TN 17 (08-14)

NL 00730.110 “E” Paragraphs and Captions

List of “E” Paragraphs and Captions

A. “ENC” Universal Text Identifier – Enclosures

ENC003 – ENCLOSURE REMARKS

If

Publication

HIB086 is generated

CMS Refund Envelope (English Only)

HIB225 is generated

CMS Refund Envelope (English Only)

LANG=S and Notice Completion Code=S, R, I or M

Spanish

REF020 is generated and domestic address and TAC-CD=D

Pub 05-10077 (English)

Pub 05-10977 (Spanish)

ENT026 is generated and domestic address and TAC-CD=D

Pub 05-10077 (English)

Pub 05-10977 (Spanish)

ENT047 is generated and domestic address and TAC-CD=D

Pub 05-10077 (English)

Pub 05-10977 (Spanish)

ENT026 is generated and domestic address and TAC-CD=D

Pub 05-10153 (English)

Pub 05-10903 (Spanish)

ENT027 is generated and domestic address and TAC-CD=D

Pub 05-10153 (English)

Pub 05-10903 (Spanish)

ENT026 is generated and domestic address and TAC-CD=D

Pub 05-10153 (English)

Pub 05-10903 (Spanish)

REF020 is generated and foreign address

Pub 05-10137 (English)

Pub 05-10138 (Spanish)

COA011 is generated and foreign address

Pub 05-10137 (English)

Pub 05-10138 (Spanish)

ENT026 is generated and foreign address

Pub 05-10137 (English)

Pub 05-10138 (Spanish)

ENT047 is generated and foreign address

Pub 05-10137 (English)

Pub 05-10138 (Spanish)

ANP003 is generated

Pub 05-10137 (English)

Pub 05-10138 (Spanish)

RPY041 is generated

Pub 05-10076 (English)

Pub 05-10976 (Spanish)

RFU001

SSA-3105 (English Only)

WAV001

SSA-3105 (English Only)

CFD004

Refund Envelope

RFU001

Refund Envelope

RFU012

Refund Envelope

OPT147

Refund Envelope

WCP003

Pub 05-10007 (English Only)

GPO001

Pub 05-10007 (English Only)

SUS047

Pub 05-10007 (English Only)

B. “ENT” Universal Text Identifiers – Entitlement

ENT004 – MATURING ACTION – LEDGER ACCOUNT FILE (LAF) C TO LAF S FOR LESSDO FOR SUPPLEMENTAL MEDICAL INSURANCE

We told (1) earlier that when we started paying (2) benefits, we would adjust them for medical insurance premiums.

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

him

Choice 2

her

Choice 3

you

ENT007 – MATURING ACTION – SUPPLEMENTAL MEDICAL INSURANCE DEDUCTED FROM BENEFITS

(1) will get benefits starting (2). We told (3) earlier that when we started paying (4) benefits, we would adjust them for medical insurance premiums.

Fill-in values:

Fill-in (1)

 

Choice 1

You

Choice 2

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

Fill-in (2)

Current Operating Month (COM) in the format Month CCYY

Fill-in (3)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (4)

 

Choice 1

you

Choice 2

him

Choice 3

her

ENT009 – LUMP SUM DEATH PAYMENT (LSDP) PAID TO WIDOW(ER) – NUMBER HOLDER (NH) DIED

(1) (2) entitled to a Social Security payment of (3) because of the death of (4) (5).

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)

Lump Sum Amount Paid (LSAP) in the format $$$$$.¢¢

Fill-in (4)

NH-NAME

Fill-in (5)

Null

ENT026 – FOR CERTAIN AWARDS, FULL RETIREMENT AGE (FRA), ENTITLEMENT CONVERSIONS

(1) (2) entitled to monthly (3) benefits beginning (4).

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

father's

Choice 2

mother's

Choice 3

child's

Choice 4

retirement

Choice 5

widower's

Choice 6

widow's

Fill-in (4)

Historical Date of Entitlement Start (BCLM-DOE-START-REL)

ENT036 – BENEFICIARY IDENTIFICATION CODE (BIC) B OR E TERMINATED DUE TO LAST CHILD IN CARE

(1) may be able to receive payments once more if (2) (3) taking care of a child of (4). The child must be under age 16 or disabled and qualify for child's payments. If (5) (6) to do this, (7) should get in touch with us again.

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

again starts

Choice 2

again start

Fill-in (4)

Number Holder’s Name (NH-NAME)

Fill-in (5)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (6)

 

Choice 1

starts

Choice 2

start

Fill-in (7)

 

Choice 1

he

Choice 2

she

Choice 3

you

ENT039 – STUDENT TERMINATION PRIOR TO AGE 19

(1) may be able to receive payments again if (2) (3) an elementary or secondary level school full-time during any month before age 19. If this happens, (4) should get in touch with us again.

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

attends

Choice 2

attend

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

ENT041 – BENEFICIARY IDENTIFICATION CODE (BIC) B2 TO B BASED ON AGE

(1) entitled to spouse benefits based on having a child in (2) care for (3). Beginning (4), (5) became entitled to spouse benefits based on (6) age.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is”

Choice 2

You are

Fill-in (2)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (3)

 

Choice 1

Historical Date of Entitlement Start (BCLM-DOE-START-REL) date in format Month CCYY

Choice 2

Historical Date of Entitlement Start (BCLM-DOE-START-REL) date plus “and” plus the BCLM-DOE-START-REL plus 1 month in the format Month CCYY and Month CCYY

Choice 3

Historical Date of Entitlement Start (BCLM-DOE-START-REL) plus “through” plus the Historical Date of Entitlement Termination (BCLM-DOETERM-REL) date minus 1 month in the format Month CCYY through Month CCYY

Fill-in (4)

Historical Date of Entitlement Start (BCLM-DOE-START-REL) for the new Beneficiary Claim Data (BCLM) occurrence for PIC B

Fill-in (5)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (6)

 

Choice 1

his

Choice 2

her

Choice 3

your

ENT047 – STUDENT AWARD OR STUDENT CHILDHOOD DISABILITY BENEFIT (CDB) AWARD

(1) (2) for child's payments as a student 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)

 

Choice 1

qualifies

Choice 2

qualify

Fill-in (3)

Historical Date of Entitlement Start (BCLM-DOE-START-REL) in the Beneficiary Claim Data (BCLM) occurrence with the Historical Current Entitlement Code (BCLM-CEC) = Student (S)

ENT049 – STUDENT AWARD OR STUDENT REINSTATEMENT

Based on the information we have, (1) entitlement will continue through (2). We will send (3) another letter when (4) entitlement ends.

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

No Longer in Full-Time Attendance Date (SRD-NLFTA-REL) in the format Month CCYY

Choice 2

End of Full-Time Attendance Date (SRD-EFTA-REL) in the format Month CCYY

Choice 3

Student Entitlement High School Graduation Date (SRD-HSGRAD-REL) in the format Month CCYY

Choice 4

End of Full-Time Attendance Date (SRD-EFTA-REL) in the format Month CCYY

Fill-in (3)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

ENT053 – MONTHLY BENEFIT AMOUNT (MBA) EQUAL ZERO DUE TO DISABILITY MAXIMUM (DMAX) - (HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF TECHNICAL ENTITLEMENT (TECENT)

We cannot pay benefits because all of the money we can pay on this record is already being paid to (1).

Fill-in values:

Fill-in (1)

Number Holder Name (NH-NAME)

ENT060 – B TO D CONVERSION WHEN NUMBER HOLDER DIES

We have not determined the amount of (1) monthly (2) benefit payment. When we complete our review of (3) record, you will receive another notice explaining (4) entitlement to (5) 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)

 

Choice 1

widower's

Choice 2

widow's

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

widower's

Choice 2

widow's

ENT061 – STUDENT TERMINATION PRIOR TO AGE 19

(1) also may be able to receive payments again if (2) (3) disabled before age 22 and (4) not married since (5) last entitlement, unless the marriage is void or annulled. If this happens, (6) should get in touch with us again.

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

becomes

Choice 2

become

Fill-in (4)

 

Choice 1

has

Choice 2

have

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (6)

 

Choice 1

he

Choice 2

she

Choice 3

you

ENT062 – NO CHANGE IN THE MONTH OF ELECTION (MOEL) DATA BASED ON THE ANNUAL REPORT DATA

We reviewed (1) record. When (2) applied, (3) asked us to start (4) benefits in (5). We found that (6) is still the month when benefits should start.

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

Choice 2

she

Choice 3

you

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

Pre-MBR Historical Date of Entitlement Start (BCLM-DOE-START-REL)

Fill-in (6)

Post-MBR Historical Date of Entitlement Start (BCLM-DOE-START-REL)

ENT070 – DISABILITY INSURANCE BENEFITS (DIB) TO RETIREMENT INSURANCE BENEFITS (RIB) AT FULL RETIREMENT AGE (FRA) WHEN PAYMENT IDENTIFICATION CODE (PIC) A CONFIRMS DATE OF BIRTH

Based on the information given to us, (1) born on (2).

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “was”

Choice 2

you were

Fill-in (2)

Payment Identification Code (PIC) A's date of birth in the format Month DD, CCYY

ENT071 – DISABILITY INSURANCE BENEFITS (DIB) TO RETIREMENT INSURANCE BENEFITS (RIB) AT FULL RETIREMENT AGE (FRA) FOR PIC A

We are changing the type of benefit (1) from Social Security. Beginning (2), (3) entitled to retirement benefits. (4) no longer entitled to disability benefits because (5) reached full retirement age.

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “receives”

Choice 2

you receive

Fill-in (2)

Full Retirement Age (FRA) attainment month for Payment Identification Code (PIC) A in the format Month CCYY

Fill-in (3)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (4)

 

Choice 1

He is

Choice 2

She is

Choice 3

You are

Fill-in (5)

 

Choice 1

he has

Choice 2

she has

Choice 3

you have

C. “ERN” Universal Text Identifiers – Earnings

ERNC03 – CAPTION

Some Earnings May Not Count

ERNC04 – CAPTION

The Earnings Limit

ERNC05 – CAPTION

Based On (1) (2) Earnings

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

Choice 3

Number Holder First Name plus NH Last name (possessive)

Choice 4

Null

Fill-in (2)

 

Choice 1

Expected

Choice 2

Null

ERNC06 – REFER TO WORKSHEET HEADER NL 00730.149D

ERNH01 – REFER TO WORKSHEET HEADER NL 00730.149D

ERN009 – PROVIDES THE AMOUNT A BENEFICIARY EXPECTS TO EARN IN THE CURRENT YEAR

Our records also show that (1) to earn (2) this year.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you expect

Fill-in (2)

Amount of Reported Earnings (AORE) in the format $$$$$.¢¢

ERN010 – EARNINGS THAT DO NOT AFFECT SOCIAL SECURITY BENEFITS.

We may not have to count all of the earnings reported for (1) in (2). Only the wages that (3) in a given year may affect Social Security benefits for that year. Here are some types of earnings that we don't count:

  • bonuses, vacation or sick pay, severance pay, or

  • commissions that (4) in one year, but do not earn in the same year;

  • retirement payments from a pension fund that may have been reported as wages.

Please contact us and let us know if (5):

  • received some money in (6) but actually earned the money before (7); or

  • earned a different amount in (8); or

  • had a net loss from self-employment in (9).

If (10) self-employed and had a net loss, we can subtract the amount of the loss from (11) wages for (12). If (13) self-employed, we won't count any income (14) received after (15) became entitled to Social Security if that income is for work performed before (16) became entitled to Social Security.

Fill-in values:

Fill-in (1)

 

Choice 1

you

Choice 2

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

Fill-in (2)

 

Choice 1

Year of Earnings Report (YOER) in the format CCYY

Choice 2

Years of Earnings Report (YOER) in the format CCYY plus “and” plus CCYY

Choice 3

Years of Earnings Report (YOER) in the format CCYY plus “through” plus CCYY

Fill-in (3)

 

Choice 1

you actually earn

Choice 2

he actually earns

Choice 3

she actually earns

Choice 4

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “actually earns”

Fill-in (4)

 

Choice 1

you receive

Choice 2

he receives

Choice 3

she receives

Choice 4

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “receives”

Fill-in (5)

 

Choice 1

you

Choice 2

he

Choice 3

she

Choice 4

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

Fill-in (6)

 

Choice 1

Year of Earnings Report (YOER) in the format CCYY

Choice 2

Years of Earnings Report (YOER) in the format CCYY plus “or” plus CCYY

Choice 3

Years of Earnings Report (YOER) in the format CCYY plus “or” plus CCYY plus “or” plus CCYY

Fill-in (7)

 

Choice 1

that year

Choice 2

these years

Fill-in (8)

 

Choice 1

Year of Earnings Report (YOER) in the format CCYY

Choice 2

Years of Earnings Report (YOER) in the format CCYY plus “or” plus CCYY

Choice 3

Years of Earnings Report (YOER) in the format CCYY plus “or” plus CCYY plus “or” plus CCYY

Fill-in (9)

 

Choice 1

Year of Earnings Report (YOER) in the format CCYY

Choice 2

Years of Earnings Report (YOER) in the format CCYY plus “or” plus CCYY

Choice 3

Years of Earnings Report (YOER) in the format CCYY plus “or” plus CCYY plus “or” plus CCYY

Fill-in (10)

 

Choice 1

you were

Choice 2

he was

Choice 3

she was

Choice 4

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “was”

Fill-in (11)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (12)

 

Choice 1

that year

Choice 2

these years

Fill-in (13)

 

Choice 1

you are

Choice 2

he is

Choice 3

she is

Choice 4

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is”

Fill-in (14)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (15)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (16)

 

Choice 1

you

Choice 2

he

Choice 3

she

Choice 4

Beneficiary’s Given Name (BGN)

ERN016 – REFER TO WORKSHEET HEADER NL 00730.149D

ERN019 – REFER TO WORKSHEET HEADER NL 00730.149D

ERN021 – EARNINGS CHANGE BUT BENEFITS ARE NOT CHANGING

We are writing to you about (1) work and earnings for (2). Our records show that (3) (4) (5).

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

Year of Earnings Report (YOER) in the format CCYY

Choice 2

comma (,)

Choice 3

and

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

expects to earn

Choice 2

expect to earn

Choice 3

earned

Fill-in (5)

 

Choice 1

Amount of Reported Earnings (AORE) in the format $$$$$¢¢ plus “in” plus Year of Earnings Report (YOER)

Choice 2

comma (,)

Choice 3

and

ERN022 – FULL RETIREMENT AGE (FRA) YEAR ANNUAL EARNINGS TEST

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)

 

Choice 1

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

Choice 2

you become

Fill-in (2)

Full Retirement Age (FRA) - using the choices below

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

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

he turns

Choice 2

she turns

Choice 3

you turn

Fill-in (5)

Full Retirement Age (FRA) - using the choices below

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

Fill-in (6)

 

Choice 1

he earns

Choice 2

she earns

Choice 3

you earn

Fill-in (7)

Annual exempt amount

Fill-in (8)

 

Choice 1

he turns

Choice 2

she turns

Choice 3

you turn

Fill-in (9)

Full Retirement Age (FRA) - using the choices below

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

Fill-in (10)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (11)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (12)

 

Choice 1

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

Choice 2

you

Fill-in (13)

Full Retirement Age (FRA) - using the choices below

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

Fill-in (14)

Full Retirement Age (FRA) attainment date

Fill-in (15)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (16)

Amount of Reported Earnings (AORE) in the format $$$$$$$¢¢

ERN025 – CALCULATIONS OF THE BENEFICIARY’S PRE-FULL RETIREMENT AGE (FRA) EARNINGS IN THE FULL RETIREMENT AGE (FRA) YEAR

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)

 

Choice 1

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

Choice 2

your

Fill-in (2)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (3)

Full Retirement Age (FRA) - using the choices below

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

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)

Total earnings in the format $$$$$$$.¢¢

Fill-in (7)

Full Retirement Age (FRA) year in the format CCYY

Fill-in (8)

Number of months prior to the Full Retirement Age (FRA) month

Fill-in (9)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (10)

Full Retirement Age (FRA) - using the choices below

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

Fill-in (11)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (12)

Total earnings in the format $$$$$$$.¢¢

Fill-in (13)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (14)

Full Retirement Age (FRA) - using the choices below

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

Fill-in (15)

 

Choice 1

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

Choice 2

you

Fill-in (16)

 

Choice 1

his

Choice 2

her

Choice 3

your

ERN026 – EFFECT OF THE BENEFICIARY'S PRIOR YEAR EARNINGS ON THE CURRENT FULL RETIREMENT AGE (FRA) YEAR BENEFITS

Based on (1) earnings of (2) last year, we expected (3) to earn over the earnings limit of (4) this year. Therefore, we withheld some of (5) benefits. However, if (6) (7) earned less than the earnings limit of (8), (9) due full benefits for all of this year.

Please contact us if you think (10) due Social Security payments for months before (11). You will have to give us an estimate of (12) earnings for the year. Read below to find out how to estimate earnings:

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)

Amount of reported earnings (AORE) for the year prior to the Full Retirement Age (FRA) year in the format $$$$$.¢¢

Fill-in (3)

 

Choice 2

him

Choice 3

her

Choice 3

you

Fill-in (4)

Full Retirement Age (FRA) year annual exempt amount in the format $$$$$.¢¢

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (6)

 

Choice 1

in

Choice 2

from

Choice 3

Month CCYY

Choice 4

through

Fill-in (7)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (8)

Full Retirement Age (FRA) year annual exempt amount in the format $$$$$.¢¢

Fill-in (9)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (10)

 

Choice 1

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

Choice 2

you are

Fill-in (11)

Full Retirement Age (FRA) in the format Month CC