BASIC (05-11)

NL 00720.190 INS Insured Status

INS001 MEDICAL INSURANCE BENEFICARY (BIC M) - NO HOSPITAL OR FULLY INSURED STATUS (Q03)

(Requested)

Caption: Your Benefits

 (1)  not worked long enough under Social Security to receive monthly benefits or premium free hospital insurance under Medicare.

Work under Social Security is figured in credits. Please read the enclosed pamphlet, “How You Earn Social Security Credits”, which explains how the credits are earned and how many a person needs to receive benefits.

To qualify for monthly benefits  (2)  a total of  (3)  work credits. For hospital insurance,  (4)   (5)  credits.  (6)  earned  (7)  credits.

 (8)  may earn the additional credits  (9)  by working under Social Security. If  (10)  the credits,  (11)  should get in touch with us to apply again.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You have

Choice 2: Beneficiary's Name has

Fill-in (2) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (3) – Requested As A Number

Choice 1: Number of quarters for insured status

Fill-in (4) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (5) – Requested As A Number

Choice 1: Number of quarters for HI coverage

Fill-in (6) - Systems Generated

Choice 1: You have

Choice 2: He has

Choice 3: She has

Fill-in (7) – Requested As A Number

Choice 1: Number of acquired quarters

Fill-in (8) - Systems Generated

Choice 1: You

Choice 2: He

Choice 3: She

Fill-in (9) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (10) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

Fill-in (11) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

INS002 CLAIMANT NEITHER FULLY INSURED NOR INSURED FOR HI (Q06)

(Requested)

Caption: Your Benefits

Neither monthly benefits nor premium–free Hospital Insurance benefits are payable at this time because  (1)  not worked long enough under Social Security. To qualify for monthly benefits,  (2)  credit for  (3)  calendar quarters of work. For Hospital Insurance benefits  (4)   (5)  quarters. Our records show that  (6)   (7)  . The enclosed leaflet explains how a person earns Social Security work credits. If  (8)  the additional quarters, please contact any Social Security office promptly.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you have

Choice 2: Beneficiary's Name has

Fill-in (2) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (3) – Requested As A Number

Choice 1: Number of required quarters for fully insured status

Fill-in (4) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (5) – Requested As A Number

Choice 1: Number of required quarters for HI status

Fill-in (6) - Systems Generated

Choice 1: you now have

Choice 2: he now has

Choice 3: she now has

Fill-in (7) - Requested As A Number

Choice 1: Number of acquired quarters

Fill-in (8) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

INS003 BENE DOES NOT QUALIFY FOR REGULAR OR TRANSITIONAL BENEFITS - NOT ENOUGH QUARTERS (Q10)

(Requested)

Caption: Your Benefits

Benefits are not payable at this time because  (1)  not worked long enough under Social Security. To qualify for regular monthly benefits,  (2)  credit for  (3)  calendar quarters of work or for transitional monthly benefits  (4)   (5)  quarters. Our records show that  (6)   (7)  . The enclosed leaflet explains how a person earns Social Security work credits. If  (8)  the additional quarters and can furnish proof of  (9)  age, please contact any Social Security office promptly.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you have

Choice 2: Beneficiary's Name has

Fill-in (2) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (3) – Requested As A Number

Choice 1: Number of required quarters for fully insured status

Fill-in (4) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (5) – Requested As A Number

Choice 1: Number of quarters required for transitionally insured status

Fill-in (6) - Systems Generated

Choice 1: you now have

Choice 2: he now has

Choice 3: she now has

Fill-in (7) – Requested As A Number

Choice 1: Number of acquired quarters

Fill-in (8) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

Fill-in (9) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

INS004 SURVIVOR BENEFITS NOT PAYABLE - DECEASED DID NOT HAVE ENOUGH QUARTERS (Q14)

(Requested)

Caption: Your Benefits

Survivor benefits are not payable on this record because  (1)  did not work long enough under Social Security. To qualify,  (2)  needed credit for either a total of  (3)  calendar quarters of work or at least 6 quarters of work in the 13-quarter period ending with death. Since our records show that  (4)  has credit for a total of  (5)  quarters of work and  (6)  in the 13-quarter period, neither of these requirements is met. The enclosed leaflet explains how a person earns Social Security work credits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: your husband

Choice 2: your former husband

Choice 3: your father

Choice 4: your mother

Choice 5: your wife

Fill-in (2) - Systems Generated

Choice 1: he

Choice 2: she

Fill-in (3) – Requested As A Number

Choice 1: Number of quarters for fully insured status

Fill-in (4) - Systems Generated

Choice 1: he

Choice 2: she

Fill-in (5) – Requested As A Number

Choice 1: Number of acquired quarters

Fill-in (6) – Requested As A Number

Choice 1: Number of acquired quarters in 13-quarter period

INS005 BENEFITS NOT PAYABLE - DID NOT WORK LONG ENOUGH UNDER U.S. SOCIAL SECURITY SYSTEM (Q15)

(Requested)

Caption: Your Benefits

Benefits are not payable at this time based on  (1)  work covered by the United States because  (2)  not worked long enough under the United States Social Security system. To qualify for  benefits,  (3)  credit for  (4)  calendar quarters of work. Our records show that under the United States Social Security system  (5)   (6)  .

The enclosed leaflet explains how  (7)  can earn Social Security work credits. If  (8)  the additional quarters of work, please contact any Social Security office right away.

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 have

Choice 2: he has

Choice 3: she has

Fill-in (3) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (4) – Requested As A Number

Choice 1: Number of required quarters of coverage

Fill-in (5) - Systems Generated

Choice 1: you now have

Choice 2: he now has

Choice 3: she now has

Fill-in (6) - Requested As A Number

Choice 1: Number of acquired quarters of coverage

Fill-in (7) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (8) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

INS006 NH NOT INSURED FOR MEDICARE (Q18)

(Requested)

Caption: Your Benefits

 (1)  not eligible for Medicare coverage at this time because  (2)  not have enough work credits. To qualify,  (3)  credit for  (4)  calendar quarters of work. Our records show that  (5)   (6)  . Government employees earn Medicare work credits for their Government employment in the same way Social Security credits are earned for non-Government employment. The enclosed leaflet explains how a person earns Social Security credits. If  (7)  the additional quarters, please contact any Social Security office promptly.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You are

Choice 2: Beneficiary's Name is

Fill-in (2) - Systems Generated

Choice 1: you do

Choice 2: he does

Choice 3: she does

Fill-in (3) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (4) - Requested As A Number

Choice 1: Required Government employment QCs

Fill-in (5) - Systems Generated

Choice 1: you now have

Choice 2: he now has

Choice 3: she now has

Fill-in 6 - Requested As A Number

Choice 1: Acquired Government employment QCs

Fill-in 7 - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

INS007 BENEFITS NOT PAYABLE - NOT ENOUGH QUARTERS TO BE FULLY OR CURRENTLY INSURED (Q17)

(Requested)

Caption: Your Benefits

Benefits are not payable on this record because  (1)  did not have enough work under Social Security to be fully or currently insured. To be fully insured, a total of  (2)  calendar quarters of work are needed. Our records show that this requirement has not been met. To be currently insured, at least 6 calendar quarters of work in the 13-quarter period ending in death are needed. Our records show that  (3)  has  (4)  . Since neither of these requirements are met, no benefits are payable. The enclosed leaflet explains how a person earns Social Security work credits.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: NH's name

Fill-in (2) - Requested As A Number

Choice 1: Number of required quarters for fully insured status

Fill-in (3) - Systems Generated

Choice 1: he

Choice 2: she

Fill-in (4) - Requested As A Number

Choice 1: Number of acquired quarters of coverage in the 13-quarter period

INS008 NO BENEFITS PAYABLE - NOT ENOUGH QUARTERS EARNED BASED ON DOB(Q05)

(Requested)

Caption: Your Benefits

Benefits are not payable at this time because  (1)  not worked long enough under Social Security. Based on the date of birth  (2)  gave us,  (3)  credit for  (4)  calendar quarters of work. Our records show that  (5)     (6)  . The enclosed leaflet explains how a person earns Social Security work credits. If  (7)  the additional quarters and can furnish proof of  (8)  age, please contact any Social Security office promptly.

Enclosure: SSA-10072

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you have

Choice 2: Beneficiary's Name +has

Fill-in (2) - Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (3) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (4) - Requested As A Number

Choice 1: Number of quarters required for insured status

Fill-in (5) - Systems Generated

Choice 1: you now have

Choice 2: he now has

Choice 3: she now has

Fill-in (6) - Requested As A Number

Choice 1: Number of acquired quarters

Fill-in (7) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

Fill-in (8) - Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

INS017 SPOUSE OR CHILD CLAIMANT - NH NOT INSURED FOR MEDICARE BASED ON UNPROVEN DATE OF BIRTH (Q22)

Caption: Your Benefits

Requested

 (1)  not eligible for Medicare coverage at this time because  (2)   does not have enough work credits. Based on the date of birth given us,  (3)   needs credit for  (4)   calendar quarters of work. Our records show that  (5)  has  (6)  calendar quarters.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You are

Choice 2: Beneficiary Name plus is

Fill-in (2) - Systems Generated

Choice 1: Number holder name

Fill-in (3) - Systems Generated

Choice 1: he

Choice 2: she

Fill-in (4) - Requested As A Number

Choice 1: Required Government employment QCs

Fill-in (5) - Systems Generated

Choice 1: Number holder name

Fill-in (6) - Requested As A Number

Choice 1: Acquired Government employment QCs

INS018 NO BENEFITS PAYABLE - NOT ENOUGH QUARTERS EARNED (Q02)

(Requested)

Caption: Your Benefits

Benefits are not payable at this time because  (1)  not worked long enough under Social Security. To qualify,  (2)  credit for  (3)  calendar quarters of work. Our records show that  (4)   (5)  . The enclosed leaflet explains how a person earns Social Security work credits. If  (6)  the additional quarters, please contact any Social Security office promptly.

Enclosure:

SSA-10072

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: you have

Choice 2: Beneficiary's Name + has

Fill-in (2) - Systems Generated

Choice 1: you need

Choice 2: he needs

Choice 3: she needs

Fill-in (3) - Requested As A Number

Choice 1: Number of required quarters for fully insured status (zero suppressed)

Fill-in (4) - Systems Generated

Choice 1: you now have

Choice 2: he now has

Choice 3: she now has

Fill-in (5) - Requested As A Number

Choice 1: Number of acquired quarters (zero suppressed)

Fill-in (6) - Systems Generated

Choice 1: you earn

Choice 2: he earns

Choice 3: she earns

INS021 AUXILIARY CLAIMANT NOT INSURED ON OWN RECORD (C23)

(Requested)

Caption: Other Social Security Benefits

 (1)   (2)  not worked long enough under Social Security to receive benefits  (3)  .

Work under Social Security is figured in credits. Please read the enclosed pamphlet, "How You Earn Social Security Credits," which explains how the credits are earned and how many a person needs to receive benefits.

To qualify for benefits,  (4)   (5)  a total of  (6)  work credits.  (7)   (8)  earned  (9)  credits, and still  (10)   (11)   (12)  more. These figures are based on  (13)   (14)  ,  (15)  .

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You

Choice 2: number holder's fullname

Fill-in (2) - Systems Generated

Choice 1: have

Choice 2: has

Fill-in (3) - Systems Generated

Choice 1: on your own record

Choice 2: on his own record

Choice 3: on her own record

Fill-in (4) - Systems Generated

Choice 1: you

Choice 2: she

Choice 2: he

Fill-in (5) - Systems Generated

Choice 1: need

Choice 2: needs

Fill-in (6) – Requested As A Number

Required QCs

Fill-in (7) - Systems Generated

Choice 1: You

Choice 2: She

Choice 2: He

Fill-in (8) - Systems Generated

Choice 1: has

Choice 2: have

Fill-in (9) - Requested As A Number

earned QCs

Fill-in (10) - Systems Generated

Choice 1: need

Choice 2: needs

Fill-in (11) – Requested As a Number

quarters still needed

Fill-in (12) - Systems Generated

Choice 1: credit

Choice 2: credits

Fill-in (13) - Requested As A One Position Alpha Character

Choice A: the date of birth

Choice B: your

Choice C: Mr plus NH-NAME, possessive

Choice D: Ms plus NH-NAME, possessive

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

Choice A: NULL

Choice B: corrected date of birth

Choice C: date of birth

Fill-in (15) - Systems Generated

Choice 1: number holder's date of birth


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720190
NL 00720.190 - INS Insured Status - 01/25/2012
Batch run: 01/25/2012
Rev:01/25/2012