NL 00701.750 Form SSA-L5620 — One Check Only Adjustment — Reconsideration Paragraph Required — Beneficiary In Conditional Pay or Suspense Status After Action
A. Sample form
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Form SSA-L562A is used to serve the same purpose as Form SSA-L562 except that the beneficiary must either be in conditional pay status or is being suspended and no payment is being made (Conditional Adjustment) or a single check is being issued to pay any retroactive increase, after which the benefits are suspended (One-Check-Only Adjustment).
A paragraph must always be furnished to explain why no payment or no further payment is being made and that the beneficiary should notify “any social security office” when the reason for suspension ceases to exist.
When this notice is used in one-check-only situations, a paragraph, standard or dictated, must be furnished indicating the amount of the check, the month(s) for which payment is being made and the approximate date the check could normally be expected to be received.
In addition to the explanation needed to explain why no payment or no further payment is being made, this notice requires two payment data fill-ins:
the new monthly rate and effective date.
the amount of the regular monthly check.
C. Preparation of Form
Fill-ins for this notice are shown on the Form SSA-573. The fill-ins will be appropriately numbered to correspond with the blank spaces on the notice.