TN 1 (07-11)

NL 00720.150 ERN Earnings

ERN022 ENFORCEMENT-FRA CASES (W18)

(Requested)

Caption: Your Benefits

In the year  (1)  age  (2)  , we only count  (3)  earnings for months before  (4)  age  (5)  . If  (6)  less than  (7)  in the months before  (8)  age  (9)  ,  (10)  can get all of  (11)  benefits. Our records show  (12)  became age  (13)  on  (14)  . We figured  (15)  earned about  (16)  in the months before full retirement age.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you become

Choice 2: beneficiary's full name becomes

Fill-in (2) - Systems Generated

Choice 1: 65

Choice 2: 65 and 2 months

Choice 3: 65 and 4 months

Choice 4: 65 and 6 months

Choice 5: 65 and 8 months

Choice 6: 65 and 10 months

Choice 7: 66

Choice 8: 66 and 2 months

Choice 9: 66 and 4 months

Choice 10: 66 and 6 months

Choice 11: 66 and 8 months

Choice 12: 66 and 10 months

Choice 13: 67

Choice 14: 70

Fill-in (3) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Choice 4: (beneficiary‘s first name)‘s

Choice 5: (beneficiary’s first name)‘s

Fill-in (4) - Systems Generated

Choice 1: you turn

Choice 2: he turns

Choice 3: she turns

Choice 4: null

Fill-in (5) - Systems Generated

Choice 1: 65

Choice 2: 65 and 2 months

Choice 3: 65 and 4 months

Choice 4: 65 and 6 months

Choice 5: 65 and 8 months

Choice 6: 65 and 10 months

Choice 7: 66

Choice 8: 66 and 2 months

Choice 9: 66 and 4 months

Choice 10: 66 and 6 months

Choice 11: 66 and 8 months

Choice 12: 66 and 10 months

Choice 13: 67

Choice 14: 70

Fill-in (6) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

Choice 4: null

Fill-in (7) - Systems Generated

Choice 1: annual exempt amount

Fill-in (8) - Systems Generated

Choice 1: you turn

Choice 2: he turns

Choice 3: she turns

Choice 4: null

Fill-in (9) - Systems Generated

Choice 1: same as Fill-in 5

Fill-in (10) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (11) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Choice 4: (beneficiary's first name)'s

Choice 5: (beneficiary's first name)'s

Fill-in (12) - Systems Generated

Choice 1: you

Choice 2: beneficiary's full name

Fill-in (13) - Systems Generated

Choice 1: same as Fill-in 5

Fill-in (14) - Systems Generated

Choice 1: enter DOB (format: MONTH DD, CCYY)

Fill-in (15) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Choice 4: (beneficiary's first name) format John

Fill-in (16) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: DOLLAR AMOUNT

ERN025 ENFORCEMENT-FRA CASES (W18)

(Requested)

Caption: Your Benefits

Here is how we figured  (1)  earnings for the months before  (2)  became age  (3)  . First, we had to find  (4)  average earnings for each month. Our records show  (5)  earned  (6)  in  (7)  . So we divided these earnings by 12 (the number of months in a year). Then, we multiplied this number times  (8)  , which is the number of months before  (9)  turned age  (10)  . Based on this, we figure  (11)  earned about  (12)  in the months before  (13)  turned age  (14)  .

Please let us know right away if:

  •  (15)  did not work all months in the year; or

  •  (16)  earnings were not evenly spaced throughout the year.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: beneficiary's full name

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Choice 4: beneficiary's first name

Fill-in (3) - Systems Generated

Choice 1: 65

Choice 2: 65 and 2 months

Choice 3: 65 and 4 months

Choice 4: 65 and 6 months

Choice 5: 65 and 8 months

Choice 6: 65 and 10 months

Choice 7: 66

Choice 8: 66 and 2 months

Choice 9: 66 and 4 months

Choice 10: 66 and 6 months

Choice 11: 66 and 8 months

Choice 12: 66 and 10 months

Choice 13: 67

Choice 14: 70

Fill-in (4) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Choice 4: (beneficiary's first name)'s

Choice 5: (beneficiary's first name)'s

Fill-in (5) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Choice 4: beneficiary's first name

Fill-in (6) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: reported earnings

Fill-in (7) - Systems Generated

Choice 1: age 70 or FRA year (same as enforcement year)

Fill-in (8) - Requested As A Number

Choice 1: number of calendar months before the person turned age 70 or FRA:

Fill-in (9) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Choice 4: beneficiary's first name

Fill-in (10) - Systems Generated

Choice 1: 65

Choice 2: 65 and 2 months

Choice 3: 65 and 4 months

Choice 4: 65 and 6 months

Choice 5: 65 and 8 months

Choice 6: 65 and 10 months

Choice 7: 66

Choice 8: 66 and 2 months

Choice 9: 66 and 4 months

Choice 10: 66 and 6 months

Choice 11: 66 and 8 months

Choice 12: 66 and 10 months

Choice 13: 67

Choice 14: 70

Fill-in (11) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Choice 4: beneficiary's first name

Fill-in (12) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: wages on TID=EAR finder

Fill-in (13) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Choice 4: beneficiary name

Fill-in (14) - Systems Generated

Choice 1: 65

Choice 2: 65 and 2 months

Choice 3: 65 and 4 months

Choice 4: 65 and 6 months

Choice 5: 65 and 8 months

Choice 6: 65 and 10 months

Choice 7: 66

Choice 8: 66 and 2 months

Choice 9: 66 and 4 months

Choice 10: 66 and 6 months

Choice 11: 66 and 8 months

Choice 12: 66 and 10 months

Choice 13: 67

Choice 14: 70

Fill-in (15) - Systems Generated

Choice 1: you

Choice 2: beneficiary's full name

Fill-in (16) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Choice 4: beneficiary's name possessive

ERN038 SELF-EMPLOYMENT EARNINGS ADJUSTED (E05)

(Requested)

Caption: Your Benefits

Self-employment earnings for  (1)  have been adjusted to  (2)  because  (3)  .

Fill-in values:

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

Choice 1: CCYY

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount

Fill-in (3) - Requested As A One Position Alpha Character

Choice 1: (A) income from renting rooms and apartments cannot be included unless special personal services are furnished to the tenants

Choice 2: (B) a farm owner's share of income cannot be included when a tenant works the farm unless the farm landlord materially participates in the production activities on his farm

Choice 3: (C) income from renting real estate cannot be included unless it is received in the ordinary course of business by a real estate dealer

Choice 4: (D) capital gains or losses not derived from the disposition of inventoriable property, stock in trade, or property held primarily for sale cannot be included

Choice 5: (E) income received from the sale of livestock held for dairy, work or breeding purposes cannot be included

Choice 6: (F) you have elected to use the option method of computing your self-employment income

Choice 7: (G) some business deductions were not taken. All expenses paid or incurred in carrying on a trade or business and a reasonable allowance for depreciation of property must be deducted in computing net earnings from self-employment

ERN039 PAYMENTS RECEIVED FROM EMPLOYER NOT COUNTED (E52)

(Requested)

Caption: Your Benefits

Payments received from  (1)  from  (2)  through  (3)  were not counted because the evidence presented to us does not show the amounts are wages.

Fill-in values:

Fill-in (1) - Requested As A Language

Choice 1: Name of employer

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

Choice 1: MM/CCYY

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

ERN040 PERMANENT DEDUCTIONS/ANNUAL REPORT PROCESSED/ADJUSTMENT LETTER TO WORKER (W01)

(Requested)

Caption: Your Benefits

 (1)  reported earnings of  (2)  for  (3)  . Based on these earnings,  (4)  of  (5)  benefits for that year should have been withheld. Since  (6)  of the benefits were withheld,  (7)   (8)  .

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Worker's name

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of earnings reported.

Fill-in (3) - Requested As A Year In Format Shown Below

Choice 1: CCYY

Fill-in (4) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$$.¢¢

Choice 1: (A) all

Choice 2: (B) none

Choice 3: amount that should have been withheld

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (6) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢

Choice 1: (A) all

Choice 2: (B) none

Choice 3: actual amount withheld

Fill-in (7) - Requested As A One Position Alpha Character

Choice 1: (A) you were paid correctly

Choice 2: (B) you were overpaid

Choice 3: (C) you are due

Choice 4: (D) he was paid correctly

Choice 5: (E) he was overpaid

Choice 6: (F) he is due

Choice 7: (G) she was paid correctly

Choice 8: (H) she was overpaid

Choice 9: (I) she is due

Fill-in (8) Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢

Choice 1: (A) null

Choice 2: amount due in $$$$$.¢¢ format

ERN041 PERMANENT DEDUCTIONS/AWARD LETTER TO WORKER (W02)

(Requested)

Caption: Your Benefits

 (1)  reported earnings of  (2)  for  (3)  . Based on these earnings,  (4)  of  (5)  benefits for that year have been withheld.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You

Choice 2: Worker's name

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY

Fill-in (4) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢

Choice 1: (A) all

Choice 2: (B) none

Choice 3: amount (show in $$$$$.¢¢)

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN042 PERMANENT DEDUCTIONS/PRIMARY WORKING/AWARD LETTER TO AUXILIARY (W04)

(Requested)

Caption: Your Benefits

Based on  (1)  earnings for  (2)  ,  (3)  of  (4)  benefits for that year have been withheld.

Fill-in values:

Fill-in (1) - Requested As A One Position Alpha Character

Choice 1: (A) NH's name (possessive)

Choice 2: (B) your

Choice 3: (C) your husband's

Choice 4: (D) your wife's

Choice 5: (E) your father's

Choice 6: (F) your mother's

Choice 7: (G) bene's name possessive + husband's

Choice 8: (H) bene's name possessive + wife's

Choice 9: (I) bene's name possessive + father's

Choice 10: (J) bene's name possessive + mother's

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

Choice 1: CCYY

Fill-in (3) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$$.¢¢

Choice 1: (A) all

Choice 2: (B) none

Choice 3: amount (show in $$$$$.¢¢)

Fill-in (4) - Requested As A One Position Alpha Character

Choice 1: (A) your

Choice 2: (B) his

Choice 3: (C) her

Choice 4: (D) your husband's

Choice 5: (E) her husband's

Choice 6: (F) your wife's

Choice 7: (G) his wife's

Choice 8: (H) the children's

ERN043 TEMPORARY DEDUCTIONS/LETTER TO WORKER (AWARD OR ADJ) (W05)

(Requested)

Caption: Your Benefits

Based on  (1)  estimated earnings of  (2)  for  (3)  ,  (4)  of  (5)  benefits for this year should be withheld.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: Beneficiary's name possessive

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY

Fill-in (4) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$$.¢¢

Choice 1: (A) all

Choice 2: (B) none

Choice 3: amount (show in $$$$$.¢¢)

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Choice 4: Beneficiary's name (possessive)

ERN044 TEMPORARY DEDUCTIONS/PRIMARY WORKING/LETTER TO AUXILIARY (AWARD OR ADJ) (W06)

(Requested)

Caption: Your Benefits

Based on  (1)  estimated earnings for  (2)  ,  (3)  of  (4)  benefits for this year should be withheld.

Fill-in values:

Fill-in (1) - Requested As A One Position Alpha Character

Choice 1: (A) your

Choice 2: (B) Beneficiary's name possessive

Choice 3: (C) your husband's

Choice 4: (D) your wife's

Choice 5: (E) the children's

Choice 6: (F) bene's name possessive + husband's

Choice 7: (G) bene's name possessive + wife's

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

Choice 1: CCYY

Fill-in (3) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢

Choice 1: (A) all

Choice 2: (B) none

Choice 3: amount (show in $$$$$.¢¢)

Fill-in (4) - Requested As A One Position Alpha Character

Choice 1: (A) your

Choice 2: (B) his

Choice 3: (C) her

Choice 4: (D) your husband's

Choice 5: (E) her husband's

Choice 6: (F) your wife's

Choice 7: (G) his wife's

Choice 8: (H) the children's

ERN045 SPOUSE REINSTATED BASED ON N/H'S WORK/EARNINGS (W08)

(Requested)

Caption: Your Benefits

Based on  (1)  spouse's work, we can pay benefits beginning  (2)  .

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

ERN046 NOTIFICATION TO BENEFICIARY THAT WE WILL WRITE AGAIN WHEN EARNINGS REPORT IS RECEIVED (W11)

(System Generated)

Caption:

We will write to you again after we know how much  (1)  actually earned. At that time, we will tell you whether  (2)  due additional benefits or  (3)  overpaid.

Fill-in values:

Fill-in (1)

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (2)

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (3)

Choice 1: are

Choice 2: is

ERN047 REGO II ENFORCEMENT – MONTHLY TEST MAY APPLY (W12)

(Requested)

Caption: Your Benefits

Our records show earnings of  (1)  were reported for  (2)  for  (3)  . We assume that  (4)  earned all of this money in  (5)  and that  (6)  worked all months of  (7)  after  (8)  became entitled to benefits.

 (9)  earnings affect the amount of Social Security benefits  (10)  due for  (11)  . However, we may not have to count all of the earnings reported for  (12)  . If any of the following apply to  (13)  , get in touch with any Social Security office and have a record of  (14)  earnings with you. Let us know if:

  •  (15)  earned some of the money before  (16)  , or

  •  (17)  earned a different amount in  (18)  , or

  •  (19)  did little or no work in at least one month of  (20)  after  (21)  became entitled to benefits, or

  •  (22)  had a loss from  (23)  self employment in  (24)  .

Fill-in values:

Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of earnings

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY year of earnings

Fill-in (4) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (5) - Systems Generated

Choice 1: CCYY (same as #3)

Fill-in (6) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (7) - Systems Generated

Choice 1: CCYY (same as #3)

Fill-in (8) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (9) - Systems Generated

Choice 1: Your

Choice 2: His

Choice 3: Her

Fill-in (10) - Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

Fill-in (11) - Systems Generated

Choice 1: CCYY (same as #3)

Fill-in (12) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (13) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (14) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (15) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (16) - Systems Generated

Choice 1: CCYY (same as #3)

Fill-in (17) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (18) - Systems Generated

CCYY (same as #3)

Fill-in (19) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (20) - Systems Generated

CCYY (same as #3)

Fill-in (21) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (22) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (23) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (24) - Systems Generated

CCYY (same as #3)

ERN048 REGO II ENFORCEMENT – MONTHLY TEST DOES NOT APPLY (W13)

(Requested)

Caption: Your Benefits

Our records show earnings of  (1)  were reported for  (2)  for  (3)  . We assume that  (4)  earned all of this money in  (5)  .

 (6)  earnings affect the amount of Social Security benefits  (7)  due for  (8)  . However, we may not have to count all of the earnings reported for  (9)  . If any of the following apply to  (10)  , get in touch with any Social Security office and have a record of  (11)  earnings with you. Let us know if:

  •  (12)  earned some of the money before  (13)  , or

  •  (14)  earned a different amount in  (15)  , or

  •  (16)  had a loss from  (17)  self employment in  (18)  .

Fill-in values:

Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of earnings

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY year of earnings

Fill-in (4) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (5) - Systems Generated

Choice 1: CCYY (same as #3)

Fill-in (6) - Systems Generated

Choice 1: Your

Choice 2: His

Choice 3: Her

Fill-in (7) - Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

Fill-in (8) - Systems Generated

Choice 1: CCYY (same as #3)

Fill-in (9) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (10) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (11) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (12) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (13) - Systems Generated

Choice 1: CCYY (same as #3)

Fill-in (14) - Systems Generated

Choice 1: You

Choice 2: He

Choice 3: She

Fill-in (15) - Systems Generated

Choice 1: CCYY (same as #3)

Fill-in (16) - Systems Generated

Choice 1: You

Choice 2: He

Choice 3: She

Fill-in (17) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (18) - Systems Generated

CCYY (same as #3)

ERN049 NO ESTIMATE/BENEFITS NOT PAID FOR CURRENT YEAR (W14)

(Requested)

Caption: Your Benefits

We do not have an estimate of how much  (1)  will earn in  (2)  . For this reason, we will assume that  (3)  will earn too much money to receive benefits this year.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

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

Choice 1: CCYY

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

ERN050 FACILITY OF PAYMENT CURRENT YEAR (W15)

(Requested)

Caption: Your Benefits

For this reason, the other members of the household together are due  (1)  more each month. We will pay  (2)  this amount instead of increasing the other benefits. However, since this money is really due the other family members, it should be used only for their needs.

Fill-in values:

Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of increase

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

ERN051 FACILITY OF PAYMENT CLOSED YEAR (W16)

(Requested)

Caption: Your Benefits

Because of  (1)  work and earnings in  (2)  ,  (3)  of  (4)  benefits for the year should have been withheld. For this reason, the other members of the household together were due  (5)  more. However, we continued to pay  (6)  instead of increasing the other benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: NH's name (possessive)

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

Choice 1: CCYY

Fill-in (3) - Requested As A One Position Alpha Character

Choice 1: (A) all

Choice 2: (B) amount

Fill-in (4) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢

Amount (total increase)

Fill-in (6) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

ERN052 MONTHLY EARNINGS TEST MONTHS PAYABLE (W17)

(Requested)

Caption: Your Benefits

We can pay  (1)  benefits for months during  (2)  when  (3)   (4)  or less and  (5)  not active in self-employment. Therefore, we will pay  (6)   (7)  .

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: beneficiary name

Fill-in (2) - Requested As A One Position Alpha Character or a date in format shown below

Choice 1: (A) this year

Choice 2: (B) last year

Choice 3: CCYY

Fill-in (3) - Requested As A One Position Alpha Character

Choice 1: (A) you earn

Choice 2: (B) you earned

Choice 3: (C) (name) earns

Choice 4: (D) (name) earned

Fill-in (4) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount

Fill-in (5) - Requested As A One Position Alpha Character

Choice 1: (A) are

Choice 2: (B) is

Choice 3: (C) were

Choice 4: (D) was

Fill-in (6) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (7) - Requested As A Date In Format Shown Below (Must Code the word ‘for’ or ‘beginning’ before the date)

Choice 1: for MM/CCYY

Choice 2: for MM/CCYY and MM/ CCYY

Choice 3: for MM/ CCYY through MM/ CCYY

Choice 4: beginning MM/ CCYY

ERN053 TO WORKING BENEFICIARY PAYMENT BASED ON ATTAINMENT OF FULL RETIREMENT AGE IN FUTURE MONTH (W21)

(Requested)

Caption: Your Benefits

We are withholding  (1)  benefits for  (2)  because of  (3)  earnings. We will begin paying  (4)  when  (5)  full retirement age. In  (6)  case that is  (7)  . We will pay  (8)  for all future months after  (9)  full retirement age.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Your

Choice 2: Beneficiary name

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

Choice 1: 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: him

Choice 3: her

Fill-in (5) - Systems Generated

Choice 1: you reach

Choice 2: he reaches

Choice 3: she reaches

Fill-in (6) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (7) - Systems Generated

Choice 1: 65 and 2 months (Full Retirement Age as determined from FRA utility, displayed in format shown)

Fill-in (8) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (9) - Systems Generated

Choice 1: you reach

Choice 2: he reaches

Choice 3: she reaches

ERN054 TEMPORARY DEDUCTIONS EQUAL PERMANENT DEDUCTIONS (MAY BE USED IN PLACE OF W01) (W29)

Caption: Your Benefits

(Requested)

 (1)  reported earnings of  (2)  for  (3)  . We withheld the right amount of benefits for the year based on  (4)  work and earnings.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You

Choice 2: Beneficiary name

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of earnings

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY

Fill-in (4) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN055 REQUEST FOR ESTIMATE/REMINDER TO REPORT EARNINGS (W32)

Caption: Your Responsibilities

(Requested)

If  (1)  more than  (2)  in  (3)  , please let us know right away, because it can affect the amount of benefits  (4)  due.  (5)  will also have to report how much  (6)  earned at the end of the year.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You earn

Choice 2: Beneficiary name earns

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of yearly earnings limit

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY of earnings

Fill-in (4) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (5) - Systems Generated

Choice 1: You

Choice 2: He

Choice 3: She

Fill-in (6) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

ERN056 ESTIMATE EQUAL TO OR LESS THAN EXEMPT AMOUNT (W36)

(Requested)

Caption: Your Benefits

Since  (1)  estimated  (2)  would earn  (3)  or less for  (4)  , we do not have to withhold any of  (5)  benefits for the year. If  (6)  work plans change and  (7)  that  (8)  will earn over  (9)  , please let us know right away.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (3) - Systems Generated

Choice 1: Current year earnings limitation

Fill-in (4) - Requested As A Date In Format Shown Below

Choice 1: CCYY

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 find

Choice 2: he finds

Choice 3: she finds

Fill-in (8) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (9) - Systems Generated

Choice 1: Current year earnings limitation (same as Fill-in 3)

ERN057 BENEFITS PAYABLE IN CURRENT OR PRIOR YEAR BECAUSE OF NON-SERVICE MONTHS (W37)

(Requested)

Caption: Your Benefits

We can pay  (1)  benefits  (2)   (3)  because  (4)   (5)   (6)   (7)  .

Please be sure to let us know right away if  (8)  work or earnings change, because changes would affect the amount of  (9)  benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

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

Choice 1: (A) for

Choice 2: (B) beginning

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Fill-in (4) - Requested As A One Position Alpha Character

Choice 1: (A) you did not

Choice 2: (B) you will not

Choice 3: (C) you are not

Choice 4: (D) he did not

Choice 5: (E) he will not

Choice 6: (F) he is not

Choice 7: (G) she did not

Choice 8: (H) she will not

Choice 9: (I) she is not

Fill-in (5) - Requested As A One Position Alpha Character

Choice 1: (A) earn more than

Choice 2: (B) earning more than

Choice 3: (C) perform substantial services in self-employment

Choice 4: (D) performing substantial services in self-employment

Fill-in (6) - Systems Generated

Choice 1: Show appropriate monthly earnings limit in format $$$$$¢¢

Fill-in (7) - Requested As A One Position Alpha Character

Choice 1: (A) during that month

Choice 2: (B) during each of those months

Choice 3: (C) Null

Fill-in (8) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (9) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN058 PARTIAL BENEFIT FOLLOWED BY FULL BENEFITS PAID IN CURRENT YEAR BECAUSE OF NON-SERVICE MONTHS (W39)

(Requested)

Caption: Your Benefits

We can pay  (1)  benefits  (2)  because  (3)   (4)   (5)  during  (6)  . Because of  (7)  estimated earnings of  (8)  for  (9)  , we can pay  (10)  only part of  (11)  benefits for  (12)  , and  (13)  full benefit for all months after that.

Please be sure to let us know right away if  (14)  work or earnings change, because changes would affect the amount of  (15)  benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

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

Choice 1: MM/CCYY

Choice 2: MM/CCYY and MM/CCYY

Choice 3: MM/CCYY through MM/CCYY

Fill-in (3) - Requested As A One Position Alpha Character

Choice 1: (A) you are not

Choice 2: (B) you will not

Choice 3: (C) he is not

Choice 4: (D) he will not

Choice 5: (E) she is not

Choice 6: (F) she will not

Fill-in (4) - Requested As A One Position Alpha Character

Choice 1: (A) earn more than

Choice 2: (B) earning more than

Choice 3: (C) perform substantial services in self-employment

Choice 4: (D) performing substantial services in self-employment

Fill-in (5) - Systems Generated

Choice 1: Monthly earnings limit

Choice 2: null

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

Choice 1: (A) that month

Choice 2: (B) each of those months

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: Estimated earnings amount

Fill-in (9) - Systems Generated

Choice 1: CCYY (current year)

Fill-in (10) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (11) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (12) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY partial benefit is paid

Fill-in (13) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (14) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (15) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN059 FULL BENEFITS PAYABLE TO AUXILIARY BECAUSE OF NUMBER HOLDER'S WORK AND EARNINGS (W41)

(Requested)

Caption: Your Benefits

Because of  (1)  work and earnings, only a partial benefit is payable for  (2)   (3)  .

Fill-in values:

Fill-in (1) - Requested As A One Position Alpha Character

Choice 1: (A) your husband's

Choice 2: (B) your wife's

Choice 3: (C) your former husband's

Choice 4: (D) your father's

Choice 5: (E) your mother's

Choice 6: (F) bene's name possessive + husband's

Choice 7: (G) bene's name possessive + wife's

Choice 8: (H) bene's name possessive + former husband's

Choice 9: (I) bene's name possessive + father's

Choice 10: (J) bene's name possessive + mother's

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

Choice 1: MM/CCYY

Choice 2: MM/CCYY and MM/CCYY

Choice 3: MM/CCYY through MM/CCYY

Fill-in (3) - Requested As A One Position Alpha Character

Choice 1: (A) null

Choice 2: (B) and each month thereafter

ERN060 PAYMENT IN CURRENT YEAR BASED ON NON-SERVICE MONTHS – THE FULL RETIREMENT AGE (W43)

(Requested)

Caption: Your Benefits

We can pay  (1)  benefits for    (2)   because  (3)  will not    (4)   (5)   during    (6)   . Because of  (7)  work, we cannot pay  (8)  any other benefits until  (9)  full retirement age. In  (10)  case that is   (11)  .

Please be sure to let us know right away if  (12)  work or earnings change, because changes could affect the amount of  (13)  benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary’s name

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

Choice 1: MM/CCYY

Choice 2: MM/CCYY and MM/CCYY

Choice 3: MM/CCYY through MM/CCYY

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) - Requested As A One Position Alpha Character

Choice 1: (A) earn more than

Choice 2: (B) perform substantial services in self-employment

Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢ or Alpha Character

Choice 1: Monthly earnings limit

Choice 2: (B) null

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

Choice 1: (A) that month

Choice 2: (B) each of those months

Fill-in (7) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (8) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (9) - Systems Generated

Choice 1: you reach

Choice 2: he reaches

Choice 3: she reaches

Fill-in (10) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (11) - Systems Generated

Choice 1: full retirement age

Fill-in (12) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (13) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN061 PAYMENT BASED ON ATTAINMENT OF FULL RETIREMENT AGE - NO PAYMENT PRIOR TO ATTAINMENT OF FULL RETIREMENT AGE (W44)

(Requested)

Caption: Your Benefits

Because of  (1)  work in  (2)  , we cannot pay  (3)  any other benefits until  (4)  full retirement age. In  (5)  case that is  (6)  .

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: CCYY

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (4) - Systems Generated

Choice 1: you reach

Choice 2: he reaches

Choice 3: she reaches

Choice 4: performing substantial services in self-employment

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (6) - Systems Generated

Choice 1: 66 and 2 months (full retirement age from FRA utility in format )

ERN062 PARTIAL AND FULL PAYMENT IN CURRENT YEAR BASED ON ESTIMATE (W45)

(Requested)

Caption: Your Benefits

Because of  (1)  estimated earnings of  (2)  for  (3)  , we can only pay  (4)  part of  (5)  benefit for  (6)  , and  (7)  full benefit for all months after that.

Please be sure to let us know right away if  (8)  work or earnings change, because changes could affect the amount of  (9)  benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: Beneficiary's Name, possessive

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Estimated earnings amount

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY

Fill-in (4) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (6) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY of partial payment

Fill-in (7) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (8) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (9) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN063 FULL AND INTERMITTENT PAYMENTS IN CURRENT YEAR BASED ON ESTIMATE (W46)

(Requested)

Caption: Your Benefits

Based on  (1)  estimated earnings of  (2)  for  (3)  , benefits are payable for  (4)  . If  (5)  estimate of earnings for the rest of the year changes or  (6)  neither earn over  (7)  as an employee nor perform  (8)  substantial services in self-employment in any months before  (9)  , please notify any Social Security office promptly.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: Beneficiary's Name, possessive

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

Choice 1: Amount (in format $$$$$.¢¢)

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY

Fill-in (4) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY and MM/CCYY

Choice 3: MM/CCYY through MM/CCYY

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (6) - Systems Generated

Choice 1: you neither earn

Choice 2: he neither earns

Choice 3: she neither earns

Fill-in (7) - Systems Generated

Choice 1: Monthly earnings limit (in format $$$$$.¢¢)

Fill-in (8) - Systems Generated

Choice 1: perform

Choice 2: performs

Fill-in (9) - Systems Generated

Choice 1: age 65” or full retirement age (i.e., 66 and 2 months)

Note: This is the FRA from the FRA utility.

ERN064 RESPONSIBILITIES OF PEOPLE ENTITLED TO A PERIOD OF DISABILITY FOR MEDICARE COVERAGE (W50)

(Requested)

Caption: Your Benefits

If  (1)  to work while  (2)  still disabled,  (3)  may be entitled to a trial work period to test  (4)  ability to resume work. During this period  (5)  may work in as many as 9 months (which need not be consecutive) and still be considered disabled for entitlement to Medicare coverage no matter how high  (6)  earnings. After the trial period has ended, we will consider the work  (7)  did in determining whether  (8)  shown by  (9)  work activity that  (10)  disability has ended. However,  (11)  not entitled to a trial work period if  (12)  entitled to a second period of disability for which  (13)  did not have to complete a waiting period.

To prevent any incorrect entitlement, please notify us promptly if:

 (14)  already returned to work when  (15)  received this notice; or

 (16)  to work in the future, regardless of how much  (17)  .

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you return

Choice 2: Beneficiary's Name returns

Fill-in (2) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (6) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (7) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (8) - Systems Generated

Choice 1: you have

Choice 2: he has

Choice 3: she has

Fill-in (9) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (10) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (11) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (12) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (13) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (14) - Systems Generated

Choice 1: you have

Choice 2: he has

Choice 3: she has

Fill-in (15) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (16) - Systems Generated

Choice 1: you return

Choice 2: he returns

Choice 3: she returns

Fill-in (17) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

ERN065 ENFORCEMENT/NO DEDUCTIONS HAD BEEN MADE/OPTIONAL STATEMENT REGARDING MONTHLY EARNINGS TEST (W53)

(Requested)

Caption: Your Benefits

Our records show that  (1)  earned  (2)  in  (3)   (4)  Because of this, we should have withheld  (5)  from  (6)  benefits for  (7)  . Therefore, we paid  (8)   (9)  too much in benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of posted earnings

Fill-in (3) - Requested As A Year In Format CCYY

Choice 1: CCYY

Fill-in (4) - Requested As A One Position Alpha Character

Choice 1: (A) “.”

Choice 2: (B) and we assume that you worked in all months of that year after you became entitled to Social Security benefits.

Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Full amount that should have been withheld

Fill-in (6) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (7) - Requested As A Date In Format Shown Below

Choice 1: CCYY

Fill-in (8) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (9) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of overpayment

ERN066 ENFORCEMENT/SOME DEDUCTIONS MADE BASED ON ANNUAL REPORT/OPTIONAL STATEMENT REGARDING MONTHLY EARNINGS TEST (W54)

(Requested)

Caption: Your Benefits

 (1)  told us that  (2)  earned  (3)  in  (4)  . However, our records show that  (5)  earned  (6)  that year  (7)  . Because of this, we should have withheld  (8)  from  (9)  benefits for  (10)  . Since we only withheld  (11)  , we paid  (12)   (13)  too much in benefits.

If  (14)  we are wrong, please get in touch with us.  (15)  should also give us any facts  (16)  to show that our records are wrong.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary Name

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of earnings shown on annual report

Fill-in (4) - Requested As A Date In Format Shown Below

Choice 1: CCYY

Choice 2: CCYY and CCYY

Choice 3: CCYY through CCYY

Fill-in (5) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (6) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of posted earnings

Fill-in (7) - Requested As A One Position Alpha Character

Choice 1: (A) “.”

Choice 2: (B) and we assume that you worked in all months of that year after you became entitled to Social Security benefits.

Choice 3: (C) and we assume that he worked in all months of that year after he became entitled to Social Security benefits.

Choice 3: (C) and we assume that he worked in all months of that year after he became entitled to Social Security benefits.

Choice 4: (D) and we assume that she worked in all months of that year after she became entitled to Social Security benefits.

Fill-in (8) - Requested As A Money Amount In Format $$$$$$.¢¢

Choice 1: Amount that should have been withheld

Fill-in (9) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (10) - Requested As A Date In Format Shown Below

Choice 1: CCYY

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

Choice 1: Amount actually withheld

Fill-in (12) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

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

Choice 1: Amount of overpayment

Fill-in (14) - Systems Generated

Choice 1: you think

Choice 2: he thinks

Choice 3: she thinks

Fill-in (15) - Systems Generated

Choice 1: You

Choice 2: He

Choice 3: She

Fill-in (16) - Systems Generated

Choice 1: you have

Choice 2: he has

Choice 3: she has

ERN067 FACILITY OF PAYMENT BENEFIT REDUCED/ANOTHER BENEFICIARY WORKING (W58)

(Requested)

Caption: Your Benefits

We are reducing  (1)  benefits to  (2)  beginning  (3)  because of a change in the earnings of  (4)  .

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: Name (possessive)

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Reduced benefit amount

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Fill-in (4) - Requested As A Language

Choice 1: Name of other beneficiary

ERN068 REASON FOR NOT REPORTING EARNINGS NOT ACCEPTED - DOMESTIC CASES (W61)

(Requested)

Caption: A Penalty Will Be Deducted From Payments

We have decided that  (1)  did not have a good reason for not giving us  (2)   (3)  report of earnings on time.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Name

Fill-in (2) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3) - Requested As A Date In Format Shown Below

Choice 1: CCYY

ERN069 PAYMENTS BASED ON ATTAINMENT OF FULL RETIREMENT AGE IN CURRENT OR PRIOR MONTH (W62)

(Requested)

Caption: Your Benefits

Because of  (1)  work in  (2)  , we cannot pay  (3)   (4)  . We will pay  (5)  for the month  (6)  full retirement age. In  (7)  case that is  (8)  . We will pay  (9)  for the month  (10)  full retirement age and the months after that.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: Name possessive

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

Choice 1: CCYY

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (4) - Requested As A Date In Format Shown Below

Choice 1: for MM/CCYY

Choice 2: for MM/CCYY and MM/CCYY

Choice 3: from MM/CCYY through MM/CCYY

Fill-in (5) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (6) - Systems Generated

Choice 1: you reach

Choice 2: he reaches

Choice 3: she reaches

Fill-in (7) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (8) - Systems Generated

Choice 1: age 65 or full retirement age

Note: this Fill-in is the FRA from FRA utility passed in skelcomp record as follow: FRA years + FRA months

Fill-in (9) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (10) - Systems Generated

Choice 1: you reach

Choice 2: he reaches

Choice 3: she reaches

ERN070 MONTHLY EARNINGS TEST APPLIES/BENEFICIARY EARNING EXEMPT AMOUNT OR LESS (W72)

(Requested)

Caption: Your Responsibilities

Please let us know right away if  (1)  more than  (2)  per month or if  (3)  will be active in self-employment.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you earn

Choice 2: Beneficiary's full name earns

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Monthly earnings limit

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

ERN071 DUAL ENTITLEMENT/SPOUSE BENEFIT WITHHELD BUT OWN “A” BENEFIT PAID (MAY BE USED ON AN AWARD OR ADJ. LETTER, CLOSED YEAR OR CURRENT YEAR) (W75)

(Requested)

Caption: Your Benefits

Because of  (1)  spouse's work and earnings, we cannot pay  (2)  a  (3)  benefit  (4)  . However, we will still pay  (5)  own retirement benefit.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: beneficiary's name possessive

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (3) - Requested As A One Position Alpha Character

Choice 1: (A) wife's

Choice 2: (B) husband's

Fill-in (4) - Requested As A Date In Format Shown Below

Choice 1: for MM/CCYY

Choice 2: for MM/CCYY and MM/CCYY

Choice 3: from MM/CCYY through MM/CCYY

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN072 BENEFITS RESUMED NO LONGER WORKING (W76)

(Requested)

Caption: Your Benefits

We are starting to pay  (1)  because  (2)  no longer working.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

ERN073 BENEFIT INCREASE TO NON-WORKING AUXILIARIES (W80)

(Requested)

Caption: Your Benefits

 (1)  is not due benefits because of  (2)  work and earnings. Therefore, we will pay  (3)  an increased benefit beginning  (4)  . This is the payment due  (5)  . The new benefit amount is  (6)  .

Fill-in values:

Fill-in (1) - Requested As A Language

Choice 1: Working Beneficiary's full name

Fill-in (2) - Systems Generated

Choice 1: his

Choice 2: her

Choice 3: your

Fill-in (3) - Requested As A One Position Alpha Character or Language

Choice 1: (A) you

Choice 2: (B) the children

Choice 3: the non-working beneficiary's first name

Fill-in (4) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY date of increase

Fill-in (5) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY payment was due

Fill-in (6) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: new monthly benefit amount

ERN074 BENEFITS WITHHELD PENDING RECEIPT OF ANNUAL REPORT (W83)

(Requested)

Caption: Things To Remember

We will decide whether  (1)  due any benefits for months before  (2)  , the month  (3)   (4)   (5)  after  (6)  let us know how much money  (7)  actually earned in  (8)  .

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 Date In Format Shown Below

Choice 1: MM/CCYY

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) - Requested As A One Position Alpha Character

Choice 1: (A) applied for benefits

Choice 2: (B) reached age 65

Choice 3: (C) reached full retirement age

Fill-in (5) - Systems Generated

Choice 1: Full Retirement Age as determined from FRA utility

Choice 2: Null

Fill-in (6) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

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: CCYY

ERN075 ANNUAL EARNINGS TEST APPLIES (W85)

(Requested)

Caption: Information About Work and Earnings

We will pay  (1)  benefits for the year after  (2)  based on the total amount  (3)  each year.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's full name

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

Choice 1: CCYY

Fill-in (3) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

ERN076 BENEFITS TO WORKING AUXILIARY STOPPED (W86)

(Requested)

Caption: Your Benefits

We told  (1)  earlier that  (2)  not due benefits because of  (3)  work and earnings, but that we would pay  (4)  instead of increasing the benefits to other family members.

For benefits payable beginning January 1996, we can no longer pay  (5)  the increase due other family members. We must pay them directly because of a change in the law.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary name

Fill-in (2) - Systems Generated

Choice 1: you are

Choice 2: Name is

Fill-in (3) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (4) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (5) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

ERN077 BENEFITS STOPPED DUE TO WORK OUTSIDE THE U.S. (W92)

(Requested)

Caption:

We cannot pay  (1)  benefits beginning  (2)  because  (3)  working outside the United States for more than 45 hours each month.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's full name

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

Choice 1: MM/CCYY

Fill-in (3) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

ERN078 FACILITY OF PAYMENT FOREIGN CASES (W94)

(Requested)

Caption: Your Benefits

 Because  (1)  working outside the United States for more than 45 hours each month,  (2)  not due benefits now. For this reason, the other members of the household are due  (3)  more money. We will pay  (4)  this amount instead of increasing the other benefits. However, since this money is really due the other family members, it should be used only for their needs.

 If  (5)  working or if  (6)  45 hours or less in any month, please let us know right away, because  (7)  may be eligible for benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you are

Choice 2: Beneficiary name is

Fill-in (2) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (3 - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount payable

Fill-in (4) - Systems Generated

Choice 1: you

Choice 2: her

Choice 3: him

Fill-in (5) - Systems Generated

Choice 1: you stop

Choice 2: she stops

Choice 3: he stops

Fill-in (6) - Systems Generated

Choice 1: you work

Choice 2: she works

Choice 3: he works

Fill-in (7) - Systems Generated

Choice 1: you

Choice 2: she

Choice 3: he

ERN079 ADDITIONAL PAYMENT DUE MEMBER OF OTHER HOUSEHOLD (W95)

(Requested)

Caption: Your Benefits

 (1)  due more money for  (2)  because of the work and earnings of another person who is getting benefits on this Social Security 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: CCYY

ERN080 BENEFITS WITHHELD DUE TO WORK OUTSIDE THE U.S (W99)

(Requested)

Caption: Your Benefits

We cannot pay  (1)  benefits  (2)  because  (3)  worked outside the United States for more than 45 hours each month.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary Name

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

Choice 1: for MM/CCYY

Choice 2: for MM/CCYY and MM/CCYY

Choice 3: from MM/CCYY through MM/CCYY

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

ERN081 POSSIBLE MOE CHANGE AFTER ANNUAL REPORT IS PROCESSED (W47)

(Requested)

Caption: Your Benefits

As  (1)  requested, the month of entitlement shown above may be changed after we receive and process  (2)  annual report of earnings. If  (3)  estimate of earnings for the year changes or there are one or more months in which  (4)  not work in self employment or for wages, please notify any Social Security office promptly.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name non possessive

Fill-in (2) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (4) - Systems Generated

Choice 1: you do

Choice 2: he does

Choice 3: she does

ERN082 FACILITY OF PAYMENT BENEFIT PAYABLE/ANOTHER BENEFICIARY STOPPED WORK OR REDUCED EARNINGS (W60)

(Requested)

Caption: Your Benefits

We can pay  (1)  because of a change in the earnings of  (2)  .

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (2) - Requested As A Language

Choice 1: Name of other beneficiary

ERN083 BENEFITS WITHHELD FOR MONTH(S) PRIOR TO FILING/ATTAINMENT OF FULL RETIREMENT AGE PENDING RECEIPT OF ANNUAL REPORT (W81)

(Requested)

Caption: Your Benefits

 (1)  are due benefits for  (2)  because  (3)  did not work during that period. Based on  (4)  estimated earnings of  (5)  for  (6)  ,  (7)  due  (8)  for  (9)  , and  (10)  due  (11)  full benefit for each month after that.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You are

Choice 2: Beneficiary's name is

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

Choice 1: MM/CCYY

Choice 2: MM/CCYY and MM/CCYY

Choice 3: MM/CCYY through MM/CCYY

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of the Estimate

Fill-in (6) - Requested As A Date In Format Shown Below

Choice 1: CCYY

Fill-in (7) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (8) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount

Fill-in (9) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Fill-in (10) - Systems Generated

Choice 1: are

Choice 2: is

Fill-in (11) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN084 (WB3) EARNINGS

(Requested)

Caption: Your Benefits

 (1)  current estimate of total earnings for  (2)  offset period this year is  (3)  .

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Your

Choice 2: Name possessive

Fill-in (2) - Systems Generated

Choice 1: your

Choice 2: Name possessive

Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Estimated total earnings for the offset period

ERN085 (WB4) EARNINGS

(Requested)

Caption: Your Benefits

 (1)  revised estimate of total earnings for  (2)  offset period this year is  (3)  .  (4)  previously estimated total earnings of  (5)  for this period.

Fill-in values: :

Fill-in (1) - Systems Generated

Choice 1: Your

Choice 2: Name possessive

Fill-in (2) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Revised estimate of total earnings for the offset period

Fill-in (4) - Systems Generated

Choice 1: You

Choice 2: Name

Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Previous estimate of total earnings for same period

ERN086 EARNINGS LIMIT INCREASED - BENEFITS DUE EARLIER BASED ON ESTIMATE (W10)

(Requested)

Caption: None

We are writing to let  (1)  know that the annual earnings test limit increased this year. The earnings limit is the amount  (2)  may earn in a year without causing a reduction in  (3)  benefits. Based on  (4)  estimate of  (5)  for this year, we told  (6)  that  (7)  benefits would begin  (8)  . Because the earnings limit was raised we can pay  (9)  benefits sooner.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you

Choice 2: beneficiary name

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (3) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (4) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) - Requested As A Money Amount In Format Shown Below

Choice 1: Estimate in $$$$$.¢¢ format

Fill-in (6) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (7) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

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

Choice 1: Month of entitlement in MM/CCYY format

Fill-in (9) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

ERN087 EARNINGS LIMIT INCREASED - ADDITIONAL BENEFITS DUE (W09)

(Requested)

Caption: None

We are writing to let  (1)  know that the annual earnings test limit increased this year. The earnings limit is the amount  (2)  may earn in a year without causing a reduction in  (3)  benefits. Based on  (4)  estimate of  (5)  for this year,  (6)  due more benefits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You

Choice 2: Beneficiary's name is

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (3) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (4) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Estimate in $$$$$.¢¢ format

Fill-in (6) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

ERN088 TO WORKING BENEFICIARY PAYMENT BASED ON ATTAINMENT OF FULL RETIREMENT AGE IN CURRENT OR PRIOR MONTH (W22)

(Requested)

Caption: Your Benefits

We withheld  (1)  benefits for  (2)  because of  (3)  earnings. We are paying  (4)  because  (5)  reached full retirement age. In  (6)  case that is  (7)  . We are paying  (8)  for the month  (9)  reached full retirement age and all later months.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: beneficiary name possessive

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

Choice 1: MM/CCYY

Choice 2: MM/CCYY and MM/CCYY

Choice 3: 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: him

Choice 3: her

Fill-in (5) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (6) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (7) - Systems Generated

Choice 1: FRA from FRA utility in format of (i.e., 66 and 2 months)

Fill-in (8) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (9) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

ERN089 SPOUSE REINSTATED AND COMBINED WITH OWN RETIREMENT BENEFIT/BASED ON N/H's WORK/EARNINGS (W07)

(Requested)

Caption: Your Benefits

Based on  (1)  spouse's work, we can pay  (2)   (3)  benefits beginning  (4)  . We will combine these benefits with  (5)  own retirement benefits, and send  (6)  one check each month.

 (7)  next check includes  (8)  benefits for  (9)  .

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (3) - Requested As A One Position Alpha Character

Choice 1: (A) husband's

Choice 2: (B) wife's

Fill-in (4) - Requested As A Date In Format Shown Below

MM/CCYY

Fill-in (5) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (6) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (7) - Systems Generated

Choice 1: Your

Choice 2: His

Choice 3: Her

Fill-in (8) - Systems Generated

Choice 1: husband's

Choice 2: wife's

Fill-in (9) - Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY and MM/CCYY

Choice 3: MM/CCYY through MM/CCYY

ERN090 EMPLOYER REPORTED EARNINGS USED TO DETERMINE BENEFITS DUE (W19)

(Requested)

Caption: Your Benefits

We adjusted  (1)   (2)  Social Security benefits based on earnings of  (3)  that  (4)  employer reported. We are writing to let  (5)  know that we will use the same amount of earnings to decide the benefits  (6)  due in  (7)  .

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: CCYY

Fill-in (3) Requested As A Money Amount in Format Shown Below

Choice 1: $$$$$.¢¢

Fill-in (4) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (6) – Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (7) - Systems Generated

Choice 1: CCYY

ERN091 EARNINGS COUNTED FOR MONTHS BEFORE FULL RETIREMENT AGE (W65)

(Requested)

Caption: You May Be Due More Benefits

Because  (1)  worked while getting Social Security, we reduced  (2)  benefits when  (3)  earned over certain limits each year. However,  (4)  may be due more Social Security benefits because of a rule that applies in the year when  (5)  full retirement age.

In the year  (6)  became  (7)  , which is  (8)  full retirement age; we count  (9)  earnings only for the months before  (10)   (11)  .

Therefore, if through  (12)   (13)  :

  • Less than the limit of  (14)  ,  (15)  due payments for all months.

  • More than the limit of  (16)  ,  (17)  due the amount left after we subtract $1 for every $3  (18)  over the limit.

Remember that, beginning with the month  (19)  full retirement age, the earnings test no longer applies. We will send  (20)  a form to find out how much  (21)  earned for the months before  (22)  reached  (23)  full retirement age. Once we receive  (24)  reply, we will pay  (25)  any additional benefits due.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you have

Choice 2: beneficiary name plus has

Fill-in (2) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

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: you reach

Choice 2: he reaches

Choice 3: she reaches

Fill-in (6) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (7) - Systems Generated

Choice 1: Full Retirement Age (i.e., 66 years and 2 months)

Fill-in (8) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (9) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (10) - Systems Generated

Choice 1: you reach

Choice 2: he reaches

Choice 3: she reaches

Fill-in (11) - Systems Generated

Choice 1: Full Retirement Age (i.e., 66 years and 2 months)

Fill-in (12) - Systems Generated

Choice 1: CCYY

Fill-in (13) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

Fill-in (14) - Systems Generated

Choice 1: Earnings Limit

Fill-in (15) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (16) - Systems Generated

Choice 1: Earnings Limit

Fill-in (17) - Systems Generated

Choice 1: you are

Choice 2: he is

Choice 3: she is

Fill-in (18) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

Fill-in (19) - Systems Generated

Choice 1: you reach

Choice 2: he reaches

Choice 3: she reaches

Fill-in (20) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (21) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (22) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (23) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (24) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (25) - Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

ERN092 BENEFITS PAYABLE IN CURRENT OR PRIOR YEAR BECAUSE OF NON-SERVICE MONTHS FOLLOWED BY SUSPENSION (W38)

(Requested)

Caption: Your Benefits

We can pay  (1)  benefits for  (2)  because  (3)   (4)   (5)  during  (6)  . We are withholding the rest of  (7)  benefits for  (8)  because of  (9)  work and earnings.

Please be sure to let us know right away if  (10)  work or earnings change, because changes would affect the amount of  (11)  benefits.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: beneficiary's name

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

Choice 1: MM/CCYY

Choice 2: MM/CCYY and MM/CCYY

Choice 3: MM/CCYY through (MM/CCYY

Fill-in (3) Systems Generated

Choice 1: you are not

Choice 2: he is not

Choice 3: she is not

Choice 4: you will not

Choice 5: he will not

Choice 6: she will not

Fill-in (4) Requested As A One Position Alpha Character

Choice 1: (A) earn more than

Choice 2: (B) earning more than

Choice 3: (C) perform substantial services in self employment

Choice 4: (D) performing substantial services in self-employment

Fill-in (5) Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢

Choice 1: (A) null

Choice 2: Amount

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

Choice 1: (A) that month

Choice 2: (B) those months

Choice 3: (C) each of those months

Fill-in (7) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

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

Choice 1: MM/CCYY

Choice 2: MM/CCYY and (MM/CCYY

Choice 3: MM/CCYY through (MM/CCYY

Fill-in (9) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (10) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (11) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ERN093 PARTIAL BENEFIT PAID TO AUXILIARY DUE TO WORKERS EARNINGS POSSIBLE FULL BENEFITS PAYABLE AFTER PARTIAL MONTH (W40)

(Requested)

Caption: Your Benefits

Because of  (1)  work and earnings, only a partial benefit is payable for  (2)   (3)   (4)  .

Fill-in values:

Fill-in (1) Requested As A One Position Alpha Character

Choice 1: (A) your husband's

Choice 2: (B) your wife's

Choice 3: (C) your former husband's

Choice 4: (D) your father's

Choice 5: (E) your mother's

Choice 6: (F) bene's name possessive + husband's

Choice 7: (G) bene's name possessive + wife's

Choice 8: (H) bene's name possessive + former husband's

Choice 9: (I) bene's name possessive + father's

Choice 10: (J) bene's name possessive + mother's

Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢

MM/CCYY of partial payment

Fill-in (3) Requested As A One Position Alpha Character

Choice 1: (A) null

Choice 2: (B) and your full benefit for each month thereafter

Choice 3: (C) and his full benefit for each month thereafter

Choice 4: (D) and her full benefit for each month thereafter

Choice 5: (E) and your full benefit for

Choice 6: (F) and his full benefit for

Choice 7: (G) and her full benefit for

Fill-in (4) Requested As A One Position Alpha Character or Date In Format Shown Below

Choice 1: (A) null

Choice 2: MM/CCYY

Choice 3: MM/CCYY and MM/CCYY

Choice 4: MM/CCYY through MM/CCYY

ERN094 NO BENEFITS DUE AUXILIARY BECAUSE OF NUMBER HOLDER'S WORK AND EARNINGS (W42)

(Requested)

Caption: Your Benefits

Because of  (1)  work and earnings, no benefits are payable at this time. If  (2)    work activity changes, some benefits may be payable to  (3) 

Fill-in values:

Fill-in (1) Requested As A One Position Alpha Character

Choice 1: (A) your husband's

Choice 2: (B) your wife's

Choice 3: (C) your former husband's

Choice 4: (D) your father's

Choice 5: (E) your mother's

Choice 6: (F) bene's name possessive + husband's

Choice 7: (G) bene's name possessive + wife's

Choice 8: (H) bene's name possessive + former husband's

Choice 9: (I) bene's name possessive + father's

Choice 10: (J) bene's name possessive + mother's

Fill-in (2) Systems Generated

Choice 1: his

Choice 3: her

Fill-in (3) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

ERNR09 LAG EARNINGS PENDING (E09)(C33)

(Requested)

Caption: Information About Work and Earnings; or Caption: Your Benefits

We used  (1)  earnings through  (2)  to figure the benefit amount. Later, we will refigure the benefit to include any earnings  (3)  had after  (4)  .  (5)  will not have to ask us to do this. After we have refigured the benefit amount, we will let you know about any increase.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Beneficiary's name

Choice 2: your

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

Choice 1: last year included in the computation

Fill-in (3) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) - Requested As A Year In Format CCYY

Choice 1: last year included in the computation

Fill-in (5) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

ERNR10 WAGES FROM EMPLOYER COULD NOT BE COUNTED (E50)

(Requested)

Caption: Your Benefits

We could not use the money received from  (1)  for  (2)  because  (3)  .

Fill-in values:

Fill-in (1) - Requested As A Language

Choice 1: employers name

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

Choice 1: year(s) CCYY

Fill-in (3) - Requested As A One Positi