TN 4 (08-12)

NL 00720.065 BRR Beneficiary Reporting Responsibility

BRR004 RIGHTS AND RESPONSIBILITIES RSI, DOMESTIC OR FOREIGN (G34)

(System Generated)

Caption: Your Responsibilities

 (1)  benefits are based on the information  (2)  gave us. If this information changes, it could affect  (3)  benefits. For this reason, it is important that you report changes to us right away.

We have enclosed a pamphlet,  (4)  . It tells you what must be reported and how to report.  (5) 

Fill-in values:

Fill-in (1)

Choice 1: Mr. Beneficiary's Name possessive

Choice 2: Ms. Beneficiary's Name possessive

Choice 3: Beneficiary's Name possessive

Choice 4: Your

Fill-in (2)

Choice 1: he

Choice 2: she

Choice 3: you

Fill-in (3)

Choice 1: his

Choice 2: her

Choice 3: you

Fill-in (4)

Choice 1: "Your Payments While You Are Outside the United States"

Choice 2: "What You Need To Know When You Get Retirement Or Survivors Benefits"

Choice 3: "What You Need To Know When You Get Social Security Disability Benefits"

Fill-in (5)

Choice 1: NULL

BRR006 DISABILITY IMPROVEMENT INFORMATION (G12)

(System Generated)

Caption: Things To Remember

If  (1)  health gets worse and you think  (2)  disabled before  (3)  full retirement age,  (4)   (5)   (6)   (7)  , you should contact us about applying again for disability benefits. Also, please get in touch with us three months before  (8)  age 62 to find out whether  (9)  for retirement benefits.

Fill-in values:

Fill-in (1)

Choice 1: Beneficiary's Last Name

Choice 2: you

Fill-in (2)

Choice 1: she is

Choice 2: he is

Choice 3: you are

Fill-in (3)

Choice 1: she reaches

Choice 2: he reaches

Choice 3: you reach

Fill-in (4)

Choice 1: full retirement age at which FRA is effective (without additional months, if applicable) in the format: 65

Fill-in (5)

Choice 1: and

Choice 2: null

Fill-in (6)

Choice 1: If present, show additional FRA months in the format: 2

Choice 2: null

Fill-in (7)

Choice 1: months

Choice 2: null

Fill-in (8)

Choice 1: she reaches

Choice 2: he reaches

Choice 3: you reach

Fill-in (9)

Choice 1: she qualifies

Choice 2: you qualify

Choice 3: he qualifies

BRR006 INDIVIDUAL AGE 62-65 (NO RIB CLAIM FILED) (T26)

(Requested)

Caption: Things To Remember

If  (1)  health gets worse and you think  (2)  disabled before  (3)  full retirement age,  (4)   (5)   (6)   (7)  , you should contact us about applying again for disability benefits. Also, please get in touch with us three months before  (8)  age 62 to find out whether  (9)  for retirement benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Beneficiary's Last name

Choice 2: you

Fill-in (2) - Systems Generated

Choice 1: she is

Choice 2: he is

Choice 3: you are

Fill-in (3) - Systems Generated

Choice 1: she reaches

Choice 2: he reaches

Choice 3: you reach

Fill-in (4) - Systems Generated

Choice 1: full retirement age at which FRA is effective (without additional months, if applicable) in the format: 65

Fill-in (5) - Systems Generated

Choice 1: and

Choice 2: null

Fill-in (6) - Systems Generated

Choice 1: If present, show additional FRA months in the format: 2

Choice 2: null

Fill-in (7) - Systems Generated

Choice 1: months

Choice 2: null

Fill-in (8) - Systems Generated

Choice 1: she reaches

Choice 2: he reaches

Choice 3: you reach

Fill-in (9) - Systems Generated

Choice 1: she qualifies

Choice 2: you qualify

Choice 3: he qualifies

BRR016 RIGHTS AND RESPONSIBILITIES NON-DIB, RRB DOM. OR FOR (G35)

(System Generated)

Caption: Your Responsibilities

The decisions we made on your claim are based on information you gave us. If this information changes, it could affect your benefits. For this reason, it is important that you report changes to us or to the Railroad Retirement Board right away. We have enclosed a pamphlet which tells you what must be reported and how to report.

Fill-in values:

NONE

BRR026 REPORTING RESPONSIBILITIES - PROVISIONAL BENEFITS (P11)

(Requested)

Caption: Your Responsibilities

You must tell us right away about any changes that may affect  (1)  benefits. You should tell us if:

  •  (2)  mailing address;

  •  (3)  to work or  (4)  work hours;

  •  (5)  doctor says  (6)  condition has improved;

  •  (7)  to leave the United States for 30 days or more;

  •  (8)  been convicted of a criminal offense; or

  •  (9)  benefits have been reinstated as either a disabled widow/widower or a disabled adult child.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Choice 4: null

Fill-in (2) - Systems Generated

Choice 1: You change your

Choice 2: He changes his

Choice 3: She changes her

Fill-in (3) - Systems Generated

Choice 1: You return

Choice 2: He returns

Choice 3: She returns

Fill-in (4) - Systems Generated

Choice 1: you increase your

Choice 2: he increases his

Choice 3: she increases her

Fill-in (5) - Systems Generated

Choice 1:Your

Choice 2: His

Choice 3: Her

Fill-in (6) - Systems Generated

Choice 1:Your

Choice 2: His

Choice 3: Her

Fill-in (7) - Systems Generated

Choice 1: You plan

Choice 2: He plans

Choice 3: She plans

Fill-in (8) - Systems Generated

Choice 1: You have

Choice 2: He has

Choice 3: She has

Fill-in (9) - Systems Generated

Choice 1: You marry and your

Choice 2: He marries and his

Choice 3: She marries and her

BRR040 FACILITY OF PAYMENT WORKER'S RESPONSIBILITIES (G36)

(System Generated)

Caption: Your Responsibilities

Please let us know if any of the following things happen:

  • The amount of money  (1)   (2)  to make changes; or

  • Another family member starts working; or

  • A family member moves out of the household.

The way we pay benefits could change if any of these things happen.

Fill-in values:

Fill-in (1)

Choice 1: you

Choice 2: she

Choice 3: he

Fill-in (2)

Choice 1: expects

Choice 2: expects

BRR057 RIB BENEFITS AT 62 MAY BE HIGHER FOR FAMILY THAN DIB (J72)

(Requested)

Caption: Things To Remember

You should get in touch with us about 3 months before  (1)   (2)  age 62. At that time, you can find out whether  (3)  family would receive higher benefits if  (4)  for retirement benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Beneficiary's Name

Choice 2: you

Fill-in (2) - Systems Generated

Choice 1: reach

Choice 2: reaches

Fill-in (3) - Systems Generated

Choice 1: your

Choice 2: her

Choice 3: his

Fill-in (4) - Systems Generated

Choice 1: you file

Choice 2: he files

Choice 3: she files

BRR075 REMINDER TO INCLUDE CLAIM NUMBER ON CORRESPONDENCE (G80)

(System Generated)

Caption: If You Disagree With The Decision

Always give  (1)  claim number on any letter or notice you send about  (2)  claim.

Fill-in values:

Fill-in (1)

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (2)

Choice 1: your

Choice 2: his

Choice 3: her

BRR076 REMINDER TO KEEP LETTER AS PERMANENT RECORD (G81)

(System Generated)

Caption: If You Disagree With The Decision

KEEP AS A PERMANENT RECORD – DO NOT DESTROY

Fill-in values:

NONE

BRR078 (WB6) BOND

Caption:

(System Generated)

Because of  (1)  work and earnings, no benefits are payable to you at this time under the rules of the Benefit Offset National Demonstration (BOND) project. If  (2)  work or earnings change, we may be able to pay some benefits in the future.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: BOND Beneficiary's Name possessive

Fill-in (2) - Systems Generated

Choice 1: BOND Beneficiary's Name possessive

BRR079 (WB7) BOND

Caption:

(System Generated)

Because of  (1)  work and earnings, benefits are payable to you at this time under the rules of the Benefit Offset National Demonstration (BOND) project. If  (2)  work or earnings change, some benefits may not be payable in the future.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: BOND Beneficiary's Name possessive

Fill-in (2) - Systems Generated

Choice 1: BOND Beneficiary's Name possessive

BRR080 REMINDER TO REPORT CHANGES IN WORK OR EARNINGS (W67)

(Requested)

Caption: Your Responsibilities

Please be sure to let us know right away if  (1)  work or earnings change, because changes could affect the amount of  (2)  benefits.

Fill-in values:

Fill-in (1) – System Generated

Choice 1: your

Choice 2: Beneficiary's Name possesive

Fill-in (2) – System Generated

Choice 1: your

Choice 2: his

Choice 3: her

BRRR13 CURRENT YEAR S.E.I. USED PENDING RECEIPT OF TAX RETURN (C06)

(Requested)

Caption: Your responsibility

 (1)  benefits are partly based on self-employment income for  (2)  . As soon as the taxable year is over,  (3)  should report this income on a Federal tax return.

Then, you must send us a copy of the return. Also, send us a cancelled check or other proof to show that  (4)  filed the return. Otherwise, we will stop  (5)  benefits and ask you to return any money we have sent you.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Your

Choice 2: Her

Choice 3: His

Fill-in (2) - Requested As A Year In Format CCYY

Choice 1: Year

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: her

Choice 3: his


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720065
NL 00720.065 - BRR Beneficiary Reporting Responsibility - 04/02/2015
Batch run: 04/02/2015
Rev:04/02/2015