ACT003 – PAPERWORK/PRIVACY ACT NOTICE PRINTED WHEN PAYMENT STUB IS PRINTED

Privacy Act Statement

The Social Security Administration (SSA) has authority to collect the information requested on the PAYMENT STUB under section 204 of the Social Security Act. Giving us this information is voluntary. You do not have to do it. We will need this information only if you choose to make payment by credit card. You do not need to fill out the credit card information if you choose another means of payment (for example, by check or money order).

If you choose the credit card payment option, we will provide the information you give us to the banks handling your credit card account and SSA's account. This will allow you to repay your overpayment with your credit card. We may also provide this information to another person or government agency to comply with federal laws requiring the release of information from our records. You can find these and other routine uses of information provided to SSA listed in the Federal Register. If you want more information about this, you may call or write any Social Security office.

We may also use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, State, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it.

Explanations about these and other reasons why information you provide us may be used or given out are available in Social Security offices. If you want to learn more about this, contact any Social Security office.

ADJ048 – UNDERPAYMENT TRANSFERRED FROM DECEASED BENEFICIARY TO SPOUSE

(1) will soon receive a payment of (2) because we owed money to (3). This payment is in addition to any monthly payments (4) may receive.

AETC02 – CAPTION

You May Be Due More Benefits

AETC06 – CAPTION

What We Will Do

AETC07 – CAPTION

The Yearly Earnings Limit

AETC08 – CAPTION

A Special Rule That Applies To Earnings In One Year

AETC09 – CAPTION

If Your Expected Earnings Change

AETC10 – CAPTION

If You Work For Wages

AETC11 – CAPTION

If You Are Self-Employed

AETC12 – CAPTION

If You Work For Wages and Are Self-Employed

AETC14 – CAPTION

How We Calculate Earnings

If You Work For Wages and Are Self-Employed

AETH01 – HEADER

How Work Affects Your Social Security

AETH02 – HEADER

How To Estimate Earnings

AET036 – INFORMATIONAL PARAGRAPH TO THE BENEFICIARY ABOUT HOW EARNINGS HAVE AFFECTED HIS OR HER SOCIAL SECURITY BENEFITS

Please read the rest of this letter carefully. In it, we explain the changes we are making to (1) benefits. We also tell you how (2) earnings have affected (3) benefits and what to do if you disagree with any of our decisions.

AET037 – REFER TO WORKSHEET HEADER NL 00730.149D

AET038 – PROVIDES THE LAST MONTHLY EARNINGS TEST YEAR’S INCOME LIMITS AND THE BENEFICIARY'S NON-SERVICE MONTHS FOR THE LAST MONTHLY EARNINGS TEST YEAR

In addition, you told us that (1) did not (2) more than (3) a month and did not work over 45 hours a month in self-employment (4) (5).

AET039 – INTRODUCTORY PARAGRAPH FOR THE BENEFICIARY ABOUT THE ANNUAL EARNINGS LIMIT FOR SPECIFIC YEARS

The earnings limit for (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11). If (12) over the allowed amount for the year, we withhold $1 in benefits for every (13) (14) above the limit. We have enclosed a worksheet to show how we applied the earnings limit to (15) earnings to figure (16) benefits.

For more information about the earnings limit, see the enclosed fact sheet called, "How Work Affects Your Social Security."

AET040 – PARAGRAPH TO A NON-RESPONDER (NRP) WITH A MID-YEAR MAILER INDICATOR ON THE MASTER BENEFICIARY RECORD (MBR) EXPLAINING THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR, WE WILL USE LAST YEAR'S EARNINGS AS THE CURRENT YEAR ESTIMATE

Earlier we asked you to estimate (1) earnings for (2). We need this estimate to decide how much Social Security benefits to pay (3) for (4). We have not heard from you. Unless you contact us with a new estimate, we will use the same estimate we used in (5) to decide (6) benefits for (7).

AET041 – PARAGRAPH TO A NON-RESPONDER (NRP) WITH NO MID-YEAR MAILER INDICATOR ON THE MASTER BENEFICIARY RECORD (MBR) EXPLAINING THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR. WE WILL USE LAST YEAR’S EARNINGS AS THE CURRENT YEAR ESTIMATE.

We base the amount of Social Security benefits (1) due on (2) estimated earnings. In (3), (4) earnings estimate was (5). Unless you contact us with a new estimate, we will use that same estimate to decide (6) benefits for (7).

AET042 – PARAGRAPH TO A WORKING BENEFICIARY THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR, WE WILL USE THE EARNINGS REPORTED BY HIS OR HER EMPLOYER LAST YEAR AS THE CURRENT YEAR ESTIMATE.

In (1), we based the amount of (2) Social Security benefits on earnings of (3) that (4) employer reported. We will use the same amount of earnings to decide (5) benefits in (6). That is, unless you contact us with a new estimate of (7) expected earnings for (8).

AET043 – REQUEST TO BENEFICIARY ASKING THEM TO NOTIFY SOCIAL SECURITY ADMINISTRATION IF HIS OR HER WORK ESTIMATE IS NOT CORRECT

(1) work plans may have changed and we want to make sure that we are paying (2) correctly. So, please check (3), and let us know right away if you think (4) will earn more or less than (5) in (6).

AET044 – EXPLAINS TO A DIVORCED AUXILIARY SPOUSE THAT A FORMER SPOUSE'S WORK NO LONGER AFFECTS BENEFITS

(1) told us (2) divorce was final in (3). Once (4) been divorced for 2 years, (5) former spouse’s work no longer affects (6) benefits. Therefore, beginning (7), we will no longer withhold or reduce (8) benefits because of (9) former spouse's work.

AET045 – REFER TO WORKSHEET HEADER NL 00730.149A

AET046 – REFER TO WORKSHEET HEADER NL 00730.149A

AET047 – REFER TO WORKSHEET HEADER NL 00730.149A

AET048 – REFER TO WORKSHEET HEADER NL 00730.149B

AET049 – REFER TO WORKSHEET HEADER NL 00730.149B

AET050 – REFER TO WORKSHEET HEADER NL 00730.149B

AET051 – REFER TO WORKSHEET HEADER NL 00730.149D

AET052 – REFER TO WORKSHEET HEADER NL 00730.149D

AGE002 – EXPLANATION OF FULL RETIREMENT AGE (FRA) ATTAINMENT WHEN BORN ON THE FIRST DAY OF THE MONTH

Because (1) born on the first day of the month, we consider (2) (3) the month before.

ALSC04 – CAPTION

If You Disagree With The Decision

ALSC06 – CAPTION

Do You Think We Are Wrong About The Overpayment

ALS017 – APPEALS LANGUAGE FOR MONTHLY BENEFIT PAYABLE (MBP) CHANGE DUE TO A THIRD-PARTY ACTION

If you disagree with the change we have made to (1) monthly payment, you have the right to appeal. We will review your case and look at any new facts you have. A person who did not make the first decision will decide your case.

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  You have 60 days to ask for an appeal.

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  The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

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  You must have a good reason if you wait more than 60 days to ask for an appeal.

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  You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2, called “Request for Reconsideration”. Contact one of our offices if you want help.

ALS020 – GENERAL APPEALS LANGUAGE

If you do not agree with this decision, you have the right to appeal. We will review your case and look at any new facts you have. A person who did not make the first decision will decide your case. We will review the parts of the decision that you think are wrong and correct any mistakes. We may also review the parts of our decision that you think are right. We will make a decision that may or may not be in your favor.

• •

  You have 60 days to ask for an appeal in writing.

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  The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

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  You must have a good reason if you wait more than 60 days to ask for an appeal.

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  You must ask for an appeal in writing. Please use our "Request for Reconsideration" form, SSA-561-U2. You may go to our website at (1) to locate the form. You can also contact us to request the form, or if you need help filling out the form.

ALS100 – PAYMENTS WILL CONTINUE WHILE THE APPEAL OF MEDICAL CESSATION IS PENDING

(1) entitled to have (2) payments continued until we notify (3) of the appeal decision made on (4) case. If (5)(6) appeal, (7) may have to pay some, or all, of this money back unless we are able to waive repayment.

ANP003 – BENEFICIARY OUTSIDE U.S. (Pub-05-10137)

Please read the enclosed pamphlet, “Social Security: Your Payments While You Are Outside the United States.” It explains what (1) will need to do to start receiving payments again.

ASTC02 – CAPTION

Information About (1) Installment Payment

ATYC01 – CAPTION

Information About Representatives Fees

ATYC03 – CAPTION

Information About Past-Due Benefits Withheld To Pay A Representative

ATY067 – SUPPLEMENTAL SECURITY INCOME OFFSET HAS BEEN DETERMINED – PAST DUE BENEFITS BEING RELEASED TO BENEFICIARY AND REPRESENTATIVE HAS NOT REGISTERED FOR DIRECT PAYMENT

If a representative, who is a (1), registers with us to receive direct fee payment, because of the law we usually withhold part of the past-due benefits to pay the fee we approve. Although (2) representative is a (3), he or she did not register for direct payment before we completed our work on (4) claim. For that reason, we did not withhold from (5) past-due benefits to pay the fee we approve. Therefore, the Social Security Administration is not involved in paying the fee. This is a matter between (6) and (7) (8).

ATY836 – EXPLANATION TO THE BENEFICIARY ABOUT THE WITHHOLDING OF REPRESENTATIVE FEES FROM PAST-DUE BENEFITS

Based on the law, we must withhold part of past-due benefits to pay an appointed representative. We cannot withhold more than 25 percent of past-due benefits to pay an authorized fee. We withheld (1) from (2) past-due benefits to pay (3) representative.