TN 2 (09-11)

NL 00720.250 PAY Payment

PAY032 DUAL ENTITLEMENT (CHECKS COMBINED) — AUXILIARY/SURVIVOR AWARD AFTER PRIMARY (A42)

(Requested)

Caption: What We Will Pay

 (1)  benefit is  (2)  as a  (3)  . This is in addition to the benefit of  (4)  on  (5)  own earnings record.

 


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: Your
Choice 2: His
Choice 3: Her
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount
Fill-in (3) Systems Generated
Choice 1: (A) wife
Choice 2: (B) husband
Choice 3: (C) widow
Choice 4: (D) widower
Choice 5: (E) mother
Choice 6: (F) father
Choice 7: (G) disabled widow
Choice 8: (H) disable widower
Choice 9: (I) disabled divorced widow
Choice 11: (J) disabled divorced widower
Choice 12: (K) child
Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
Amount
Fill-in (5) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

PAY067 PMA PAYMENT REDUCED BY AMOUNT OF CRITICAL PAYMENT (B55)

(System Generated)

Caption: What We Will Pay

We will subtract  (1)  from your next check. This is the amount we paid you before we finished work on  (2)  claim.


Fill-in values:
Fill-in (1)
CPA in format 99,999.99
Fill-in (2)
Choice 1: your
Choice 2: Beneficiary's Name Possessive

PAY068 CMA ONLY PAYMENT DUE - CRITICAL PAYMENT DEDUCTION MADE (B58)

(System Generated)

Caption: What We Will Pay

When we figured how much to pay you through  (1)  , we subtracted the money which we already paid you while we finished work on  (2)  claim.


Fill-in values:
Fill-in (1)
If LAF equals C: CMA minus one month in format January 1993. If LAF does not equal C: find first EFD with equal RFD to current LAF and is greater than DOEC. This Fill-ins is EFD minus one month in format January 1993.
Fill-in (2)
Choice 1: your
Choice 2: full name Possessive

PAY072 EXPLANATION THAT FIRST CHECK INCLUDES AN INSTALLMENT AMOUNT (B50)

(Requested)

Caption: What We Will Pay

This check includes  (1)  regular monthly payment of  (2)  for  (3)  .


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (2) Systems Generated
Amount
Fill-in (3) Systems Generated
Month and Year

PAY073 PAYMENT OF PAST-DUE BENEFITS WILL BE PAID IN INSTALLMENTS (B51)

(Requested)

Caption: What We Will Pay

 (1)  still due back payments of  (2)  for past months.  (3)  will receive this money over a period of months. We will send  (4)   (5)  more each month with  (6)  regular payment until all of the extra money is paid.


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
amount of past due benefit payable
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (4) Systems Generated
amount of installment
Fill-in (5) Systems Generated
Choice 1: your
Choice 2: her
Choice 3: his
Fill-in (6) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her

PAY161 CMA or MBP = $0.00 After Adjustments (G07)

(System Generated)

Caption: None

No payment is due at this time because of adjustments made to  (1)  benefits.


Fill-in values:
Fill-in (1)
Choice 1: his
Choice 2: her
Choice 3: your
Choice 4: Beneficiary's Name

PAY176 IRMAA – CHANGE RESULTS IN PREMIUM REFUND (HB2)

(Requested/Generated)

Caption: What We Will Pay and Why

Based on the information we have,  (1)   (2)  due a Medicare Part B premium refund.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: Beneficiary's Name
Choice 2: you
Fill-in (2) Systems Generated
Choice 1: is
Choice 2: are

PAY180 CHECK PARAGRAPH USED WHEN ARF AND/OR DRC NOT PROPERLY APPLIED (B20)

(System Generated)

Caption: What We Will Pay

 (1)  next check for  (2)  includes additional benefits through  (3)  .

After that,  (4)  will receive a new regular monthly payment of  (5)  .


Fill-in values:
Fill-in (1)
Choice 1: Your
Choice 2: Beneficiary's name possessive
Fill-in (2)
Amount
Fill-in (3)
Month/Year (PMA)
Fill-in (4)
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5)
Amount of new MPA

PAY181 PAYMENT RESUMED AFTER SOME WITHHOLDING (M15)

(Requested)

Caption: Your Benefits

Since we withheld  (1)  , we can pay  (2)  beginning  (3) 


Fill-in values:
Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
Amount
Fill-in (2) Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (3) Requested As A Date In Format Shown Below
MM/CCYY

PAY182 PAYMENT STOPPED (M16)

(Requested)

Caption: Your Benefits

We are stopping  (1)  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
MM/CCYY

PAY183 ADDITIONAL WITHHOLDING REQUIRED (M18)

(Requested)

Caption: Your Benefits

Since we withheld  (1)  , we must withhold  (2)  more.


Fill-in values:
Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
Amount
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount

PAY184 INCORRECT EARNINGS OVERPAYMENT CAUSED BY REDUCTION IN BENEFIT AMOUNT (M26)

(Requested)

Caption: Your Benefits

We reviewed our records, and found that a mistake was made when  (1)  benefit amount was increased. In  (2)   (3)  earned  (4)  instead of  (5)  , which was the amount we used when we figured  (6)  payment. We have now corrected our records, and found that we paid  (7)   (8)  too much in benefits.


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
CCYY erroneous earnings posted
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
Amount of correct earnings
Fill-in (5) Requested As A Money Amount In Format $$$$$.¢¢
Amount of incorrect earnings
Fill-in (6) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (8) Requested As A Money Amount In Format $$$$$.¢¢
Amount of overpayment

PAY212 INITIAL PARTIAL AWARD/PARTIAL MONTH BENEFITS PAID (B78)

(Requested)

Caption: Your Benefits

We used  (1)   (2)   (3)   (4)   (5)  to decide how much to pay  (6)  . We are still working on  (7)  claim. When we make a final decision about the  (8)  , we will figure the amount of  (9)  payments. We will send you another letter to let you know if there will be any change in  (10)  payments.


Fill-in values:
Fill-in (1) Requested As A One Position Alpha Character
Choice 1: (A) a date of birth of
Choice 2: (B) a date of marriage of
Choice 3: (C) wages through
Fill-in (2) Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/DD/CCYY
Fill-in (3) Requested As A One Position Alpha Character
Choice 1: (A) for
Choice 2: (B) null
Fill-in (4) Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Choice 3: null
Fill-in (5) Requested As A One Position Alpha Character
Choice 1: (A) husband
Choice 2: (B) null
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: (A) date of birth
Choice 2: (B) wages
Choice 3: (C) date of marriage
Fill-in (9) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (10) Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive

PAYB15 SINGLE PAYMENT FOLLOWED BY SUSPENSION/TERMINATION (B29)

(Requested)

Caption: What We Will Pay

 (1)  will receive  (2)  around  (3)  . This is the money, after all deductions,  (4)  due for  (5)  .


Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (2) - Systems Generated
Amount of benefits after deductions
Fill-in (3) - Systems Generated
MM/DD/CCYY
Fill-in (4) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (5) - Systems Generated
MM/CCYY

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720250
NL 00720.250 - PAY Payment - 07/10/2015
Batch run: 03/29/2017
Rev:07/10/2015