GARC01 – CAPTION
         If You Disagree With The Court Order
         GAR012 – GARNISHMENT AMOUNT DEDUCTED FROM PRIOR MONTHLY ACCRUAL (PMA) AND/OR CURRENT
               MONTHLY ACCRUAL (CMA)
         We took out (1) from (2) benefits due (3) through (4) to pay (5) child support, alimony,
            or court ordered victim restitution.
         
         
            
               
               
                  
                  
                     
                     | Fill-in values: |   | 
               
               
                  
                  
                     
                     | Fill-in (1) |   | 
                  
                     
                     | Choice 1 | Deductions/Additions History Amount (DAH-AMOUNT) for Deductions/Additions History
                           Item Code (DAH-ITEM) 465 (Garnishment) and a Deductions/Additions History Type of
                           Payment (DAH-TOP) = PMA (P)
                         | 
                  
                     
                     | Choice 2 | Deductions/Additions History Amount (DAH-AMOUNT) for Deductions/Additions History
                           Item Code (DAH-ITEM) 465 (Garnishment) and Deductions Additions History Type of Payment
                           (DAH-TOP) = RCMA (R) or PCMA (C)
                         | 
                  
                     
                     | Fill-in (2) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) | 
                  
                     
                     | Fill-in (3) |   | 
                  
                     
                     | Choice 1 | you | 
                  
                     
                     | Choice 2 | him | 
                  
                     
                     | Choice 3 | her | 
                  
                     
                     | Fill-in (4) |   | 
                  
                     
                     | Choice 1 | Current Operating Month (COM) in the format Month CCYY | 
                  
                     
                     | Choice 2 | Deferred Payment Date (DPD) in the format Month CCYY | 
                  
                     
                     | Fill-in (5) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | his | 
                  
                     
                     | Choice 3 | her | 
               
            
          
         GAR013 – GARNISHMENT AMOUNT DEDUCTED FROM THE MONTHLY BENEFIT PAYABLE (MBP)
         We will take out (1) from (2) benefit each month to pay (3) child support, alimony,
            or court ordered victim restitution.
         
         
            
               
               
                  
                  
                     
                     | Fill-in values: |   | 
               
               
                  
                  
                     
                     | Fill-in (1) | Deductions/Additions History Amount (DAH-AMOUNT) for Deductions/Additions History
                           Item Code (DAH-ITEM) 465 (Garnishment) and Deductions/Additions Type of Payment (DAH-TOP)
                           = MBP (M)
                         | 
                  
                     
                     | Fill-in (2) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) | 
                  
                     
                     | Fill-in (3) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | his | 
                  
                     
                     | Choice 3 | her | 
               
            
          
         GAR014 – GARNISHMENT DEDUCTION STARTS – LEDGER ACCOUNT FILE (LAF) = C and CURRENT
               AMOUNT (CAMT) = $0.00
         We withheld (1) from (2) monthly payment to pay child support, alimony, or court ordered
            victim restitution.
         
         
            
               
               
                  
                  
                     
                     | Fill-in values: |   | 
               
               
                  
                  
                     
                     | Fill-in (1) | Deductions/Additions History Amount (DAH-AMOUNT) for Deductions/Additions History
                           Item Code (DAH-ITEM) 465 (Garnishment) and Deductions Additions History Type of Payment
                           (DAH-TOP) = RCMA (R) or PCMA (C)
                         | 
                  
                     
                     | Fill-in (2) |   | 
                  
                     
                     | Choice 1 | Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) | 
                  
                     
                     | Choice 2 | your | 
               
            
          
         GAR015 – GARNISHMENT DEDUCTION AMOUNT CHANGES – CLOSED PERIOD CHANGE ONLY
         We changed the amount we take out of (1) monthly benefit to pay (2) child support,
            alimony, or court ordered victim restitution.
         
         
            
               
               
                  
                  
                     
                     | Fill-in values: |   | 
               
               
                  
                  
                     
                     | Fill-in (1) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) | 
                  
                     
                     | Fill-in (2) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | his | 
                  
                     
                     | Choice 3 | her | 
               
            
          
         GAR016 – GARNISHMENT AMOUNT NO LONGER BEING DEDUCTED FROM SOCIAL SECURITY ADMINISTRATION
               BENEFITS
         We stopped taking money out of (1) benefits for child support, alimony, or court-ordered
            victim restitution.
         
         
            
               
               
                  
                  
                     
                     | Fill-in values: |   | 
               
               
                  
                  
                     
                     | Fill-in (1) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) | 
               
            
          
         GAR062 – GARNISHMENT REFUND AND ANOTHER TITLE II REDESIGN INTRODUCTORY PARAGRAPH IS
               GENERATED
         This payment includes a refund of money we withheld to pay for (1) child support,
            alimony, or court ordered victim restitution.
         
         
            
               
               
                  
                  
                     
                     | Fill-in values: |   | 
               
               
                  
                  
                     
                     | Fill-in (1) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) possessive | 
               
            
          
         GAR063 – GARNISHMENT REFUND AND NO OTHER TITLE II REDESIGN INTRODUCTORY PARAGRAPH
               GENERATED
         (1) due a refund of money we withheld to pay child support, alimony, or court ordered
            victim restitution.
         
         
            
               
               
                  
                  
                     
                     | Fill-in values: |   | 
               
               
                  
                  
                     
                     | Fill-in (1) |   | 
                  
                     
                     | Choice 1 | You are | 
                  
                     
                     | Choice 2 | Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is” | 
               
            
          
         GAR088 – NO APPEAL RIGHTS APPLY FOR GARNISHMENT DEDUCTION BUT APPEAL RIGHTS APPLY
               FOR ANOTHER TITLE II REDESIGN REASON
         The appeal rights discussed below do not apply to the court ordered child support,
            alimony, or court ordered victim restitution. If you disagree with the court order,
            you will need to contact the court directly, or have a lawyer do it for you.
         
         GAR091 – GARNISHMENT DEDUCTION AMOUNT CHANGES – ONGOING
         We made a change in (1) child support, alimony or court ordered victim restitution
            because (2) monthly benefit amount changed. (3) current court order may not have changed.
         
         
            
               
                  
                  
               
               
                  
                  
                     
                     | Fill-in values: | 
               
               
                  
                  
                     
                     | Fill-in (1) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) | 
                  
                     
                     | Fill-in (2) |   | 
                  
                     
                     | Choice 1 | your | 
                  
                     
                     | Choice 2 | his | 
                  
                     
                     | Choice 3 | her | 
                  
                     
                     | Fill-in (3)  |   | 
                  
                     
                     | Choice 1 | Your | 
                  
                     
                     | Choice 2 | His | 
                  
                     
                     | Choice 3 | Her | 
               
            
          
         GAR092
         We are writing to you about court order number *F1. We stopped taking money out of
            *F2 Social Security payments because *F3. The *F4 that we sent you in *F5 was the
            last payment due.
         
         Fill-Ins
         *F1-1 case
 *F1-2 civil action number
         
         *F2-1 full name as it appears on the order possessive
         *F3-1 he is no longer receiving payments
         *F3-2 she is no longer receiving payments
         *F3-3 you ordered that we no longer withhold this money
         *F3-4 he has paid more than the court order required
         *F3-5 she has paid more than the court order required
         *F4-1 dollar amount of last payment
         *F5-1 month and year
            
         RCYC01
         GAR093
         (Enclosure: Refund Envelope: The enclosure will appear at the end of the notice)
         *F1 should not have received the *F2 that we sent after that date. Please return the
            *F3 to us by check or money order. Make it payable to the Social Security Administration.
            Be sure to put *F4 claim number on the check or money order.
         
         IMPORTANT:  Please use the Refund Envelope enclosed in our letter to mail your payment to us.
            Always include the claim number on the check or money order. If you no longer have
            the envelope, please mail your payment to:
         
         
            Social Security Administration
            
            Mid Atlantic Program Service Center
            
            PO Box 3430
            
            Philadelphia PA 19122-9985 
            
         
         Enclosure: Refund Envelope
           
         Fill-Ins:
         *F1-1 “You” (NOTE: Use this fill-in when sending this notice directly to the receiver. The receiver
            could be the court or another party.)
         
         *F1-2 Name of receiver of garnished payments if other than the court (Use Name of
            receiver of garnished payments if other than the court, when sending this notice to
            the court asking them to return money they ordered us to send the receiver.)
         
         *F2-1 combined dollar amount of all the checks that we shouldn't have sent
         *F3-1 combined dollar amount of all the checks that we shouldn't have sent
         *F4-1 Beneficiary’s name possessive
            
         OPTIONAL:
         OPTC02
           
         OPTIONAL:
         GAR094 
         If *F1 receiving payments again, we will need a new court order before we can start
            withholding money for child support, alimony, or court ordered victim restitution.
         
         (NOTE: Use this sentence only when using choice 1 or 2 of fill-in 3 for GAR 092, i.e., he
            or she is not currently receiving Social Security payments.)
         
         *F1-1 you start
         *F1-2 Beneficiary’s name starts
         REQUIRED Either CTDO or 3901D
            
         Enclosures: 
 Refund Envelope