TN 46 (12-13)

SI 02310.999 Exhibits of SSI Interfaces

Exhibit A VA Extract and Legend

Exhibit B RRB Extract and Legend

Exhibit C Form SSA-3570 (RRB/SSR Interface RRB Payment History)

Exhibit D DOD Extract and Legend

Exhibit E Form SSA-2495 (Authorization to Disclose Internal Revenue Service Information)

Exhibit F SSR Prison Inmate Alert

A. Exhibit A – Department of Veterans Affairs (VA) Extract and Legend

 

1. VA Extract

Field #

Record Location

Field Name

Field Size

Field Format

Description/Comments

1

1-4

Record Length

4

Numeric

Will contain the total physical length of the record. Field will always be populated with value (number of bytes).

2

5-13

VA File Number

9

Alpha

Field will contain the unique number assigned to the VBA record. Field will always be populated with a value.

3

14-22

Veterans SSN

9

Alpha Numeric

Field will contain the Veteran’s Social Security number. If None=Send Spaces.

4

23-31

Beneficiary SSN

9

Alpha Numeric

The Person Entitled to the VA benefit. Will belong to the Beneficiary getting the money. If None=Send Spaces.

5

32-33

Payee Number

2

Numeric

Field will always be populated with a value. Field will contain a value indicating who is entitled to the benefit (Primary Beneficiary of the Award).

6

34-35

Total Dependency Code

2

Numeric

The Total Dependency Code field will be populated with a value indicating the total number of dependents on the Primary Beneficiary Award. Standard Dependency Codes will be used except for the following: For Parents DIC-(91) Sole Surviving Parent (rate chart); (92) One of Two Parents with No Spouse (rate chart); and (93) One of Two Parents with Spouse (rate chart). For Apportionment Awards-(10) Spouse; (81) Children; and (50 or 60) Parents. Fields will always be populated with a value. Note: Total Dependency Code=How Many Dependents the Beneficiary is Eligible to receive $ for.

7

36-37

THS Dependency Code

2

Numeric

The THS (Total Being Paid on This Award) Dependency Code field will be populated with a value indicating the total number of dependents the Beneficiary is actually being paid for on this award (i.e., dependents minus the apportioned dependents). Standard Dependency Codes will be used except for the following: For Parents DIC-(91) Sole Surviving Parent (rate chart); (92) One of Two Parents with No Spouse (rate chart). For Apportionment Awards-(10) Spouse; (81) Children; and (50 or 60) Parents. Fields will always be populated with a value. Note: THS Dep Code=How Many Dependents the Beneficiary is Actually Being Paid For.

8

38

Record Type Code

1

Alpha

Field will contain a value indicating the basis for benefit payments. Field will always be populated with a value. Values for: (C) Comp; (G) Spouse DIC Pay Grade; (R) Spouse DIC Reform ;(A) Apportionment; (M) MOH; (I) Improved Pension Live; (D) Child DIC; (B) Spouse Improved Pension Death; (P) Parents DIC; (F) Child Improved Pension; (O) Override (GAO); and (X) Protected Rate (Old Law Pension, 306 Pension; Death Compensation and/or Special Parents DIC).

9

39

The Current Award Status Code (formerly The Current Status of an Award)

1

Alpha

Award Status Code Values will be: (A) Active; (T) Terminated; (S) Suspended. Field will always be populated with a value.

10

40

Beneficiary Gender Code

1

Alpha

Field will contain a value indicating the sex of the person entitled to benefit (Primary Beneficiary). Values are (F) Female and (M) Male, or Blank. If None (Unknown)=Send Spaces.

11

41-70

First Name of Beneficiary

30

Alpha

Field will contain the first name of the person entitled to the benefit (Veteran or Payee other than Veteran). If None=Send Spaces.

12

71-100

Middle Name of Beneficiary

30

Alpha

Field will contain the middle name of the person entitled to the benefit (Veteran or Payee other than Veteran). If None=Send Spaces.

13

101-130

Last Name of Beneficiary

30

Alpha

Field will contain the last name of the person entitled to the benefit (Veteran or Payee other than Veteran). If None=Send Spaces.

14

131-138

Beneficiary Birth Date

8

Alpha Numeric

Field will contain the date of birth for the person entitled to the benefit (Veteran or Payee other than Veteran). CCYYMMDD Format should reflect the Entitled Person.

15

139-140

Beneficiary Aid & Attendance/ Housebound Code (Formerly Beneficiary Aid & Attendance/ Housebound Indicator)

2

Alpha

Field will contain a value if the Beneficiary is entitled to Aid & Attendance or Housebound benefits. Values are (AA) Aid & Attendance and (HB) Housebound. If None=Send Spaces.

16

141-142

Spouse Aid & Attendance/ Housebound Code (Formerly Spouse Aid & Attendance/ Housebound Indicator)

2

Alpha

Field will contain a value if the dependent Spouse is entitled to Aid & Attendance or Housebound benefits. Values are (AA) Aid & Attendance and (HB) Housebound. If None=Send Spaces.

17

143

$90 Rate Indicator

1

Alpha

Values are (Y) Yes or (N) No. Field will always be populated with a value. If an Improved Pension Bene (Veteran or Surviving Spouse) with no dependents is in a Medicaid-approved nursing home, the indicator will be set to “Y.” If a Veteran in receipt of Improved Pension with no dependents is in a VHA or Contract Nursing Home, the indicator will be set to “Y.” Note: If there is an Institutionalization Decision of Private Nursing Home Care or VHA or Contract Nursing Home Care in VETSNET, the indicator will be set to “Y.”

18

144

Vet Married to Vet Indicator

1

Alpha

Values are (Y) Yes or (N) No. This field indicates if the Beneficiary is married to another Beneficiary (Spouse). A value of “Y” will only be generated if both Beneficiaries are in receipt of Pension benefits. If a Vet Married to Vet Pension award is generated through rate override (GAO), the indicator will be set to “N.” Field will always be populated with a value.

19

145

Incarceration Indicator (Formerly Prison Code)

1

Alpha

Values=(Y) Yes or (N) No. Field will always be populated with a value. Note: If the Primary Beneficiary has an Incarceration decision, the value will be set to “Y.”

20

146-148

Station Number

3

Numeric

Field will always contain the Station of Jurisdiction of the award. Field will always be populated with a value.

21

149-151

Percent of Disability

3

Numeric

Field will only be populated if the Beneficiary is receiving Compensation (Service Connected Disability) benefits.

22

152-153

SMC Payment Code

2

Alpha Numeric

If there is no entitlement to SMC, send spaces. Default=Spaces.

23

154-161

SMC Amount

8

Numeric

Field will always be populated with a value. Default=0 (zeros). Note: Field will contain the monthly SMC rate amount from the SMC Codes and Rate chart.

24

162-169

Disability Comp Basic Rate

8

Numeric

Field will contain the combined percentage (%) rate based on the Disability Compensation-Basic Rates chart without any dependents or SMC add-ons. Default=0 (zeros). Field will display a monthly amount. Note: Field will contain the amount of service connected compensation a Veteran Beneficiary is entitled to based on his/her combined degree only (without dependents or SMC).

25

170-181

Entitlement Code

12

Alpha Numeric

Field will contain the Entitlement Code from the current award line based on the type of benefit, branch and period of service. Field will always be populated with a value.

26

182-193

Change Reason

12

Alpha

Field will contain the reason for change in award based on the Change Reason Hierarchy List. Default=Spaces.

27

194-205

Suspense Reason

12

Alpha

Field will contain the reason for award in suspense status based on the Suspense Hierarchy List. Default=Spaces.

28

206-213

Date of Suspense

8

Alpha Numeric

Format is (CCYYMMDD). Default=Spaces. Note: Suspense Date= Last Paid Date (Date Last Paid).

29

214-221

Total Gross Award Amount

8

Numeric

Total Gross Award Amount=The total amount of cash benefits that a family unit is entitled to per award. Field will always be populated with a value. Default=0 (zeros). Note: Field will display monthly amount.

30

222-229

Total Gross Award Date

8

Alpha Numeric

Field will contain the award effective date of the Total Gross Award Amount. Format is (CCYYMMDD). Field will always be populated with a value.

31

230-237

Payment Amount

8

Numeric

Payment Amount=The final recurring amount of the payment that goes to the Beneficiary. Field will always be populated with a value. Note: Field will display monthly amount paid to each beneficiary.

32

238

Pay Month/ Frequency Code

1

Numeric

Values are: (0)= Monthly; (3)= Quarterly; (2)= Semi-Annual; (1)= Annual. Field will always be populated with a value.

33

239-246

Beneficiary Income Amount

8

Numeric

Beneficiary Income Amounts=All income for Beneficiary. Field will always be populated with a value. Default=0 (zeros). Note: Field will display total annual amount.

34

247

Beneficiary Earned Income Indicator

1

Alpha

Values=(Y)Yes or (N)No. Field will always be populated with a value. Note: If the Beneficiary has any earned income, set the indicator to (Y).

35

248

Beneficiary Retirement Code

1

Alpha

Values=(B)Black Lung; (C)Civil Service Retirement; (O)Other (Type Unknown); (M)=Military Retirement; (R) Railroad Retirement Board; (S)Social Security; and (X)Multiple Retirement Codes. If None=Send Spaces.

36

249-256

Beneficiary Retirement Amount

8

Numeric

Beneficiary Retirement Amount=Total Amount of All Retirement Income for Beneficiary. Note: Field will display annual amount. If the Beneficiary is not in receipt of retirement benefits, send (0) zeros.

37

257-264

Spouse Income Amounts

8

Numeric

Spouse Income Amounts=All Income for the Spouse. Field will always be populated with a value. Default=0 (zeros). Field will display the total annual amount. Note: If Spouse Income is used to calculate the IVAP, it will be in the SSA Record Layout for VA Interface.

38

265

Spouse Earned Income Indicator

1

Alpha

Values=(Y) Yes or (N) No. Field will always be populated with a value. Note: If the Spouse has any earned income that is used to calculate the IVAP, set the indicator to (Y).

39

266

Spouse Retirement Code

1

Alpha

Values=(B)Black Lung;(C)Civil Service Retirement; (O)Other (Type Unknown); (M)Military Retirement; (R)Railroad Retirement Board; (S)Social Security; and (X)Multiple Retirement Codes. If None=Send Spaces.

40

267-274

Spouse Retirement Amount

8

Numeric

Spouse Retirement Amount=Total Amount of All Retirement Income for the Spouse. Note: Field will display annual amount.

41

275-282

MAPR Amount

8

Numeric

MAPR=Maximum Annual Pension Rate. Field will always be populated for Pension (Income Based) Benefits. Default=0 (zeros). Note: Field will display annual amount.

42

283-290

MAPR without A&A/HB Amount (Formerly MAPR without Amount)

8

Numeric

This field includes the Maximum Annual Pension Rate without A&A of Housebound Field will always be populated with a value for Pension (Income Based) Benefits. Default=0 (zeros). Note: Field will display annual amount.

43

291

Programmatic Overpayment Indicator

1

Alpha

Values=(Y) Yes or (N) No. Field will always be populated with a value. Note: Indicator will be set to (Y) if a30B A/R exists with a deduction amount. If not, the indicator will be set to (N).

44

292-299

Total Deduction Amount

8

Numeric

Field will always be populated with a value. Default=0(zeros). Note 1: Total Deduction Amount=Total Deduction Amount Being Taken Out of Monthly Recurring Check. Note 2: Field will display monthly amount. Note 3: VA will only send data for those deductions that are on the SSA approved list.

45

300-307

Total Withholding Amount

8

Numeric

Field will always be populated with a value. Default=0 (zeros). Note 1: Field will display monthly amount. Note 2: VA will only send data for those withholdings that are on the SSA approved list. Note 3: If there are two or more withholdings, VA will send the total amount of all the withholdings.

46

308-315

Total A/R Amount

8

Numeric

Field will always be populated with a value. Default-0 (zeros). Note 1: Total A/R Amount=Total Amount Being Taken Out of Monthly Check. Note 2: Field will display monthly amount. Note 3: VA will only send data for those A/Rs that are on the SSA approved list.

47

316-323

Total Proceeds Amount

8

Numeric

Field will be populated with a default value equal to zeros (0). Note: Field will remain in SSA Record Layout for VA Interface. SSA would like a default value of zeros sent at this time.

48

324-331

Total Apportionment Amount

8

Numeric

Field will always be populated with a value. Default=0 (zeros). Note 1: Field will contain the total amount of all Apportionments on the Primary Beneficiary award. Note 2: Field will display monthly amount.

49

332-339

Income for VA Purposes

8

Numeric

Field will only be populated for Pension (Income Based) benefits. Default=0 (zeros). Note: Field will display annual amount.

50

340-347

Medical Expenses Amount

8

Numeric

Field will only be populated for Pension (Income Based) benefits. Default=0 (zeros). Note 1: Field will display the total amount of medical expenses reported to VA for the family unit. Note 2: Field will contain an annual amount.

51

348

Fiduciary Indicator

1

Alpha

Values=(Y) Yes or (N) No. Field will always be populated with a value. Note: Field will contain a (Y) value if a 3rd Party (not the Beneficiary) is receiving the payment.

52

349

DIC 2 Year Kicker Indicator

1

Alpha

Values=(Y) Yes or (N) No. Field will always be populated with a value. Note: Set the value to (Y) if the surviving spouse has one or more children under the age of 18 on the award and has entitlement to the transitional benefit (38 USC 1311(f)).

53

350

DIC 8 Year Kicker Indicator

1

Alpha

Values=(Y) Yes or (N) No. Field will always be populated with a value. Note: Set the value to (Y) if at the time of the Vet’s death, the Vet was in receipt of or entitled to receive compensation for a service connected disability rated totally disabling (including a rating based on individual un-employability) for a continuous period of at least 8 years preceding death AND the surviving spouse was married to the Vet for those same 8 years (38 USC 1311 (a)(2)).

54

351-352

DIC Pay Grade Code

2

Alpha Numeric

Field will be populated with a value if the Beneficiary is being paid DIC benefits based on the Veteran’s pay grade. Default=Spaces.

55

353

Foreign Address Indicator

1

Alpha

Values=(Y) Yes or (N) No. Field will always be populated with a value. Note: Field will contain a (Y) value if there is an address with a country code.

56

354

Address Type Code (formerly Address Type Indicator)

1

Alpha

Values=(C) Corporate and (B) BDN. Field will always be populated with a value.

57

355-854

Address Data

500

Alpha

Will contain 1 of 2 address formats. (B) Address Type will contain the standard BDN 120 position address (6 lines of 20 positions each). (C) Address Type will contain the following fields (i.e., layout): Address Name (35 bytes); Address Fiduciary Type (50 bytes); Address Name Beneficiary (90 bytes); Address Line 1 (35 bytes); Address Line 2 (35 bytes); Address Line 3 (35 bytes); City Name (30 bytes); State Name (2 bytes); Country Type Name (50 bytes); Foreign Postal Code (16 bytes); Province Name (35 bytes); Territory Name (45 bytes); Military Postal Type (12 bytes); Military Post Office (12 bytes) and Filler 18 bytes.

58

855-859

Zip Code

5

Numeric

If None=Send Spaces. Note: If the record has a foreign address, the field will be populated with zeros (0).

59

860-867

Spouse Date of Birth

8

Date

Format is (CCYYMMDD). If None=Send Spaces.

60

868-876

Spouse SSN

9

Alpha Numeric

If None=Send Spaces.

61

877-906

Spouse First Name

30

Alpha

If None=Send Spaces.

62

907-936

Spouse Middle Name

30

Alpha

If None=Send Spaces.

63

937-966

Spouse Last Name

30

Alpha

If None=Send Spaces.

64

967-974

Child 1 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

65

975-983

Child 1 SSN

9

Alpha Numeric

If None=Send Spaces.

66

984-1013

Child 1 First Name

30

Alpha

If None=Send Spaces.

67

1014-1043

Child 1 Middle Name

30

Alpha

If None=Send Spaces.

68

1044-1073

Child 1 Last Name

30

Alpha

If None=Send Spaces.

69

1074

Child 1 School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and ins school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

70

1075-1082

Child 2 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

71

1083-1091

Child 2 SSN

9

Alpha Numeric

If None=Send Spaces.

72

1092-1121

Child 2 First Name

30

Alpha

If None=Send Spaces.

73

1122-1151

Child 2 Middle Name

30

Alpha

If None=Send Spaces.

74

1152-1181

Child 2 Last Name

30

Alpha

If None=Send Spaces.

75

1182

Child 2 School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and in school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

76

1183-1190

Child 3 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

77

1191-1199

Child 3 SSN

9

Alpha Numeric

If None=Send Spaces.

78

1200-1229

Child 3 First Name

30

Alpha

If None=Send Spaces.

79

1230-1259

Child 3 Middle Name

30

Alpha

If None=Send Spaces.

80

1260-1289

Child 3 Last Name

30

Alpha

If None=Send Spaces.

81

1290

Child 3 School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and in school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

82

1291-1298

Child 4 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

83

1299-1307

Child 4 SSN

9

Alpha Numeric

If None=Send Spaces.

84

1308-1337

Child 4 First Name

30

Alpha

If None=Send Spaces.

85

1338-1367

Child 4 Middle Name

30

Alpha

If None=Send Spaces.

86

1368-1397

Child 4 Last Name

30

Alpha

If None=Send Spaces.

87

1398

Child 4 School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and in school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

88

1399-1406

Child 5 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

89

1407-1415

Child 5 SSN

9

Alpha Numeric

If None=Send Spaces.

90

1416-1445

Child 5 First Name

30

Alpha

If None=Send Spaces.

91

1446-1475

Child 5 Middle Name

30

Alpha

If None=Send Spaces.

92

1476-1505

Child 5 Last Name

30

Alpha

If None=Send Spaces.

93

1506

Child 5 School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and in school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

94

1507-1514

Child 6 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

95

1515-1523

Child 6 SSN

9

Alpha Numeric

If None=Send Spaces.

96

1524-1553

Child 6 First Name

30

Alpha

If None=Send Spaces.

97

1554-1583

Child 6 Middle Name

30

Alpha

If None=Send Spaces.

98

1584-1613

Child 6 Last Name

30

Alpha

If None=Send Spaces.

99

1614

Child 6 School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and in school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

100

1615-1622

Child 7 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

101

1623-1631

Child 7 SSN

9

Alpha Numeric

If None=Send Spaces.

102

1632-1661

Child 7 First Name

30

Alpha

If None=Send Spaces.

103

1662-1691

Child 7 Middle Name

30

Alpha

If None=Send Spaces.

104

1692-1721

Child 7 Last Name

30

Alpha

If None=Send Spaces.

105

1722

Child 7 School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and in school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

106

1723-1730

Child 8 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

107

1731-1739

Child 8 SSN

9

Alpha Numeric

If None=Send Spaces.

108

1740-1769

Child 8 First Name

30

Alpha

If None=Send Spaces.

109

1770-1799

Child 8 Middle Name

30

Alpha

If None=Send Spaces.

110

1800-1829

Child 8 Last Name

30

Alpha

If None=Send Spaces.

111

1830

Child 8 School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and in school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

112

1831-1838

Child 9 Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

113

1839-1847

Child 9 SSN

9

Alpha Numeric

If None=Send Spaces.

114

1848-1877

Child 9 First Name

30

Alpha

If None=Send Spaces.

115

1878-1907

Child 9 Middle Name

30

Alpha

If None=Send Spaces.

116

1908-1937

Child 9 Last Name

30

Alpha

If None=Send Spaces.

117

1938

Child 9 New School Indicator (New Field)

1

Alpha

Values (Y) Yes or (N) No. Field will always be populated with a value. Rule: If the child is over the age of 18 and in school, set the indicator to “Y.” If the child is not over the age of 18 or not in school, set the indicator to “N.”

118

1939-1946

Father Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

119

1947-1955

Father SSN

9

Alpha Numeric

If None=Send Spaces.

120

1956-1985

Father First Name

30

Alpha

If None=Send Spaces.

121

1986-2015

Father Middle Name

30

Alpha

If None=Send Spaces.

122

2016-2045

Father Last Name

30

Alpha

If None=Send Spaces.

123

2046-2053

Mother Date of Birth

8

Alpha Numeric

Format is (CCYYMMDD). If None=Send Spaces.

124

2054-2062

Mother SSN

9

Alpha Numeric

If None=Send Spaces.

125

2063-2092

Mother First Name

30

Alpha

If None=Send Spaces.

126

2093-2122

Mother Middle Name

30

Alpha

If None=Send Spaces.

127

2123-2152

Mother Last Name

30

Alpha

If None=Send Spaces.

NOTE: The VA Extract File will display the children present on the VA Interface from youngest to oldest based on date of birth.

2. VA Legend

a. General Payee Number Codes

Description

Value

Veteran

00

Spouse or Surviving Spouse

10

Child #1

11

Child #2

12

Child #3

13

Child #4

14

Child #5

15

Child #6

16

Child #7

17

Child #8

18

Child #9

19

Father

50

Mother

60

b. Payee Number Codes for Awards Under 38 U.S.C. 421(a) Only

Description

Value

Spouse or Surviving Spouse

70

Child #1

71

Child #2

72

Child #3

73

Child #4

74

Child #5

75

Child #6

76

Child #7

77

Child #8

78

Child #9

79

Institutional Award to Veteran Under 38 CFR 3.852

99

c. Record Type Codes

Description

Value

Apportionment

A

Spouse Improved Pension Death

B

Compensation

C

Child Dependency Indemnity Compensation (DIC)

D

Month of Death (MOD)

E

Child Improved Pension

F

Spouse Dependency Indemnity Compensation (DIC) Pay Grade

G

Improved Pension Live

I

Medal of Honor (MOH)

M

Override

O

Parent Dependency Indemnity Compensation (DIC)

P

Spouse Dependency Indemnity (DIC) Reform

R

Protected Rate

X

d. Entitlement Codes

Description

Value

Converted BDN Entitlement Code

CV

Death DIC – Korean Conflict

37

Death DIC – Mexican Border Period

67

Death DIC – Peacetime

47

Death DIC – Persian Gulf War

07

Death DIC – Philippine – WWII

97

Death DIC – Philippine Peacetime

99

Death DIC – Special Allowance – Korean Conflict

39

Death DIC – Special Allowance – Peacetime

49

Death DIC – Special Allowance – Vietnam Era

79

Death DIC – Special Allowance – WWI

29

Death DIC – Vietnam Era

77

Death DIC – WWI

17

Death DIC – WWII

27

Death DIC – War with Spain

57

Death Improved Pension – Korean Conflict

3D

Death Improved Pension – Mexican Border Period

6D

Death Improved Pension – Peacetime

4D

Death Improved Pension – Persian Gulf War

0D

Death Improved Pension – Vietnam Era

7D

Death Improved Pension – WWI

1D

Death Improved Pension – WWII

2D

Death Improved Pension – War with Spain

5D

Death Pension – PL86-211-Korean Conflict

38

Death Pension – PL86-211-Mexican Border Period

68

Death Pension – PL86-211-Vietnam Era

78

Death Pension – PL86-211-WWI

18

Death Pension – PL86-211-WWII

28

Death Pension – PL86-211-War with Spain

58

Death Pension-Protected-Civil War

86

Death Pension-Protected-Indian War

66

Death Pension-Protected-Korean Conflict

36

Death Pension-Protected-WWI

16

Death Pension-Protected-WWII

26

Death Pension-Protected-War with Spain

56

Death Compensation-Korean Conflict

35

Death Compensation-Peacetime

45

Death Compensation-Philippine WWII

95

Death Compensation-Vietnam Era

75

Death Compensation-Wartime-WWI

15

Death Compensation-Wartime-WWII

25

Disability Compensation-Korean Conflict

31

Disability Compensation-Mexican Border Period

61

Disability Compensation-Peacetime

41

Disability Compensation-Persian Gulf War

01

Disability Compensation-Philippine-WWII

91

Disability Compensation-Vietnam Era

71

Disability Compensation-WWI

11

Disability Compensation-WWII

21

Disability Compensation-Month of Death

51

Disability Improved Pension-Korean Conflict

3L

Disability Improved Pension-Mexican Border Period

6L

Disability Improved Pension-Persian Gulf War

0L

Disability Improved Pension-Vietnam Era

7L

Disability Improved Pension-WWI

1L

Disability Improved Pension-WWII

2L

Disability Improved Pension-Month of Death

43

Disability Pension-PL86-211/670-Korean Conflict

34

Disability Pension-PL86-211/670-Mexican Border

64

Disability Pension-PL86-211/670-Vietnam Era

74

Disability Pension-PL86-211/670-WWI

14

Disability Pension-PL86-211/670-WWII

24

Disability Pension-PL86-211/670-War with Spain

54

Disability Pension-Protected(SAW 90 Days) KC

32

Disability Pension-Protected(SAW 90 Days) WWI

12

Disability Pension-Protected(SAW 90 Days) WWII

22

Disability Pension-Protected-War with Spain

52

EOR – PL2-73/PL743

05

Medal of Honor-Civil War

8M

Medal of Honor-Gulf War

0M

Medal of Honor-Korean Conflict

3M

Medal of Honor-Mexican Border

6M

Medal of Honor-Peacetime

4M

Medal of Honor-Philippines

9M

Medal of Honor-Spanish American War

5M

Medal of Honor-Vietnam Era

7M

Medal of Honor-World War I

1M

Medal of Honor-World War II

2M

e. Current Award Status Codes

Description

Value

Active

A

Terminated

T

Suspended

S

f. Change Reason Codes

Description/Value

SSA Conversion

Original Award

00

Entitled Month of Death (MOD) Benefit

90

Month of Death Benefits End

(MODEND)

99

Death of Beneficiary (DB)

22

Failed to Furnish Requested Evidence (FFRE)

16

Compensation Rating Adjustment (31)

37

Change in Spouse Status (23)

15

Forfeiture (FORF)

04

No Longer A&A (NLAA)

51

Change in Parent Status

24

Hospitalized Basic Pension Adjustment

01

Hospitalized SMC Adjustment

38

Incarceration Adjustment

13

Pension Rating Adjustment

27

Special Monthly Compensation Adjustment

32

Special Monthly Entitlement Adjustment

40

Special Monthly Pension Adjustment

33

Countable Income Adjustment

15

Not on SSA Hierarchy or None

Blank

B. Exhibit B – Railroad Board Extract

 

Railroad Record Format:

The following explains the railroad record format. The fields that you will need to reference have been blocked.

RRB RECORD FORMAT - PAYMENT RUN OPF MM/DD/YY1

HUN2 000000000 SSR PERSON TYPE      3

BENE NAME    4  RRB ID 0000000005 RR BIC     6

BENE SS 0000000007 RRB DOB MMDDYY COB 00 EMP SN 000000000

RR STATUS 0 RR RATE $$$.¢¢8 SMIB DED $$.¢¢9 SUPP ANNU AMT $$.¢¢1 0

CAN 000000000 BIC 00 SS DOB MMDDYY SS STATUS SS AMT $$$.¢¢

RCD NO 0 BENE TYPE 00 TERM/SUSP CODE 00 TERM/SUSP DATE MMYY

TOT RATE $$$.¢¢PREV TOT RATE $$$.¢¢PREV RATE $$$.¢¢

RR ACCR AMT .00 SUPP ACCR AMT .00 SS ACCR AMT .00

ACCT DATE MMDDYY CUR AWD 0 PART AWD 0 POL CODE 0

ZIP CODE 00000 ADDR

LEGEND:

1- Date of RRB Run

2- Housed - under number

3- Type record: Individual, Eligible Spouse, Ineligible Spouse or Parent 1, Parent 2 (points to the person on the SSIRD for Analysis; not identifying information)

4- Beneficiary

5- RRB Claim Number

6- RRB BIC: RA, RH-railroad employee  JA-joint award or dual entitlement

          MA, MH-spouse     PA, PD, PH - parent

          WA, WD, WH-widow(er)  CA, CD, CH-consolidated family award

7-Beneficiary's SSN

8- RR Rate: This is the basic railroad benefit which the recipient is entitled to after SMIB is deducted.

9- SMIB Ded: This is the amount of the SMIB premium being deducted.

10 - Supp Annu Amt: This is an extra RR benefit which a small number of RR beneficiaries receive.

C. Exhibit C - Form SSA-3570 (RRB/SSR Interface RRB Payment History)

G-SSA-3570

Printer Friendly Version

D. Exhibit D - Department of Defense (DOD) Extract and Legend

 

DOD/SSI INTERFACE - DOD EXTRACT
RUN DATE: 99/99/99

 

HUN: 999-00-9999  SSN: 999-00-9999    PERTYP: 9    NAME: XXXXXXXXXXX

TYPE OF BENEFICIARY: XXXXXXXX    SBP BENEFIT TYPE: 9

DATE OF BIRTH RETIREE: 99/99/9999 YR OF BIRTH SURVIVING SPOUSE: 9999 YR OF BIRTH YOUNGEST CHILD: 9999

BENEFICIARY ADDRESS: XXXXXXXXXXXXXXXXXXXX

             XXXXXXXXXXXXXXXXXXXX

             XXXXXXXXXXXXXXXXXXXX

ZIP CODE: 99999

MILITARY CLAIM NUMBER: 999999999    MILITARY SERVICE BRANCH: X FAN: XX

DATE OF ENTITLEMENT: 99/99/9999

RETIREE CURRENT PAY STATUS: X

MONTHLY COUNTABLE PENSION: $9999.99

DATE TERMINATED/SUSPENDED: 99/99/99

REASON TERMINATED/SUSPENDED: X

1. DOD Extract Legend

Data
Element

Source

Definition

Possible Entries

Run Date

DOD

Effective date of extract

MMDDYY

HUN

SSR

Housed-Under Number

 

SSN

SSR

Military Beneficiary's SSN

 

PER TYPE

SSR

Military Beneficiary's SSI
Person Type

 

NAME

DOD

Military Beneficiary's Name

 

Type of Beneficiary

DOD

Type of Military Benefit
Received

Retiree, RSFPP, SBP

SBP Benefit

DOD

Type of SBP Benefit

1 = Spouse Only

Type

 

Received (if applicable)

2 = Child Only

   

3 = Spouse and Child

   

4 = Insurable Interest

   

5 = Death on Active Duty

   

6 = Minimum Income Widow

Date of Birth Retiree

DOD

Retiree's Date of Birth

MM/DD/YYYY

Year of Birth Surviving Spouse

DOD

Surviving Spouse's Year of Birth

YYYY

Year of Birth Youngest Child

DOD

Youngest Child's Year of Birth

YYYY

Beneficiary Address

DOD

Beneficiary's Address

 

Zip Code

DOD

Beneficiary's Zip Code

 

Military Claim Number

DOD

Beneficiary' Military Claim Number (suffixes not included)

 

Military

DOD

Military Retiree's

A = Army

Service

 

Branch of Service

N = Navy

Branch

  

F = Air Force

   

M = Marines

FAN

DOD

DOD FAN Code (For DOD Internal Purposes)

 

Date of Entitlement

DOD

Beneficiary Date of Entitlement to Military Benefits

MM/DD/YYYY

Retiree

DOD

DOD Retiree Pay Status

1 = Receiving Retired Pay

Current

  

2 = Currently entitled

Pay Status

  

to retired pay but not being paid (no survivor remittance required)

   

3 = Currently entitled to retired pay but not being paid (required survivor remittance)

   

4 = Terminated from entitlement during last reporting period

Monthly Countable Income

DOD

Countable Military Pension for Month of Run (equals “taxable income” )

$$$$¢¢

Date
Terminated
/Suspended

DOD

Last month military benefits paid

MM/DD/YY

Reason

DOD

Reason for termination

Terminated/Suspended Codes

Terminated/

 

of military benefits

Retirees:

Suspended

   

 

 

 

A = death

B = recalled to active duty

C = removed from TDRL

D = removed from TDRL

E = TDRL suspended

F = waiver for civil service

G = VA Offset

H = dual comp/pay cap offset

J = pay refused

K = suspended whereabouts unknown

L = suspended suspected death

M = suspended misc. reasons

Z = code not applicable

   

Termination/Suspension codes

   

RSFPP:

 

 

 

A = death

B = remarriage

C = child annuitant past age limit

D = child annuitant no longer in school

E = incapacitated child recovery

F = suspected death

G = certificate of eligibility not returned

Z = code not applicable

 

 

 

SBP:

 

 

 

A = death

B = remarriage

C = child annuitant pay age limit

D = child annuitant no longer in school

E = incapacitated child recovery

F = income of annuitant over limit

G = DIC award amount greater than annuity amount

H = child annuity superseded by reinstatement of surviving spouse

J = suspected death

K = certificate of eligibility not returned

Z = code not applicable

2. Explanation of Abbreviations

  1. TDRL - Temporary Disability Retirement List

  2. RSFPP - Retired Serviceman's Family Protection Plan

  3. SBP - Survivor Benefit Plan

  4. DIC - Dependency and Indemnity Compensation

E. Exhibit E Form SSA-2495 (Authorization to Disclose Internal Revenue Service Information)

G-SSA-2495-1

Printer Friendly Version

G-SSA-2495-2

Printer Friendly Version

F. Exhibit F - SSR Prison Inmate Alert

SSR Prison Inmate Alert

 

 

Run Date: MM/DD/YY

DO: 999

SSN: xxx-00-xxxx

Name Doe, M

 

Date of Confinement: MM/YY

Mailing Address: 123 Any St.       Anytown ST   xxxxx

Residence Address: 432 Any St.    Anytown ST   xxxxx

Correctional Facility Code:   9999

Concurrent Title II/XVI Eligibility Code:   Y


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502310999
SI 02310.999 - Exhibits of SSI Interfaces - 12/17/2013
Batch run: 12/17/2013
Rev:12/17/2013