TN 17 (08-14)

NL 00730.106 “C” Paragraphs and Captions

List of “C” Paragraphs and Captions

A. “CDB” Universal Text Identifier – Childhood Disability Benefits

CDB003 – USED ON CHILDHOOD DISABILITY BENEFIT (CDB) AWARDS TO EXPLAIN TRIAL WORK PERIOD

If (1) (2) while (3) (4) still disabled, (5) may qualify for a trial work period to test (6) ability to work. During this period, (7) may work 9 months, sometimes more, and not lose Social Security disability payments because of the work, no matter how much (8).

To end the trial work period, the 9 months of work must take place in a 60-month period. The months do not have to be in a row. After the trial work period has ended, we will look at the work (9) did and decide if (10) (11) still disabled. The pamphlet described below has more information about the trial work period and other rules that may help (12) return to work.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

Fill-in (2)

 

Choice 1

works

Choice 2

work

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

is

Choice 2

are

Fill-in (5)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (6)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (7)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (8)

 

Choice 1

he earns

Choice 2

she earns

Choice 3

you earn

Fill-in (9)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (10)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (11)

 

Choice 1

is

Choice 2

are

Fill-in (12)

 

Choice 1

him

Choice 2

her

Choice 3

your

B. “CDR” Universal Text Identifiers – Childhood Disability Review

CDR001 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD - MEDICAL EXAM IN 3 YEARS

Doctors and other trained staff decided that (1) (2) disabled under our rules.

But, this decision must be reviewed at least once every 3 years. We will send you a letter before we start the review. Based on that review, (3) benefits will continue if (4) still disabled, but will end if (5) no longer disabled.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (5)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

CDR002 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD - MEDICAL EXAM IN 5–7 YEARS

Doctors and other trained staff decided that (1) (2) disabled under our rules.

However, we must review all disability cases. Therefore, we will review (3) case in 5 to 7 years. We will send you a letter before we start the review.

Based on that review, (4) benefits will continue if (5) still disabled, but will end if (6) no longer disabled.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (6)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

CDR004 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD – DISABILITY NOT PERMANENT

The doctors and other trained personnel who decided that (1) (2) disabled expect (3) health to improve. Therefore, we will review (4) case in the future.

We will send you a letter before we start the review. Based on that review, (5) benefits will continue if (6) (7) still disabled, but will end if (8) (9) no longer disabled.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (6)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (7)

 

Choice 1

is

Choice 2

are

Fill-in (8)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (9)

 

Choice 1

is

Choice 2

are

CDR063 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) SUSPENDED - FAILURE TO COOPERATE

We cannot pay (1) benefits because our records show that (2) did not return information we asked for concerning (3) disability.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

Fill-in (2)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

CDR065 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) SUSPENDED - FAILURE TO COOPERATE

If we stop (1) Social Security disability benefits and you do not give us the information we asked for before (2), (3) will have to file a new application to get Social Security disability benefits again. If we do not hear from you by this date, we will send you another letter which will give you the information about (4) appeal rights.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)

Choice 2

your

Fill-in (2)

Add 12 months to the first effective date in History data that corresponds to the
ongoing Continuing Disability Review (CDR) Failure to Cooperate (FTC) suspension
and display in the format Month CCYY

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

CDR066 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) TERMINATED FOR FAILURE TO COOPERATE

(1) no longer (2) for Social Security disability benefits beginning (3) because our records show that (4) did not return information we asked for during (5) continuing disability review.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

You

Fill-in (2)

 

Choice 1

qualifies

Choice 2

qualify

Fill-in (3)

Historical Date of Entitlement Termination (BCLM-DOETERM-REL) - this date
corresponds to the first effective date in History (HIST) data on the
post-MBR of the Continuing Disability Review (CDR) Failure to Cooperate (FTC) for
PIC A or W or the CDR FTC for PIC C in the format Month CCYY)

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

CDR067 – ADVISES AUXILIARY THAT BENEFITS ARE TERMINATED DUE TO NUMBER HOLDER'S FAILURE TO COOPERATE

We can no longer pay (1) benefits because (2) no longer qualifies for Social Security disability benefits beginning (3).

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

Fill-in (2)

NH-NAME

Fill-in (3)

Historical Date of Entitlement Termination (BCLM-DOETERM-REL) that
corresponds to the first effective date in History (HIST) data for the Disability
Insurance Benefits Cessation (DIBCES) termination which is used for an
auxiliary when the Number Holder fails to cooperate

C. “CFD” Universal Text Identifiers – Conserved Funds

CFDC02 – CAPTION

If You Saved Any Money

CFD003 – CONSERVED FUNDS REQUESTED FROM FORMER PAYEE

While you were (1) payee, you may have saved some money for (2). If you have, you should return it to us unless you have already made other plans with us for handling it. The money you will need to return includes:

  1. Interest earned from these savings and investments.

  2. Money you have left over from any checks we sent you.

  3. Any checks you might receive after the date of this letter.

Fill-in values:

Fill-in (1)

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Fill-in (2)

 

Choice 1

him

Choice 2

her

CFD004 – TELLS FORMER PAYEE HOW TO RETURN CONSERVED FUNDS

To do this, you can write us a check or money order. Make it out to the Social Security Administration. Be sure to write “Conserved Funds for (1), (2)” on that check or money order. Please mail it in the enclosed envelope.

Fill-in values:

Fill-in (1)

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Fill-in (2)

Claim Number plus Payment Identification Code (PIC)

D. “CHK” Universal Text Identifiers – Information about Checks

CHKC05 – CAPTION

When We Begin Your Payments Again

CHKC09 – CAPTION

Your Benefits

CHKC10 – CAPTION

Information About Your Checks

E. “CIC” Universal Text Identifiers – Child in Care

CIC006 – AGED SPOUSE MONTHLY BENEFIT AMOUNT IS CHANGING BECAUSE A CHILD HAS LEFT THE SPOUSE’S CARE

We changed (1) monthly benefit to (2) beginning (3). We changed 4) benefit because (5) no longer (6) a child who is entitled to benefits in (7) care.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)

Choice 2

your

Fill-in (2)

Monthly Benefit Amount (MBA) in the format $$$$$.¢¢

Fill-in (3)

Effective date of Monthly Benefit Amount (MBA) change in the format Month CCYY

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (6)

 

Choice 1

has

Choice 2

have

Fill-in (7)

 

Choice 1

his

Choice 2

her

Choice 3

your

CIC007 – AGED SPOUSE BENEFIT AMOUNT CHANGED DUE TO HAVING A CHILD IN CARE

We changed (1) monthly benefit to (2) beginning (3). We changed (4) benefit because (5) now (6) a child who is entitled to benefits in (7) care.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)

Choice 2

your

Fill-in (2)

Monthly Benefit Amount (MBA) in the format $$$$$.¢¢

Fill-in (3)

Effective date of Monthly Benefit Amount (MBA) change in the format Month CCYY

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (6)

 

Choice 1

has

Choice 2

have

Fill-in (7)

 

Choice 1

his

Choice 2

her

Choice 3

your

CIC008 – AGED SPOUSE BENEFIT AMOUNT CHANGE DUE TO NOT HAVING A CHILD IN CARE BECAUSE THE CHILD IS NO LONGER ENTITLED

We changed (1) monthly benefit to (2) beginning (3). We changed (4) benefit because the child in (5) care is no longer entitled to benefits.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)

Choice 2

your

Fill-in (2)

Monthly Benefit Amount (MBA) in the format $$$$.¢¢

Fill-in (3)

Effective date of Monthly Benefit Amount (MBA) change in the format Month CCYY

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

CIC012 – TELLS PARENT THAT CHILDHOOD DISABILITY BENEFITS (CDB) REVIEW IS EVERY 3 YEARS

You are entitled to benefits because doctors and other trained staff decided that your child is disabled under our rules. But, this decision must be reviewed at least once every 3 years. We will send you or your child a letter before we start the review. Based on that review, your benefits will continue if your child is still disabled, but will end if your child is no longer disabled.

CIC013 – TELLS PARENT THAT CHILDHOOD DISABILITY BENEFITS (CDB) REVIEW IS EVERY 5 TO 7 YEARS

You qualify for benefits because doctors and other trained staff found that you have a disabled child in your care. However, we must review all disability cases. Therefore, we will review your child's case in 5 to 7 years. We will send you a letter before we start the review. Based on that review, your benefits will continue if your child is still disabled, but will end if your child is no longer disabled.

CIC014 – CHILDHOOD DISABILITY BENEFITS (CDB) DISABILITY NOT PERMANENT

You are entitled to benefits because you have a disabled child in your care. The doctors and other trained personnel who made the disability decision expect your child's health to improve. Therefore, we will review your child's case in (1). We will send you a letter before we start the review. Based on that review, your benefits will continue if your child is still disabled. But they will end if your child is no longer disabled.

Fill-in values:                                                                           

Fill-in (1)

the future                                        

F. “CLO” Universal Text Identifiers – Closeout

CLOC01 – CAPTION

Other Social Security Benefits

CLO002 – EXPLAINS THE LIMITATION OF BENEFITS

(1) (2) can receive from us at this time. In the future, if you think (3) might qualify for another benefit from us, (4) will need to apply again.

Fill-in values:

Fill-in (1)

This benefit is the only benefit                     

 

These benefits are the only benefits

Fill-in (2)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

you

Choice 2

he

Choice 3

she

CLO029 – BENEFICIARY IDENTIFICATION CODE (BIC) B ENTITLEMENT CONVERSION TO BIC D OR E

If (1) married more than once, please contact us. (2) may be able to get a higher benefit on the record of a prior spouse.

Fill-in values:                                                                                     

Fill-in (1)

 

Choice 1

you were                                                 

Choice 2

he was

Choice 3

she was

Fill-in (2)

 

Choice 1

You

Choice 2

He

Choice 3

She

G. “COA” Universal Text Identifiers – Change of Address

COA004 – TAX TREATY WITH SWITZERLAND

We will deduct a 15 percent Federal income tax from (1) monthly benefits. This is because of a treaty with Switzerland which says we will tax Social Security benefits paid to residents of Switzerland at this rate.

Please let us know if (2) (3) address again.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)

Choice 2

Beneficiary’s Given Name (BGN) (possessive)

Choice 3

your

Fill-in (2)

 

Choice 1

he changes

Choice 2

she changes

Choice 3

you change

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

COA005 – TAX TREATY - CHANGE TAX STATUS

We are no longer deducting Federal income tax from (1) benefits. We do not deduct this, if (2) a U.S. citizen, or if (3) in the United States, Canada, Egypt, Germany, Ireland, Israel, Italy, Japan, Romania or the United Kingdom.

Also, if an individual is a citizen and resident of India, all or part of that person's benefits can be exempt from this Federal income tax if those benefits are based on Federal, State, or local government employment.

Please let us know if (4) (5) address again.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)

Choice 2

your

Fill-in (2)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (3)

 

Choice 1

he lives

Choice 2

she lives

Choice 3

you live

Fill-in (4)

 

Choice 1

he changes

Choice 2

she changes

Choice 3

you change

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

COA011 – CHANGE OF ADDRESS (COA) - DOMESTIC TO FOREIGN ADDRESS

We have changed (1) address as you asked. However, we will continue to send (2) payments to (3) financial institution. Please check the mailing address we used for (4). If it is not complete or if you move again, please let us know.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)

Choice 2

your

Fill-in (2)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

H. “COP” Universal Text Identifier – Copy of Notice

COP001 – TELLS THE BENEFICIARY A COPY OF THE NOTICE IS BEING SENT TO HIS OR HER REPRESENTATIVE

We are sending a copy of this notice to (1) (2) (3) (4) (5).

Fill-in values:                                                                   

Fill-in (1)

your representative                                     

Fill-in (2)

Null

Fill-in (3)

Null

Fill-in (4)

Null

Fill-in (5)

Null

I. “CPS” Universal Text Identifiers – Critical Payment System

CPS001 – CRITICAL PAYMENT SYSTEM (CPS) PAID AND DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

Based on the information we have, (1) (2) previously paid benefits on this record. The amount deducted for these benefits paid will be shown under the heading What We Will Pay and When.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

Fill-in (2)

 

Choice 1

was

Choice 2

were

CPS002 – CRITICAL PAYMENT SYSTEM (CPS) PAID AND DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

We deducted (1) for money (2) (3) already paid from the check (4) will receive on or about (5).

Fill-in values:

Fill-in (1)

 

Choice 1

Deductions/Additions History Amount that corresponds to Deductions/Additions
History Item Code 330 (Critical Payment Being Withheld)

Fill-in (2)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

you

Fill-in (3)

 

Choice 1

was

Choice 2

were

Fill-in (4)