TN 18 (06-03)

SI 02005.100 Computation Worksheet With Certain SSI Notices

A. Background

Certain SSI notices dated July 29, 2002, and later, include computation worksheets that explain how we compute payment amounts for individuals who have no income or certain unearned income. Certain SSI notices dated January 28, 2003, and later, also include computation worksheets for earned income. All of these situations can appear together in one notice with worksheets.

Computation worksheets for eligible couples are included in notices dated July 7, 2003, and later.

We made these changes to notices to comply with the Ford et al. v. Apfel court case, which is a nationwide class action lawsuit.

Computation worksheets for more complex situations will continue to be added in the future.

NOTE: Follow the special notice procedures in NL 01001.010 if the notice will be sent to a claimant, beneficiary, or representative payee who alleges being blind or visually impaired.

B. List of notices with computation worksheets

The affected notices are:

  • Notice of Award, SSA-L8025;

  • Notice of Disapproved Claim, SSA-L8030;

  • Notice of Change in Payment, SSA-L8151 and SSA-L8100;

  • Notice of Planned Action, SSA-L8155;

  • Important Information, SSA-L8165 and SSA-L8166. (The SSA-L8165, which does not include appeal rights, will only have a worksheet when presumptive disability payments are paid.)

The worksheets appear after the signature page of the notice.

C. Types of income that can appear on a computation worksheet

1. Types of Unearned Income

The following types of unearned income can appear separately or in combination on a worksheet:

  • Social Security benefits (type A)

  • Railroad Retirement benefits (type D)

  • Department of Veterans Affairs payments (type C)

  • Worker's Compensation (type Q)

  • Employment related pension (type P)

  • Income from interest, dividends, rents, or royalties (type R)

  • Civil Service pension (type M)

  • Military pension (type L)

  • Miscellaneous income (type S)

  • Child support payment (type N)

  • Value of food, clothing, or shelter (type H)

  • Value of food and shelter (type J)

  • Department of Veterans Affairs assistance payments (type E)

  • Assistance payments based on need (type F)

  • Income based on need (private) (type O) .

2. Types of Earned Income

The following earned income can appear separately or in combination with unearned income listed in SI 02005.100C.1.:

  • Wages (type W)

  • Net income from self-employment (type S)

  • Net loss from self-employment (type N).

D. References

NL 00801.005, Systems Generated Notices

NL 00804.115, Titles, Lead-ins, and Payment Summary

E. Examples - sample notices

1. Example-Sample Notice of Change (SSA-L8151) with a Military Pension and Wages as the Income and a Federally Administered State Supplementary Payment

G-SSA-L8151-1

 View PDF Version

G-SSA-L8151-2

Printer Friendly Version

G-SSA-L8151-3

Printer Friendly Version

G-SSA-L8151-4

Printer Friendly Version

G-SSA-L8151-5

Printer Friendly Version

G-SSA-L8151-6

 View PDF Version

2. Example - Notice of Change (SSA-L8151) with a Military Pension and Wages as the Income and No Federally Administered State Supplementary Payment

G-SSA-L8151-6