TN 38 (09-24)
ENT001 STUDENT ENFORCEMENT (B22)
(System Generated)
Caption: Your Responsibility
We are writing to let you know that (1) (2) for child's payments as a student. Based on the information we have, (3) benefits will continue through (4) . We will send another letter when we stop (5) benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name possessive
Fill-in (2) - Systems Generated
Choice 1: qualify
Choice 2: qualifies
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: her
Choice 3: his
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: her
Choice 3: his
ENT015 RIB ALLOWANCE SUBSEQUENT DIB DENIAL (J17)
(Requested)
Caption: Other Social Security Benefits
Although (1) cannot receive disability benefits, (2) still entitled to 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
ENT027 DUAL ENTITLEMENT AWARD — PRIMARY AND AUXILIARY/SURVIVOR BENEFITS AWARDED SIMULTANEOUSLY
— ONE NOTICE SENT (A38)
(Requested)
Caption: None
(1) entitled to monthly (2) benefits beginning (3) . (4) also entitled to (5) benefits on the record of (6) beginning (7) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You are
Choice 2: He is
Choice 3: She is
Fill-in (2) - Systems Generated
Choice 1: disability
Choice 2: retirement
Fill-in (3) - Systems Generated
Choice 1: MM/CCYY
Fill-in (4) - Systems Generated
Choice 1: You are
Choice 2: He is
Choice 3: She is
Fill-in (5) - Requested As A One Position Alpha Character
Choice 1: (A) wife's
Choice 2: (B) husband's
Choice 3: (C) widow's
Choice 4: (D) widower's
Choice 5: (E) mother's
Choice 6: (F) father's
Choice 7: (G) disabled widow's
Choice 8: (H) disabled widower's
Choice 9: (I) disabled divorced widow's
Choice 10: (J) disabled divorced widower's
Choice 11: (K) Child's
Fill-in (6) - Requested
Choice 1: Number holder's name on the other record
Fill-in (7) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
ENT028 DUAL ENTITLEMENT - PRIMARY AWARD - SIMULTANEOUS ENTITLEMENT TO AUXILIARY/SURVIVOR
BENEFITS - SEPARATE PAYMENTS (A40)
(Requested)
Caption: Your Benefits
(1) also entitled to (2) benefits on the record of (3) beginning (4) . We are sending (5) another letter about these benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You are
Choice 2: He is
Choice 3: She is
Fill-in (2) - Requested As A One Position Alpha Character
Choice 1: (A) wife's
Choice 2: (B) husband's
Choice 3: (C) widow's
Choice 4: (D) widower's
Choice 5: (E) mother's
Choice 6: (F) father's
Choice 7: (G) disabled widow's
Choice 8: (H) disabled widower's
Choice 9: (I) disabled divorce widow's
Choice 10: (J) disabled divorced widower's
Choice 11: (K) Child's
Fill-in (3) - Requested
Choice 1: Number holder on the other record
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: her
Choice 3: him
ENT029 DUAL ENTITLEMENT AUXILIARY/SURVIVOR AWARD - SIMULTANEOUS ENTITLEMENT ON PRIMARY RECORD
- SEPARATE PAYMENTS (A41)
(Requested)
Caption: Your Benefits
(1) also entitled to benefits on (2) own earnings record beginning (3) . We are sending (4) another letter about these benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You are
Choice 2: He is
Choice 3: She is
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: her
Choice 3: his
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: her
Choice 3: him
ENT038 BENEFITS REDUCED TO ZERO UNDER DIB FAMILY MAXIMUM PROVISIONS (J74)
(Requested/Generated)
Caption: Your Benefits
We have approved (1) application for (2) benefits. (3) entitlement date is (4) . However, we cannot pay (5) any benefits because all of the money we can pay on this record is already being
paid to (6) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Your
Choice 2: Full name possessive
Fill-in (2) - Requested As A One Position Alpha Character
Choice 1: (A) spouse's
Choice 2: (B) child's
Choice 3: (C) parent's
Fill-in (3) - Systems Generated
Choice 1: His
Choice 2: Her
Choice 3: Your
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY (DOEC)
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: her
Choice 3: him
Fill-in (6) - Requested As A Language
Choice 1: Number holders full name
ENT048 ACCRUED BENEFITS TEMPORARILY WITHHELD PENDING FINAL RECOMMENDATION (B23)
(Requested)
Caption: Your Benefits
We are withholding payment for (1) until we decide the best way
to make payments.
Fill-in values:
Fill-in (1) - Requested As A Date In Format Shown Below
Choice 1: MM/YYYY
Choice 2: MM/YYYY and MM/YYYY
Choice 3: MM/YYYY through MM/YYYY
ENT051 HI DATE OF ENTITLEMENT (H10)
(Requested/Generated)
Caption: Information About Medicare
You are entitled to hospital insurance under Medicare beginning (1) .
Fill-in values:
Fill-in (1) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
ENT052 SMI DATE OF ENTITLEMENT (H12)
(Requested/Generated))
Caption: Information About Medicare
You are entitled to medical insurance under Medicare beginning (1) .
Fill-in values:
Fill-in (1) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
ENT056 NO PAYMENT AWARD ENTITLED TO AN EQUAL OR LARGER BENEFIT ON ANOTHER RECORD (B41)
(Requested)
Caption: Your Benefits
We approved (1) claim for (2) benefits. However, we cannot pay (3) on (4) record because (5) entitled to an equal or larger benefit on another Social Security record.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (2) - Requested As A One Position Alpha Character
Choice 1: (A) wife's
Choice 2: (B) husband's
Choice 3: (C) widow's
Choice 4: (D) widower's
Choice 5: (E) mother's
Choice 6: (F) father's
Choice 7: (G) disabled widow's
Choice 8: (H) disabled widower's
Choice 9: (I) disabled divorced widow's
Choice 10: (J) disabled divorced widower's
Choice 11: (K) child's
Fill-in (3) - Systems Generated
Choice 1: him
Choice 2: you
Choice 3: her
Fill-in (4) - Requested As A Language
Choice 1: Number holder's name possessive
Fill-in (5) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
ENT062 MONTH OF ENTITLEMENT CONFIRMED (A52)
(Requested)
Caption: Your Benefits
We reviewed (1) record. When (2) applied, (3) asked us to start (4) benefits in (5) . We found that (6) is still the month when benefits should start.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary Name possessive
Choice 2: your
Fill-in (2) - Systems Generated
Choice 1: he
Choice 2: she
Choice 3: you
Fill-in (3) - Systems Generated
Choice 1: he
Choice 2: she
Choice 3: you
Fill-in (4) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (5) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (6) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
ENT063 BENEFICIARY ENTITLED ON TWO ACCOUNTS A BENEFITS (PREVIOUSLY AWARDED) TO BE COMBINED
WITH WIDOW(ER)'S BENEFITS AND PAYMENT OF LUMP-SUM (B07)
(Requested)
Caption: What We Will Pay
The check, which includes the money (1) due through (2) , will also include a lump-sum payment of (3) . This is a one-time payment we make because of a worker's death.
After that, we will send (4) benefits in one check each month. The check will include (5) which (6) due on (7) own Social Security record and (8) which (9) due on the other record.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you are
Choice 2: Beneficiary Name is
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of lump-sum
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount MBP
Fill-in (6) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (7) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount MBP
Fill-in (9) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
ENT064 UNDERPAYMENT PAID TO OTHER BENEFICIARY (B08)
(Requested)
Caption: What We Will Pay
Your (1) check includes (2) which we owed (3) .
Fill-in values:
Fill-in (1) - Requested As A One Position Alpha Character
Choice 1: (A) next
Choice 2: (B) first
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of underpayment
Fill-in (3) - Requested As A One Position Alpha Character or language
Choice 1: (A) your wife
Choice 2: (B) your husband
Choice 3: (C) your father
Choice 4: (D) your mother
Choice 5: name of beneficiary
ENT065 SIMULTANEOUS A AND AB AWARDS (B17)
(Requested)
Caption: Other Social Security Benefits
We are still working on (1) (2) claim for spouse's benefits. When we decide whether or not (3) is entitled to benefits, we will send (4) a letter.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary name possessive
Fill-in (2) - Requested As A One Position Alpha Character
Choice 1: (A) wife's
Choice 2: (B) husband's
Fill-in (3) - Systems Generated
Choice 1: he
Choice 2: she
Fill-in (4) - Systems Generated
Choice 1: him
Choice 2: her
ENT066 AUXILIARY CLAIM PENDING (C07)
(Requested)
Caption: Things To Remember
We are still working on (1) claim. When we decide whether or not (2) entitled to benefits, we will send another letter to give our decision.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: your
Fill-in (2) - Systems Generated
Choice 1: he is
Choice 2: she is
Choice 3: you are
ENT067 UNDERPAYMENT DUE TO DEATH OF BENEFICIARY SHARED WITH INDIVIDUAL(S) OF EQUAL ENTITLEMENT
(C09)
(Requested)
Caption: What We Will Pay
This check includes (1) , which is part of the money which was due (2) . Each person who is eligible for part of this money will get an equal share. The
amount shown above is (3) share.
Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount
Fill-in (2) - Requested As A Language
Choice 1: Name of deceased individual
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: Beneficiary name possessive
ENT068 RIGHTS AND RESPONSIBILITIES DOMESTIC CONVERSION FROM DIB (G14)
(System Generated)
Caption: Your Responsibilities
It is important that you report changes that could affect (1) benefits to us right away. To explain these changes, we have enclosed a pamphlet,
When You Get Social Security Retirement or Survivor Benefits. What You Need To Know.
It will tell you what must be reported and how to report. Please be sure to read the
part of the pamphlet which explains how earnings from work could change (2) payments.
Fill-in values:
Fill-in (1)
Choice 1: your
Choice 2: Beneficiary name possessive
Fill-in (2)
Choice 1: your
Choice 2: Beneficiary name possessive
ENT069 RIGHTS AND RESPONSIBILITIES FOREIGN CONVERSION FROM DIB (G15)
(System Generated)
Caption: Your Responsibilities
It is important that you report changes that could affect (1) benefits to us right away. To explain these changes, we have enclosed a pamphlet,
Your Social Security Checks While You Are Outside the United States. It will tell
you what must be reported and how to report. The pamphlet explains that we may not
pay (2) if (3) more than 45 hours in a month.
Fill-in values:
Fill-in (1)
Choice 1: your
Choice 2: Beneficiary name possessive
Fill-in (2)
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (3)
Choice 1: you work
Choice 2: he works
Choice 3: she works
ENT070 DATE OF BIRTH ESTABLISHED DIFFERENT FROM THAT ALLEGED OR DATE ESTABLISHED BEFORE ATTAINMENT
OF RETIREMENT AGE (C08)
(Requested/Generated)
Caption: The Basis For Our Decision
Based on the information given to us, (1) born on (2) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's name + was
Choice 2: you were
Fill-in (2) - Requested As A Date In Format Shown Below
MM/DD/CCYY
ENT075 NEW BENEFICIARY ENTITLED TO BENEFITS (J79)
(Requested)
Caption: Your Benefits
Since (1) now entitled to benefits, we changed the amount we can pay (2) beginning (3) . We will continue to pay this new monthly amount as long as (4) (5) payments.
Fill-in values:
Fill-in (1) - Requested As A One Position Alpha Character
Choice 1: (A) name of terminated beneficiary is
Choice 2: (B) names of terminated beneficiaries are
Choice 3: (C) you are
Fill-in (2) - Systems Generated
Name (or names) of previously entitled beneficiary (or
beneficiaries)
Fill-in (3) - Requested As A Date In Format Shown Below
MM/CCYY (date of adjustment)
Fill-in (4) - Systems Generated
Choice 1: Beneficiary's Name + receives
Choice 2: you receive
Fill-in (5) - Requested As A One Position Alpha Character
Choice 1: (A) workers' compensation
Choice 2: (B) public disability
Choice 3: (C) workers' compensation and public disability
ENT082 SMI-PBID DATE OF ENTITLEMENT
(Systems Generated)
Caption: Information about Medicare
(1) Medicare Part B Immunosuppressive Drug coverage starts (2) .
Fill-in Values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's Name (possessive)
Choice 2: Your
Fill-in (2) - Systems Generated
Choice 1: MM/CCYY