BASIC (05-11)

NL 00720.045 AMN Amended SSI Output

AMN008 SSI OFFSET APPLIED (A58)

(Requested)

Caption: Your Benefits

In an earlier letter, we told you we were withholding  (1)  Social Security benefits for  (2)  . We did this because we thought we might have to reduce  (3)  Social Security benefits if  (4)  also received Supplemental Security Income (SSI) money for this period.

Now we are writing to let you know that we cannot pay  (5)   (6)  of the Social Security benefits we withheld. This is because  (7)  received SSI money for  (8)  .

When you receive SSI money for a month, and later you receive Social Security benefits, we sometimes have to reduce your Social Security benefits. We do this to make sure that your total SSI and Social Security monthly payment is not more than it would have been if the Social Security benefits had been paid on time.

Allowing for  (9)  Social Security benefits, we should have paid  (10)   (11)  less in SSI money. Because of this, we are reducing  (12)  Social Security benefits by  (13)  .  (14) 

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (2) Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (3) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (4) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (5) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (6) Requested As A One Position Alpha Character

Choice 1 (A): any

Choice 2 (B): all

Fill-in (7) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (8) Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (9) Systems Generated

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (10) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (11) Request As A Money Amount in Format $$$$$.¢¢

Amount of SSI payments

Fill-in (12) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (13) Request As A Money Amount in Format $$$$$.¢¢

Amount of the reduction

Fill-in (14) - Requested As A One Position Alpha Character

Choice 1 (A): In your next check, we will pay you the amount due for this period.

Choice 2 (B): We cannot pay you any back benefits.

Choice 3 (C): null

AMN009 ADDITIONAL BENEFITS SUBJECT TO SSI OFFSET (A60)

(Requested)

Caption: Your Benefits

Additional benefits for  (1)  have been  (2)  because  (3)  received Supplemental Security Income checks for this period.

Fill-in values:

Fill-in (1) Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (2) Requested As A One Position Alpha Character

Choice 1 (A): withheld

Choice 2 (B): reduced

Fill-in (3) Systems Generated

Choice 1: you

Choice 2: Beneficiary's Name