NL 00708.005 Usage Chart for Numbered Paragraphs

A. Claims Paragraphs

  1. AGE

  2. DEPENDENCY REQUIREMENTS

  3. RELATIONSHIP

  4. WAGES, SELF-EMPLOYMENT, MILITARY SERVICE AND RAILROAD EMPLOYMENT

  5. DIB APPLICATION FILED AFTER DEATH OF NUMBER HOLDER

  6. CHILDHOOD DISABILITY

  7. DIB NOT DISABLED

  8. RIB/DIB (RIB or DIB)

  9. DWB WIDOW(ER)

  10. LUMP-SUM DISALLOWANCES

B. Failure to Meet Earnings (or Prescribed Period) Requirement

 ParagraphFill-ins
DIB-NH Deceased and Not Insured at Alleged Onset or Later3182
General Description of Earnings Requirement320.1None
Description of 6/12 Test—Disability Before Age 24320.2None
Description of Earnings Requirement—Disability Between the Ages 24-31320.3None
Description of Earnings Requirement—Disability at Age 31 or Later—Not Due to Statutory Blindness320.4None
Description of Fully Insured Test—Disability Due to Statutory Blindness320.5None
DWB—Explanation of the Disability Requirement and the Prescribed Period320.6None
DIB Denial—Earnings Requirement Not Met—No QC at Any Time322.2None
DIB Denial—AOD Before Age 24—6/12 Test Not Met in AQD or Later322.32
DIB Denial—AOD Between Ages 24-31—Earnings Requirement Not Met in AOD or Later322.42
DIB Denial—AOD at Early Age—Earnings Requirement Not Met322.6None
DIB Denial—Earnings Requirement Not Met in AOD (AOD 1973 or Later) Disability Due to Statutory Blindness322.72
DWB Denial—Disabled When Alleged or Onset Established Later Than Alleged—Prescribed Period Requirement Not Met323.12
DIB Denial—Disabled in Quarter Alleged or Onset Established Later Than Alleged—Disabled Before Age 24—6/12 Test Not Met323.23
DIB Denial—Disabled in Quarter Alleged or Onset Established Later Than Alleged—Disabled Between Ages 24-31—Earnings Requirement Not Met323.32
DIB Denial—Disabled in Quarter Alleged or Onset Established Later Than Alleged—Disabled Age 31 or Later—Earnings Requirement Not Met—Disability Not Due to Statutory Blindness323.44
DIB Denial—Disabled in Quarter Alleged or Onset Established Later Than Alleged—Disability Due to Statutory Blindness—Earnings Requirement Not Met—EOD 1/73 or Later323.53
DIB—Not Disabled Before Insured Status Expired324(A)1

C. Work and Earnings Deduction

 ParagraphFill-ins
Suspension of Payment to Child(ren)—W/E Employed600None
Auxiliary Beneficiary Suspended Because “A” Worked608 R2
Work Deduction for the Month Immediately Preceding the Current Month6091
Overpayment-Credit Months Involved6339
Penalty Determination—Good Cause Not Found—Current Payment Status—Explanation of Late Filing Not Furnished635(A) R1
Penalty Determination—Good Cause Not Found—Current Payment Status—Explanation of Late Filing Furnished635(B) R1
Penalty Determination—Good Cause Not Found—Conditional Benefit Status—Explanation of Late Filing Not Furnished636(A) R1
Penalty Determination—Good Cause Not Found—Conditional Benefit Status—Explanation of Late Filing Furnished636(B) R1
Late Filing of Report—Beneficiary Not Previously Notified of Good Cause and Penalty—Foreign Work Deduction660 R2
To Working Beneficiary—Temporary Deductions—Deferred Resumption Based on Age 706833
“A” Receiving “B” or “B1” Benefit in Combined Check—“B” or “B1” Benefits Suspended Because Spouse is Working6861
To Working Beneficiary—Yearly Earnings Assumed721 R2
To Working Beneficiary—Work Month Assumed722 R3
Reminded to File an Annual Report778 R1
Payment Based on Age 70 Attainment779 RNone

D. Awards

 ParagraphFill-ins
Proceeds of Check for Month of Death or Later and Overpayment Accrued Prior to Death Withheld From Lump Sum59(B)4
To Applicant—Part of Lump Sum Authorized to be Paid to Funeral Home, Part Paid to Applicant671
Primary Benefits Based on Transitionally Insured Status731
Underpayment Award in Addition to Other Award (Benefit to Wife Included With Payment)407(A)None
Increase in Rate—Benefits Payable at Both Rates4302
Decrease in Rate—Benefits Payable at Both Rates4322
Check to Deceased Beneficiary Outstanding—Amount Withheld From Lump Sum and /or Underpayment Award (Modify Where More Than One Check)685 R5
Lump Sum Payment Widow—Lump Sum Death Payment Being Made as a PMA Check While the Initial “D” Award Will be Made as a CMA Payment6871
Combined “AB” Check for Month of Death Negotiated by Surviving Spouse Under “Superendorsement” Process691None
Lead-In Paragraph for Award Notices9501
Former Representative Payee Notified Student Benefits Will be Paid Directly to Student958 RNone

E. Suspension/Offset

 ParagraphFill-ins
To Former Wife—No Child in Her Care—Payment Suspended18(a)None
Currently Suspended With Some Benefits Payable441
Wife Under 62 and Widow Under 60 With Payee—Child No Longer Entitled52(C)2
SSI Offset overpayment—Offset Period is Same as Retroactive (PMS) Period804
SSI Offset Overpayment—Offset Period Less Than Retroactive (PMA) Period815
Additional Information Regarding the Student's Benefits733 RNone

F. Reinstatement

 ParagraphFill-ins
Completion of Form SSA-21 (or SSA-22-F4) by Beneficiary (or Payee of Beneficiary) Who Has Moved to Foreign Country684None

G. Adjustment

 ParagraphFill-ins
E or D Conversion Affecting Other Survivors10None
Benefits Now Payable With Some Months Suspended44(A)3
Previous Action Revised Upon Reconsideration (For Residents Other Than U.S., Guam, American Samoa, Philippines, Canada, Mexico, Western Samoa and British Virgin Islands)136(D) FNone
Previous Action Revised Upon Reconsideration After Implied Request (For Residents Other Than U.S., Guam, American Samoa, Philippines, Canada, Mexico, Western Samoa and British Virgin Islands)136(E) FNone
Program Service Center Reconsiders Case Remanded Prior to a Hearing137None
Hearing Paragraph for Reconsidered Disability Cases Hearing Paragraph Used in Reconsideration Notice140None
Where Claim is Denied on the Basis of Res Judicata140(A)None
Increase in Rate—Benefits Payable at Both Rates4302
Decrease in Rate—Benefits Payable at Both Rates4322
Change in Benefit Rate439None
Change in Benefit Rate—Increase or Decrease in Benefits for Retroactive Period439(A) RNone
Beneficiary's Benefit Rate Adjusted Due to Termination of Benefits to Another Beneficiary4403
Change in One Beneficiary's Rate—Wage Earner's and Spouse's Benefits Combined441 RNone
Form SSA-L562 Change in Rate Reasons462(A-M)1
Waiver of Deduction Overpayment—Auxiliary Beneficiaries6241
Overpayment—30 Day Adjustment Paragraph651 RNone
Student Entitled—Family Maximum Case—No Adjustment Required6521
Late Filing of Report—Beneficiary Not Previously Notified of Good Cause and Penalty—No Child-in-Care Deduction656A R2
Auxiliary Beneficiary Living With W/E Also Overpaid—Request for Refund (to be added to W/E's Notice)6623
Auxiliary Beneficiary Living With W/E Also Overpaid—Adjustment Possible (to be added to W/E's Notice)6637
Combined Check—Check for Month Subsequent to Month of Death Adjusted Against Current Benefits6762

H. Terminations

 ParagraphFill-ins
To Former Wife—Child No Longer Entitled16(A)None
Wife Under 62 and Widow Under 60 (50 if Disabled)With Payee—Child No Longer Entitled52(C)2
Child Receiving Direct Payment—Age 18—Terminated61(A)1
Child Paid By Employer While Attending School209(A)None
School Does Not Qualify as an Educational Institution209(B)1
Disability Ceases—Payments Terminate412Varies
Title II—VR Continued Payments—Termination Paragraph4132
Title XVI—VR Continued Payments—Termination Paragraph4142
Title II—VR Cessation-Auxiliaries in Separate Households—VR Payments Terminate4151
Title II—VR Cessation—Auxiliaries in the Same Household—VR Payments Terminate4173
Spouse (B1) (B2), Age 62 When Last Child Terminated671None

I. Appellate Process and Attorney Fees

 ParagraphFill-ins
Court Order Provides for Payment of Attorney Fees1452
Notice to Auxiliary Living Apart that Court Order Does Not Provide for Payment of Attorney Fee146.24
Direct Payment of Attorney's Fee at the Time Award is Made to Claimant1471
Combined Notice Where Direct Payment of Attorney Fee is Made at the Time Award is Made to Claimant147.11
Separate Notice to Auxiliary Where Attorney Fee Has Not Yet Been Authorized148.21
Title II Offset Cases When a Fee for Representation is Involved (Offset Adjustment Notice)9704
Authorized Check Equals Amount of Past-Due Benefits Withheld980None
Authorized Check is Less Than Amount of Past-Due Benefits Withheld980.11
Authorized OHA Fee Equals Amount of Past-Due Benefits Withheld980.41
Authorized OHA Fee is Less Than Amount of Past-Due Benefits Withheld980.52
Authorized OHA Fee Exceeds Amount of Past-Due Benefits Withheld980.62
Fee Waiver or Statement That No Fee Will be Charged981.1None
Waiver of Right to Direct Payment981.2None
Future Month of Entitlement Case—No Past-Due Benefits Available981.3None
Fee Petition Incomplete After District Office Contact982None
Representative is Not an Attorney983None
Fee Waiver (or Statement That No Fee Will Be Charged) Received After Past-Due Benefits Have Been Withheld9852
Prior Payment to Attorney—Additional Benefits Available9864
Questionable Attorney-Client Relationship9871

J. Medicare

 ParagraphFill-ins
SMIB Termination Reversal Paragraphs—Computer Generated if Effective Month of Buy-in Precedes Termination Month Shown as “MT” Factor in Item 7 of SSA-1016KNone
Disallowance of Claim for Hospital Insurance—Not Full Retirement Age2651
Disallowance of Claim for Hospital and Medical Insurance Coverage—Not 65—Applicant Filed Under Deemed Insured Provision2661
Medical Insurance Beneficiary (“M” BIC) Potential Entitlement as Spouse of Premium Payer2671
Covered or Potentially Covered Under the Federal Employees Health Benefits Act of 1959—Deemed Insured272None
Applied Before Beginning of Initial Enrollment Period274None
Not a Resident of One of the 50 States or the District of Columbia2781
Special QC's Requirement for Entitlement to HI Under Deemed Insured Provisions—Full Retirement Age In or After 19682842
Chronic Renal Disease Disallowance—Opening Paragraphs2901
Disability Established—Health Insurance Coverage Date Begins More Than 2 Months After the Current Operating Month, HI/SMI Begins in Same Month2951
Medicare Termination—Revised Date of Entitlement2971
to Disability Benefits2971
Lead-in Paragraph—Medical Premiums Due3682
Suspension of Benefits or Payment Deferred Beyond Current Year—Combined Payments—A and B Beneficiaries Enrolled Under SMI (A Worked)703RNone
Deferred Payment Action—To Recover Overpayment Liable for Premiums704None
Deferred Payment Action—To Recover Overpayment Redeferred for Premiums Due705None
One-Check-Only Followed by a Suspension-Combined Check Situation (A Worked)—Both A and B Enrolled in SMI7071
One-Check—Only Followed by a Deferred Payment Action in Current Year7081
To Secondary Beneficiary-Monthly Benefit Payable Less Than $17095
To Secondary Beneficiary—Monthly Benefit Payable is Same as Premium7102
To Secondary Beneficiary—Monthly Benefit Payable is Less Than Premium7116
Representative Payee for HI and/or SMI Enrollee7163
Termination of Monthly Benefits and HI With SMI Entitlement Transferred to New Account718None
Explanation of Medicare Premiums and Deductions Under Public Law (P.L.) 97-248, Sec. 278719None
Discontinuance of State Buy—In Due to Non-Payment of SSI728None
Continuance of State Buy-In When SSI Payments Stopped729None
DIB Terminates—HI/SMI Coverage Terminates—No Refunds on Remittance Due7411
DIB Terminates—HI/SMI Coverage Terminates—Premium Arrearage Exists—No DIB Overpayment or Underpayment7424
DIB Terminates From Suspense—DIB Underpayment HI/SMI Premiums for Month Following Month of Notice to be Deducted From DIB Underpayment—Beneficiary Not Billed for SMI Premiums (to be used in conjunction with paragraph No. 741)7433
DIB Terminates From Suspense—DIB Underpayment for Months—HI/SMI Premiums for Month Following Month of Notice to be Deducted From DIB Underpayment—Beneficiary Not Billed for SMI Premiums743(A)4
DIB Terminates From Suspense—No DIB Overpayments or Underpayments Beneficiary Billed for SMI Premiums—Premium Arrearage Exists (to be used in conjunction with paragraph No. 741)7444
DIB Terminates From Suspense—DIB Underpayment—Beneficiary Billed for SMI Premium—Premium Arrearage Exists Which Will be Deducted From the Next Check (to be used in conjunction with paragraph No. 741)7454
DIB Terminates From Suspense—DIB Underpayment for Multiple Months—Beneficiary Billed for SMI Premiums—Premium Arrearage Exists Which Will be Deducted From the Next Check745(A)5
DIB Terminates—HI Coverage Terminates—No SMI Coverage7461
SMI Refund Paragraph (to be used in conjunction with paragraph No. 741 when excess premiums will be refunded by SOBER)747None
Medicare Ineligibility Paragraph (to be used when beneficiary's DOST and DOCA are prior to the date of entitlement to HI/SMI. It is also to be used when a Future Cessation Date (FCD) equal to or earlier than the date of entitlement to HI/SMI is being established.)748None
DIB Terminates—HI/SMI Coverage Terminates—Premium Arrearage Exists Along With DIB Overpayment7493
DIB Terminates—HI/SMI Coverage Terminates—Premium Arrearage Exists for One Month Along With DIB Overpayment749(A)3
DIB Terminates—HI/SMI Coverage Terminates—Premium Arrearage Exists for Prior Months Along With DIB Overpayments749(B)4
DIB Terminated From Suspense—DIB Overpayment Exists—Beneficiary Billed for SMI Premiums—Premium Arrearage Exists (to be used in conjunction with paragraph No. 741)7503
DIB Terminated-Excess SMI Premiums Used to Reduce Overpayment7514
DIB Terminated From Suspense—DIB Underpayment for One Month—Excess Premiums to be Refunded by SOBER7526
DIB Terminated From Suspense—DIB Underpayment for Multiple Months—Excess Premiums to be Refunded by SOBER752(A)7
HI and SMI Coverage for RD Beneficiaries (Dialysis)790None
Closed Period—Entitlement/Termination (Dialysis)7913
HI/SMI Termination Due to RD Cessation (Dialysis)7922
Equitable Relief—RD Termination Cases—DOTH is Earlier Than DOTS—Beneficiary Not Notified Timely (Dialysis)7934
HI and SMI Coverage for RD Beneficiaries (Transplant)7942
HI/SMI Termination Due to RD Cessation (Transplant)7952
Equitable Relief-RD Termination Cases—DOTH is Earlier Than DOTS—Beneficiary Not Notified Timely (Transplant)7964
NH—Capacity for SGA8501
NH—Impairment Not Severe—Medical Consideration Alone851None
NH—Impairment Not Severe—Medical Consideration Alone (Date ER Last Met)8521
NH or Disabled Child—Impairment Not Expected to Last 12 Months853None
NH or Disabled Child—Impairment Did Not Last 12 Months854None
Disabled Child—Impairment Not Severe—Medical Consideration Alone or Condition Disabling But Did Not Exist Before Age 22 (Over Age 22)855None
Disabled Child—Impairment Not Severe—Medical Consideration Alone or Condition Disabling But Did Not Exist Before Age 22 (Under Age 22)856None
Disabled Child—Capacity for SGA—Vocational Consideration (Over Age 22)857None
Disabled Child—Capacity for SGA—Vocational Consideration (Under Age 22)858None
NH—Not Disabled Before Insured Status Expired8592
NH—Not Insured at Alleged Onset Or Later860None
Disabled Widow(er)'s Prescribed Period Expired Before Alleged Onset8612
NH—Explanation of Disability Requirement862None
Disabled Widow(ers)—Explanation of the Disability Requirement and the Prescribed Period863None
Expiration of Widow(er)'s Prescribed Period8642
Childhood Disability—Law Paragraph—Claimant Age 22 or Over865None
Childhood Disability—Law Paragraph—Claimant Not Yet Age 22866None
Widow(ers), Mother, Father or Surviving Divorced Spouse Entitled to Survivors Benefits—Claim Filed for Medicare Coverage—Explanation of Disability Requirement for Medicare Coverage867None
Widow(ers) Not Disabled—Lack of Severity868None
Widow(ers)—Not Disabled at Any Time Prescribed Period Requirement Met For Deemed Entitlement to Medicare Coverage8691
NH—Disabled Widow(ers) or Child—Applicant Does Not Want to Continue Development of Claim870None
NH—Disabled Widow(ers) or Child—Failure to Follow Prescribed Treatment872None
Widow(ers) Not Disabled—Impairment is Severe at Time of Adjudication But Not Expected to Last 12 Months874None
Widow(ers) Not Disabled—Impairment No Longer Severe At Time of Adjudication and Did Not Last 12 Months875None
NH—Disabled Widow(ers) or Child—Insufficient Evidence Furnished876None
NH—Disabled Widow(ers) or Child Fails or Refuses to Submit to Medical Examination877None
NH or Widow(er) Has Demonstrated Ability to Engage in SGA Despite Condition881None
NH Demonstrated Ability to Engage in SGA Despite Impairment Within 29 Months Before Attaining Full Retirement Age883None
NH—Claim Filed After Death—Not Disabled at Any Time Earnings Requirement Met8844
NH—Claim Filed After Death—Not Disabled—Lack of Severity8853
NH—Claim Filed After Death—Not Disabled—Impairment is Severe At Time of Death But Would Not Have Been Expected to Last 12 Months8862
NH—Claim Filed After Death—Not Disabled—Impairment No Longer Severe At Time of Death and Did Not Last 12 Months8873
NH—Claim Filed After Death—Insufficient Evidence8881
NH—Claim Filed After Death—Denial—Applicant Does8892
Not Want To Continue Development of Claim NH—Claim Filed After Death—Denial—Impairment Was Severe But Claimant Failed to Follow Prescribed Treatment8904
NH—Claim Filed After Death—Not Disabled At Any Time Earnings Requirement Met—Medical Consideration Alone8914
NH—Claim Filed After Death—Not Disabled—Lack of Severity—Medical Consideration Alone8922
DIB or CDB Medical Cessation8932
DIB or CDB Cessation—Work Activity (No Trial Work Period)8942
DIB or CDB Cessation—Whereabouts Unknown or Failure to Cooperate—Required Information Not Submitted8952
DIB or CDB Cessation—Whereabouts Unknown or Failure to Cooperate—Requested Medical Examination Not Taken8962
Disability Ends Prior to Beginning of Medicare Coverage897None
Disability Ends After Medicare Coverage Begins898None
CDB Reentitlement Notice8991
Medicare Coverage Termination9011
DWB Cessation—Medical Evidence Indicates Ability to Perform SGA9022
Medicare Termination—Disability Ends Prior to Medicare Coverage903None
Medicare Termination—Disability Ends After Medicare Coverage Begins9041
State Agency and M.D. Participation in Decision914None
Prior Freeze Not Affected by Current Denial916None
Periodic Review Scheduled917None
Lead-In Language for Closed Period and Later Onset Date Allowances918None
Disability Requirement and 7-Year Period Attachment919None
Disability and Earnings Requirement Attachment920None
Dual Entitlement—Subsequent Award—Medicare Awarded Previously and Will Continue on First Account940None

K. Extended Period of Eligibility

 ParagraphFill-ins
EPE Case—Cessation—9 Months of Trial Work Complete Beneficiary Performing SGA9053
EPE Case—Explanation of 15-Month Reinstatement Period906None
EPE Case—Impairment-Related Work Expenses Not Allowed As Claimed907None
EPE Case—Impairment-Related Work Expenses Insufficient to Reduce Earnings Below SGA908None
EPE Case—9 Months of Trial Work Complete—Medical Review—Disability Continues909None
EPE Case—9 Months of Trial Work Complete—Medical Review—Disability Ceases9101
EPE Case—Medicare Has Begun Prior to End of TWP911None
EPE Case—If 24th Month of Entitlement Has Not Been Reached Prior to End of TWP9121
Expiration of Disability Insured Status9132

L. General Miscellaneous

 ParagraphFill-ins
Change of Payee—Former Representative Payee An Individual35R1
Change of Payee—Former Representative Payee an Agency or Institution35(A) R1
Applicant Not Entitled to Underpayment—Not on Priority List50(D)2
Applicant Not Entitled to Underpayment—Another Individual Higher in the Order of Priority Who is Eligible to Receive Underpayment50(E)3
No Underpayment Exists—Request for Payment Denied50(F)None
U.S. Federal Income Tax Withheld from Underpayment Paid to Nonresident Alien512
Award Amended to Exclude Disability Period70None
Exclusion of Disability Period Does Not Increase Benefit71None
Primary Benefits Based on Transitionally Insured Status731
Address Paragraph for ALJ, ODO, PSC, OHA1601
Fee Petition Paragraph for Court Cases161None
Applicant Not Entitled to Monthly Benefits—Worker Not Fully Insured2012
To Husband or Widower—W/E or S/E Person Not Fully and Currently Insured2022
Spouse Not Yet 62 and No Child in Care Age 16 or Under or Disabled205(B)RNone
Child 18 or Over Not Disabled or a Full-Time Student2091
Child Paid by Employer While Attending School209(A)None
School Does Not Qualify As an Educational Institution209(B)1
Widow/Widower Under 60—No Child “In-Care” —Child Entitled to Benefits2121
If the Widow/Widower May Become Entitled to Benefits at Age 60, Add the Following212(A)1
Surviving Divorced Spouse Not Entitled, Child Requirement Not Met213(A)1
Disallowance for More Than One Reason but Insufficient Proof in File to Make Decision2401
Insured Individual Died After Deportation244None
Wife, Child, or Husband Disallowed Because W/E Not Entitled to RIB or DIB245None
Denial of Requests for Withdrawal of Claim—Requested Consent Statements Absent251None
Denial of Request for Withdrawal—Refund Not Made2521
Withdrawal Approved, New Award Made—Notice to Person Whose Entitlement is Nullified2554
Withdrawal Approved—Notice to Wife, Husband or Child Whose Entitlement is Nullified2564
Insert Paragraph for Form SSA-L250 (SSA-L850)—Withdrawal Approved After Award257None
Insert Paragraph for Form SSA-L250 (SSA-L850)—Withdrawal Approved Before Adjudication258None
Wife or Widow—Under 72—W/E Transitionally Insured2612
Widow Age 72 or Over Disallowed—No Transitional Insured Status—W/E Attained 65 or Died Before 19572633
Request for Change of Address—Claimant Entitled to Hospital Insurance Benefits But Not Monthly Benefits264None
Not a Resident of U.S.—Deemed Insured270None
Not a U.S. Citizen and Does Not Meet Alien Residency Requirement—Deemed Insured271None
Claim Disallowed For Nonmedical Reasons—Disability Determination Unnecessary288None
Lead-in Paragraph3062
Reconsideration Paragraph3072
Hearing Paragraph3081
Right to File Subsequent Application3091
DIB—Not Qualified Before Full Retirement Age—Substantial Gainful Work313(A)None 
Disability Denial—General Closeout Paragraph314None
Description of Earnings Requirement—Special Insured Status Requirements for Subsequent Period of DIB320.9None
Allowance—Subsequent Period of DIB, Special Insured Status—Benefits Payable 5/83, First Possible Month of Entitlement Earlier3211
Applicant Mentions Another Disability Program351None
Reexamination Scheduled—Beneficiary Hospitalized3541
Statutory Blindness—DIB Allowance Under 1972 Amendments—First Month of Entitlement Restricted to 01/733582
Initial Notice—Reference to Follow-up Notice if Title II Underpayment or Overpayment Involved365None
Lead-in Paragraph—Underpayment of Title II Benefits Involved3662
Lead-in Paragraph—Overpayment of Title II Benefits Involved3672
DIB—Rate Increase—Two Rates Payable372None
DIB—Rate Increase—Change in Disability Period374None
Claimant Insured for RIB—No RIB Claim Filed378None
Information Concerning Hospital and Medical Insurance—Claimant Age 63-64 3 /4379None
DIB and DWB Applications Filed380RNone
Freeze or DIB Continuance (After Full Retirement Age)388None
DWB Cessation—Medical Improvement3963
DIB Cessation—Overpayment Involved3973
DIB Cessation—Overpayment Involved—SMI Premiums Included in Overpayment397(A)4
DIB Cessation—Underpayment Involved for One Month3983
DIB Cessation—Underpayment Involved for Multiple Months398(A)4 
Title II “Lead-in” Paragraph399None
Request for Refund399(A)1
Disability Ceases—Payments Continue4082
Personalized Notice Lead-In409None
Title II VR Cessation-Auxiliaries in Separate Households—Payments Continue4101
Title II-VR Cessation—Auxiliaries in Same Household—Payments Continue4111
Combined Check—Primary or Auxiliary Beneficiary Dies—Check for Month Subsequent to Month of Death Outstanding679RNone
SSA-1560-U4 Return Address Paragraph SEPSC731None
Reference to Title XVI Claim—Dual Entitlement Case (Title XVI Disclaimer Paragraphs)842None
Multiple Claims—Benefits Being Paid on One—Current Claim Being Denied900None
Government Pension Total Offset1000None
Government Pension Partial Offset1001None

M. Continuing Disability Review Cessations

 ParagraphFill-ins
Lead In - Medical Improvement Cessation - Title II4000None
Lead In - Group I Exception - Title II4001None
Lead In - Medicare Only - Current Coverage - Medical Improvement4002None
Lead In - Medicare Only - Current Coverage - Group I Exception4003None
Lead In - Medicare Only - Future Coverage - Medical Improvement4004None
Lead In - Medicare Only - Future Coverage - Group I Exception4005None
Lead In - Reopening To Cessation - Medical Improvement - Title II4006None
Lead In - Reopening To Cessation - Group I Exception - Title II4007None
Lead In - Reopening To Closed Period - Medical Improvement - Title II4008None
Lead In - Reopening To Closed Period - Group I Exception - Title II4009None
Lead In - Medicare Only - Reopening To Cessation - Current Coverage - Medical Improvement4010None
Lead In - Medicare Only - Reopening To Cessation - Current Coverage - Group I Exception4011None
Lead In - Medicare Only - Reopening To Cessation - Future Coverage - Medical Improvement4012None
Lead In - Medicare Only - Reopening To Cessation - Future Coverage - Group I Exception4013None
Lead In - Auxiliary Notice40143
Lead In - Group II Exception - Title II4022None
Lead In - Later Cessation - Medical Improvement - Title II40382
Lead In - Basis Change Only4040None
Referral To Personalized Attachment4041None
Benefits/Payments End40432
Benefits End - Auxiliary40443
Medicare Ends40481
Medicare Ends - Medicare Only40492
No Future Medicare Coverage40512
Vocational Rehabilitation - Title II4052None
DDS Decision4054None
Right to Reconsideration4056None
Right To Reconsideration - Disability Cessation - Section 301 Case4057None
Benefit Continuation - Medicare Involved - Primary Beneficiary - Title II4059None
Benefit Continuation - Auxiliary40601
Benefit Continuation - Medicare Involved - Later Cessation or Basis Change Only4063None
Benefit Continuation - Later Cessation or Basis Change Only - Auxiliary40641
Disability Hearing Information4066None
If You Need Help With Your Appeal4069None
Things To Remember - Title II4070None
Things To Remember - Medicare - Current Coverage4071None
Things To Remember - Medicare - Future Coverage4072None
DO Referral4078None
DIB, DI or CDB Medical Cessation – Title II/XVI”40801
Disability Cessation - Clear Cut - Title II40811
DIB, DWB or CDB Cessation - Whereabouts Unknown or Failure to Cooperate - Required Information Not Submitted - Title II40821
DIB, DWB, CDB Cessation - Whereabouts Unknown or Failure to Cooperate - Requested Medical Examination Not Taken - Title II40831
Medical Cessation - Advances in Medical Therapy or Technology - Title II/ Title XVI40841
Medical Cessation - Advances in Vocational Therapy or Technology - Title II /Title XVI40851
Medical Cessation - New or Improved Diagnostic or40861
Evaluative Techniques - Title II/Title XVICessation - Prior Determination in Error - Title II/Title XVI40871
Cessation - Fraud - Title II/Title XVI40881
Failure to Follow Prescribed Treatment - Title II/Title XVI40951
DWB Medical Cessation - Title II40961
Benefit Continuation Rights - Medicare Not Involved4097None
Appeal Rights - Face-to-Face Hearing - Reopening to a Later Onset4098None
Appeals Rights - ALJ Hearing - Title II4104None
Benefits End - Later Cessation - Title II41152
Lead In - Reopening To Later Cessation - No Medical Improvement - Title II41162
Lead In - Reopening To Cessation - Group II Exception - Title II4127None
Right To Reconsideration (Foreign Claim)4131None
Right To Reconsideration - Auxiliary (Foreign Claim)4132None
Right To Reconsideration - Award Notice - Revision To Later Onset (Foreign Claim)4133None
General Closing Paragraph (Foreign Claim)41341
Disability Hearing Information (Foreign Claim)4135None
Auxiliary Notice - Lead In - Allowance To Denial41582
Lead In - Allowance to Denial - Title II4159None
Right To Reconsideration - Award Notice4160None
Lead In - Affirmation of a Denial4170None
Lead In - Affirmation of a Later Onset41711
Lead In - Affirmation of a Closed Period41722
Appeal of the Earlier Decision4173None
DDS Decision - Foreign Version4175None
Appeals Rights - ALJ Hearing Formal Remands4176None