choice 17: the resource he transferred was not worth enough to make him ineligible for SSI.

    Choice 18: the resource she transferred was not worth enough to make her ineligible for SSI.

    Choice 19: the resource you transferred does not make you ineligible for SSI.

    Choice 20: the resource he transferred does not make him ineligible for SSI.

    Choice 21: the resource she transferred does not make her ineligible for SSI.

TRF016 (CHANGE IN INELIGIBILITY PERIOD—RECONSIDERATION)

When Used: This paragraph is used for a reconsideration when SSA affirms its determination that the individual did transfer the resource, but changes its determination of the number months in the period of ineligibility or of the month the period begins.

Based on the information provided for this reconsideration, we determine that __1___ gave away __2___ or sold it for less than it was worth in __3___. Based on the value of the __4___, we now determine that __5___ __6___ not eligible for SSI from __7___ through __8___ .

TFR016 Example:

Based on the information provided for this reconsideration, we determine that you gave away a parcel of land or sold it for less than it was worth in May 2000. Based on the value of the parcel of land, we now determine that you were not eligible for SSI from June 2000 through September 2000.

TFR016 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Type of resource transferred (e.g., a house, a car)

  3. Month/year (the month the transfer occurred)

  4. Type of resource transferred (e.g., house, car)

  5. Choice 1: you

    Choice 2: he

    Choice 3: she

  6. Choice 1: were

    Choice 2: was

    Choice 3: are

    Choice 4: is

  7. Month/year (first month of period of ineligibility)

  8. Month/year (final month of period of ineligibility)

TRF017 (CHANGE IN CASH TRANSFER—RECONSIDERATION)

When Used: This paragraph is used for a reconsideration when SSA affirms its determination that the individual did give away cash, but changes its determination of the dollar value, the number months in the period of ineligibility, or the month the period begins.

Based on the information provided for this reconsideration, we determine that __1___ gave away __2___ cash in __3___. Based on the amount of money given away, we now determine that __4___ __5___ not eligible for SSI from __6___ through __7___ .

TRF017 Example:

Based on the information provided for this reconsideration, we determine that you gave away $3,500 cash in May 2000. Based on the amount of money given away, we now determine that you were not eligible for SSI from June 2000 through September 2000 .

TRF017 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Dollar value of the cash transferred

  3. Month/year (the month the transfer occurred)

  4. Choice 1: you

    Choice 2: he

    Choice 3: she

  5. Choice 1: were

    Choice 2: was

    Choice 3: are

    Choice 4: is

  6. Month/year (first month of period of ineligibility)

  7. Month/year (final month of period of ineligibility)

TRF018 (INDIVIDUAL NOW ELIGIBLE—REVISED DETERMINATION)

When Used: This paragraph is used when SSA revises a determination for a past period. Previously SSA had determined the individual was ineligible due to a resource transfer. SSA's revised determination is that the individual was eligible for that past period.

Based on new information, we now determine that __1___ __2___ eligible for SSI starting in __3____ because __4____ .

TRF018 example:

Based on new information, we now determine that you were eligible for SSI starting in January 2000 because you did not transfer the resource in order to get SSI payments.

TRF018 Fill-Ins:

  1. Choice 1: you

    Choice 2: he

    Choice 3: she

  2. Choice 1: were

    Choice 2: was

  3. Month/year (in past period that individual started to be eligible for SSI)

  4. Choice 1: you gave away a resource or sold it for less than it was worth but you could not pay for your food and shelter without getting an SSI payment for that month.

    Choice 2: he gave away a resource or sold it for less than it was worth but he could not pay for his food and shelter without getting an SSI payment for that month.

    Choice 3: she gave away a resource or sold it for less than was worth but she could not pay for her food and shelter without getting an SSI payment for that month.

    Choice 4: the resource you transferred was returned to you.

    Choice 5: the resource he transferred was returned to him.

    Choice 6: the resource she transferred was returned to her.

    Choice 7: you intended to receive fair market value for the resource you transferred.

    Choice 8: he intended to receive fair market value for the resource he transferred.

    Choice 9: she intended to receive fair market value for the resource she transferred.

    Choice 10: you did not transfer the resource in order to get SSI payments.

    Choice 11: he did not transfer the resource in order to get SSI payments.

    Choice 12: she did not transfer the resource in order to get SSI payments.

    Choice 13: you did not transfer the resource for less than it was worth.

    Choice 14: he did not transfer the resource for less than it was worth.

    Choice 15: she did not transfer the resource for less than it was worth.

    Choice 16: the resource you transferred was not worth enough to make you ineligible for SSI.

    Choice 17: the resource he transferred was not worth enough to make him ineligible for SSI.

    Choice 18: the resource she transferred was not worth enough to make her ineligible for SSI.

    Choice 19: the resource you transferred does not make you ineligible for SSI.

    Choice 20: the resource he transferred does not make him ineligible for SSI.

    Choice 21: the resource she transferred does not make her ineligible for SSI.

TRF019, TRF020, TRF021, TRF022 and Caption TRFC01

When