Effective Dates: 12/17/2013 - Present Previous | Next

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 3^rd 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)

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

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)

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: 04/25/2016
Rev:12/17/2013

Program Operations Manual System (POMS)