TN 30 (03-96)
NL 00703.624 DIB to RIB Conversion — Full Retirement Age PAC Reduction
Document Identifier for Word Processor: E3624
A. EXHIBIT LETTER
Under a special provision of the Social Security Act, now that you are full retirement age and your disability benefits have been changed to retirement benefits, your monthly medical insurance premium amount has been reduced from $ (1) to $ (2) . Therefore, effective
(3) , your monthly benefit payment has been increased to $ (4) .
If You Have Any Questions
B. REQUESTING INSTRUCTIONS
This notice will be used when:
a DIB to RIB conversion has occurred and
payment status is current-pay to current-pay and
Form HCFA-1585A contains the following legend “FULL RETIREMENT AGE PAC REDUCTION MANUAL LETTER NECESSARY”
new SMI premium amount
effective date of change in SMI premium amount
new monthly benefit payable
Refer to NL 00703.005E. for 3901C text.
C. TYPING INSTRUCTIONS
Information for this letter will be shown on Form SSA-573. The name and address, if not given, can be taken from the latest Form SSA-3926-EP in file.