TN 7 (02-06)

NL 00715.220 IRS Tax Levy Paragraphs/UTIs

LVY022

We withheld __(1)___ from ___(2)___ benefits due through ___(3)___ to pay ___(4)___ obligation to IRS.

FILL-IN

  1. CMA Tax Levy amount ($$$,$$$.¢¢)

  2. your/(beneficiary’s first and last name)’ (apostrophe only)/(beneficiary’s first and last name)’s (apostrophe “s”)

  3. Month and Year of CMA (format – “December 2005”).

  4. Your/his/her/the

LVY023

Thereafter, we will withhold ___(1)___ from ___(2)___ benefit each month to pay ___(3)___ obligation to IRS.

FILL-IN

  1. Tax Levy amount deducted from ongoing check amount ($$$,$$$.¢¢).

  2. your/his/her/(beneficiary’s first name)’ (apostrophe only)/(beneficiary’s first name)’s (apostrophe “s”)

  3. your/his/her/the

LVY024

We will continue to withhold from ___(1)___ benefit each month to pay ___(2)___ obligation to IRS.

FILL-IN

  1. your/(beneficiary’s first and last name)’ (apostrophe only)/(beneficiary’s first and last name)’s (apostrophe “s”)

  2. your/his/her/the

LVY025

We changed ___(1)___ payment to ___(2)___ beginning ___(3)___ because we are no longer withholding benefits to pay ___(4)___ obligation to IRS.

FILL-IN

  1. your/(beneficiary’s first and last name)’ (apostrophe only)/(beneficiary’s first and last name)’s (apostrophe “s”)

  2. Ongoing MBP ($$,$$$.¢¢)

  3. Month and Year of IRS Tax Levy Termination Date (format – “January 2005”)

  4. your/his/her/the

LVY026

We changed ___(1)___ payment to ___(2)___ beginning ___(3)___ because we are increasing the amount we are withholding each month to pay ___(4)___ obligation to IRS.

FILL-IN

  1. your/(beneficiary’s first and last name)’ (apostrophe only)/(beneficiary’s first and last name)’s (apostrophe “s”)

  2. Ongoing MBP ($$,$$$.¢¢)

  3. Month and Year of new IRS Tax Levy deduction amount effective date (format – “January 2005”)

  4. your/his/her/the

LVY027

We changed ___(1)___ payment to ___(2)___ beginning ___(3)___ because we are reducing the amount we are withholding each month to pay ___(4)___ obligation to IRS.

FILL-IN

  1. your/(beneficiary’s first and last name)’ (apostrophe only)/(beneficiary’s first and last name)’s (apostrophe “s”)

  2. Ongoing MBP ($$,$$$.¢¢)

  3. Month and Year of new IRS Tax Levy deduction amount effective date (format – “January 2005”)

  4. your/his/her/the


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900715220
NL 00715.220 - IRS Tax Levy Paragraphs/UTIs - 02/21/2006
Batch run: 01/27/2009
Rev:02/21/2006