TN 25 (10-16)

NL 00730.136 R Paragraphs and Captions

List of “R” Paragraphs and Captions

A. RCY Universal Text Identifiers - Recovery

RCYC01 – CAPTION

How to Pay Us Back

RCYC04 – CAPTION

Do You Think That You Do Not Owe This Money?

RCYC05 – CAPTION

Reduction To Collect Your SSI Overpayment

RCY002 – CROSS PROGRAM RECOVERY FOR SUPPLEMENTAL SECURITY INCOME (SSI) OVERPAYMENT

We paid (1) more in Supplemental Security Income (SSI) payments in the past than (2) due. Our records show that (3) us (4) in SSI payments. By law, we can collect SSI overpayments from the Social Security benefits that (5). We withheld (6) from (7) Social Security benefits to collect (8) of the SSI payments that (9).

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 was

Choice 2

she was

Choice 3

you were

Fill-in (3)

 

Choice 1

he still owes

Choice 2

she still owes

Choice 3

you still owe

Fill-in (4)

Cross Program Recovery Overpayment Amount (CPR-OPAMT) in the format $$$$$$.¢¢

Fill-in (5)

 

Choice 1

he receives

Choice 2

she receives

Choice 3

you receive

Fill-in (6)

Cross Program Recovery Underpayment Amount (CPR-UPAMT) in the format $$$$$$.¢¢

Fill-in (7)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (8)

 

Choice 1

some of

Choice 2

Null

Fill-in (9)

 

Choice 1

he owes

Choice 2

she owes

Choice 3

you owe

RCY003 – CROSS PROGRAM RECOVERY FOR SUPPLEMENTAL SECURITY INCOME (SSI) OVERPAYMENT - USED WITH RCY002

You may ask us to review our finding that you still owe the money. You may have evidence to show that you already paid some or all of the money or that we previously waived collection of it. If so, give us this evidence when you ask for review. We will review the evidence you give us and the information we have. We will send you a letter with our decision. If we find that you do not owe us this amount, then we will correct our records.

For more information on requesting review, see "If You Disagree With The Decision" below.

RCY006 – BENEFITS RAISED - PARTIAL RECOVERY ENDS

We have raised (1) benefits back to (2) regular monthly payment amount. This is because (3) repaid the overpayment money (4) owed us.

Fill-in values:

 

Fill-in (1)

 

Choice 1

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

Choice 2

Beneficiary Given Name (BGN) (possessive)

Choice 3

your

Fill-in (2)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

RCY007 – PARTIAL RECOVERY ENDS - NO REMAINING OVERPAYMENT

We are withholding (1) from (2) benefits. This is the remaining balance (3) owed on (4) overpayment.

Fill-in values:

 

Fill-in (1)

Monthly Recovery Amount (MRA) on the pre-MBR in the format $$$$

Fill-in (2)

 

Choice 1

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

Choice 2

your

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

B. “REF” Universal Text Identifiers – Referral

REFC01 – CAPTION

Suspect Social Security Fraud?

Please visit http://oig.ssa.gov/r or call the Inspector General’s Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Questions

REF001 – REFERRAL FOR DOMESTIC ADDRESS

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. However, if you have any specific (1) questions, you can call us at 1-800-772-1213. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call out TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

(2)

If you do call or visit an office, please have this letter with you. It will help us answer your questions.

Fill-in values:

 

Fill-in (1)

Null

Fill-in (2)

field office address

REF002 – REFERRAL FOR FOREIGN ADDRESS

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you should contact any Social Security office or the nearest United States Embassy or Consulate. You may also write the Social Security Administration, P.O. Box 17769, Baltimore, Maryland, 21235-7769, USA. Please be sure to include your claim number if you do write. However, if you visit an office, please have this letter with you. It will help the people there answer your questions. Medicare information is available on the Internet at www.medicare.gov.

REF003 – REFERRAL FOR DOMESTIC ADDRESS

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (1). We can answer most questions over the phone. If you are deaf or hard of hearing, you may call out TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

(2)

If you do call or visit an office, please have this letter with you. It will help us answer questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

Fill-in values:

 

Fill-in (1)

Null

Fill-in (2)

local field office telephone number in format 1-XXX-XXX-XXXX

 

field office address

REF008 – FIELD OFFICE REFERRAL - DEFAULT

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific (1) questions, call us toll-free at 1-800-772-1213. We can answer most questions over the phone. If you prefer to visit one of our offices, please check the local telephone directory for the office nearest you. Or call us and we can give you the office address. Please have this letter with you if you call or visit an office. It will help us answer your questions.

Fill-in values:

 

Fill-in (1)

Null

REF018 – STATE BUY-IN/BUY-OUT REFERRAL FOR DOMESTIC ADDRESS

(1)

If you have any questions (2) you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (3). We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:

(4)

If you do call or visit an office, please have this letter with you. It will help us answer questions. Also if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

Fill-in values:

 

Fill-in (1)

 

Choice 1

If you have any questions about the State Medicaid Program, please contact your State public assistance office.

Choice 2

If you have any questions about the State retirement system, please contact that office

Choice 3

Null

Fill-in (2)

about Medicare

Fill-in (3)

local Social Security office telephone number, in format, 1-XXX-XXX-XXXX

Fill-in (4)

use the street address, City, State and zip code corresponding to the MBR District Office Code (DOC)

REF020 – DEFERRAL - ADVANCE FILE MATURING

To make sure you get the correct amount of benefits, you need to report promptly any changes in the amount you earn or expect to earn. You should also report any other changes that may affect your payment.

The pamphlet (1) describes the events you need to report. If you no longer have the pamphlet, you can get one from any Social Security office, or the nearest United States Embassy or Consulate.

Fill-in values:

 

Fill-in (1)

 

Choice 1

“Your Social Security Checks...While You Are Outside the United States”

Choice 2

“When You Get Social Security Disability Benefits...What You Need to Know”

Choice 3

“When You Get Social Security Retirement or Survivors Benefits...What You Need to Know”

REF056 – REFERRAL - RAILROAD RETIREMENT

If you have any questions, please contact your local Railroad District Office or the Railroad Retirement Board. The address is U.S. Railroad Retirement Board, 844 Rush Street, Chicago, Illinois 60611-2092.

C. REP Universal Text Identifiers – Claimant Representation

REPC01 – CAPTION

If You Want Help With Your Appeal

REP002 – APPEALS INFORMATION - NOT USED ON END-STAGE RENAL DISEASE (ESRD) TERMINATION NOTICE

You may choose to have a representative help you. We will work with this person just as we would work with you. If you decide to have a representative, you should find one quickly so that person can start preparing your case.

Many representatives charge a fee only if you receive benefits. Others may represent you for free. Usually, your representative may not charge a fee unless we approve it. Your local Social Security office can give you a list of groups that can help you find a representative.

If you get a representative, you or that person must notify us in writing. You may use our Form SSA-1696 “Appointment of Representative.” Any local Social Security office can give you this form.

REP005 – APPEALS INFORMATION FOR AN END-STAGE RENAL DISEASE (ESRD) TERMINATION NOTICE

You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your Social Security office has a list of groups that can help you with your appeal. If you get someone to help you, you should let us know.

D. RFU Universal Text Identifiers - Refund

You should refund this overpaymRFU001 – OVERPAYMENT REQUESTED FROM TERMINATED BENEFICIARY ent within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Include (1) claim number (as shown above) on your check or money order.

If you cannot refund the full (2) now, please send:

  • A partial payment,

  • An explanation of why you cannot pay the full amount now, and

  • A plan to repay the money.

Fill-in values:

 

Fill-in (1)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (2)

Overpayment amount in the format $$$$$$.¢¢

RFU002 – OVERPAYMENT REQUESTED - FOREIGN ADDRESS

If you pay us by check or money order, make sure that the check or money order is in United States (U.S.) dollars or in local currency equal to U.S. dollars. When you pay us in local currency, we use the exchange rates in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment to us, please go to the nearest U.S. Embassy or consulate. They will help you make the refund.

RFU004 – SUPPLEMENTAL SECURITY INCOME (SSI) IS DETERMINED AND SOCIAL SECURITY RETROACTIVE BENEFITS ARE GREATER THAN THE SSI WINDFALL OFFSET AMOUNT

We compared (1) Social Security and SSI benefits. We found we should have paid (2) (3) less in SSI benefits. We will withhold this amount from (4) Social Security benefits.

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

you

Choice 2

him

Choice 3

her

Choice 4

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

Fill-in (3)

Deductions Additions History Amount (DAH-AMOUNT) that corresponds to the Deductions Additions History Type of Payment (DAH-TOP) = PMA (P) and Deductions Additions History Item (DAH-ITEM) = 345 (DIB SSI offset) or the DAH ITEM = 346 (RIB SSI offset) in the format $$$$$$.¢¢

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

RFU006 – SUPPLEMENTAL SECURITY INCOME (SSI) IS DETERMINED AND THE SOCIAL SECURITY RETROACTIVE BENEFITS ARE LESS OR EQUAL TO THE WINDFALL OFFSET AMOUNT

We compared (1) Social Security and SSI benefits. We found that we should have paid (2) (3) less SSI benefits. As a result, we cannot pay (4) any of the Social Security benefits we withheld.

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

you

Choice 2

him

Choice 3

her

Choice 4

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

Fill-in (3)

Deductions Additions History Amount (DAH-AMOUNT) that corresponds to the Deductions Additions History Type of Payment Code (DAH-TOP) = PMA (P) and [Deductions Additions History Item Code (DAH-ITEM) = 345 (DIB SSI offset or DAH-ITEM=346 (RIB SSI offset)] in the format $$$$$$.¢¢.

Fill-in (4)

 

Choice 1

you

Choice 2

him

Choice 3

her

Choice 4

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

RFU007 – SUPPLEMENTAL SECURITY INCOME (SSI) WINDFALL OFFSET IS DETERMINED AND THERE IS NO SSI OFFSET APPLIED TO SECURITY BENEFITS THEREFORE RETRO BENEFITS ARE PAYABLE TO THE BENEFICIARY

Our records show that (1) did not get SSI money for (2). We can refund all of the Social Security money withheld.

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

History Start date of the first month where Reason for Suspension = WINFAL in the format Month CCYY

Choice 2

Start date that corresponds to the Reason for Suspension = WINFAL plus ”through” plus the stop date of the last WINFAL Suspension month

RFU012 – TITLE II OVERPAYMENT ADJUSTMENT FROM BENEFITS WHEN OVERPAYMENT AMOUNT IS GREATER THAN MONTHLY BENEFIT AMOUNT (MBA)

You should refund this overpayment of (1) within 30 days. Please make your check or money order payable to "Social Security Administration," and send it to us in the enclosed envelope. Include (2) claim number (as shown above) on your check or money order.

If we do not receive your refund within 30 days, we will hold back (3) full benefit starting with the payment you would normally receive (4) about (5). We will continue holding back (6) benefits until we recover the overpayment.

If you cannot refund the full overpayment now or cannot afford to have us hold back (7) full benefit, you may ask us to hold back a smaller amount each month. Contact us to discuss your plan for repaying the balance. You may need to show us proof of (8) assets, monthly income, and expenses.

Fill-in values:

 

Fill-in (1)

Overpayment amount in format $$$$$$.¢¢

Fill-in (2)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

Null

Choice 2

for him

Choice 3

for her

Fill-in (5)

Date of payment in the format Month DD, CCYY

Fill-in (6)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (7)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (8)

 

Choice 1

your

Choice 2

his

Choice 3

her

E. RIN Universal Text Identifiers – Rate Information

RIN006 – EXPLAINS ADJUSTMENT REDUCTION FACTOR INCREASE

Because (1) retired early, we reduced (2) monthly Social Security benefit. The amount that we reduced it was based on the number of months (3) would receive benefits before (4). However, (5) didn't receive benefits some of these months because (6) worked and earned over certain limits. So, we must increase (7) benefit amount to give credit for these months.

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

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

Choice 2

his

Choice 3

her

Choice 4

your

Fill-in (3)

 

Choice 1

BGN

Choice 2

he

Choice 3

she

Choice 4

you

Fill-in (4)

 

Choice 1

full retirement age

Choice 2

age 62

Choice 3

age 60

Fill-in (5)

 

Choice 1

Beneficiary Given Name (BGN)

Choice 2

he

Choice 3

she

Choice 4

you

Fill-in (6)

 

Choice 1

Beneficiary Given Name (BGN)

Choice 2

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

Choice 3

he

Choice 4

she

Choice 5

you

Choice 6

he and his spouse

Choice 7

she and her spouse

Choice 8

you and your spouse

Choice 9

his spouse

Choice 10

her spouse

Fill-in (7)

 

Choice 1

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

Choice 2

his

Choice 3

her

Choice 4

your

RIN007 – EXPLAINS DELAYED RETIREMENT CREDIT INCREASE

When (1) filed for Social Security benefits, we figured the benefit amount based on (2) earnings history at that time. If after becoming entitled to benefits, (3) to work, (4) may earn credit for this additional work. So, we must increase (5) benefit amount to give credit for these months.

We apply the increase sometime after it is due. This is because earnings information is not available until after each tax year.

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 2

his

Choice 3

her

Choice 4

your

Fill-in (3)

 

Choice 1

he continues to work or later returns

Choice 2

she continues to work or later returns

Choice 3

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “continues to work or later returns”

Choice 4

you continue to work or later return

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

RIN008 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY IS TERMINATED OR BECOMES ENTITLED ON THE RECORD

We changed (1) monthly benefit to (2) starting (3). We made this change because we (4) paying benefits to another person on this record.

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

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA increase

Choice 2

NA-HIST-POST-MBA in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) increase

Choice 2

NA-HIST-START month in the format Month CCYY

Fill-in (4)

 

Choice 1

started

Choice 2

stopped

RIN012 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - COST OF LIVING INCREASE

We raised (1) monthly benefit to (2) beginning (3) because the cost of living increased.

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

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA decrease

Choice 2

NA-HIST-POST-MBA in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) increase

Choice 2

NA-HIST-START month in the format Month CCYY

RIN013 – AUXILIARY'S MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO ANOTHER BENEFICIARY'S DEATH

We changed (1) monthly benefit to (2) starting (3). We changed (4) benefit because of the death of (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

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA increase

Choice 2

NA-HIST-POST-MBA in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) increase due to death

Choice 2

NA-HIST-START month in the format Month CCYY

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

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

Choice 2

another person entitled on this record

RIN044 – AUXILIARY MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY ENTITLED AND COST-OF-LIVING ADJUSTMENT (COLA)

We changed (1) monthly benefit to (2) beginning (3) because we started paying another person(s) on this record. This change also includes the cost of living increase.

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

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢

Choice 2

NA-HIST-POST-MBA in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY

Choice 2

NA-HIST-START month in the format Month CCYY

RIN045 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY TERMINATES AND COST-OF-LIVING ADJUSTMENT (COST-OF-LIVING ADJUSTMENT (COLA))

We changed (1) monthly benefit to (2) beginning (3) because benefits to another entitled person(s) stopped. This change also includes the cost of living increase.

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

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢

Choice 2

NA-HIST-POST-MBA in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY

Choice 2

NA-HIST-START month in the format Month CCYY

RIN046 – NUMBER HOLDER NOTICE WORKERS’ COMPENSATION (WC)/PUBLIC DISABILITY BENEFIT (PDB) INVERSE OFFSET POSTPONED MONTHLY BENEFIT AMOUNT (MBA) CHANGE

We changed (1) monthly benefit to (2) beginning (3).

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)

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢

Fill-in (3)

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY

RIN047 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - AGE REDUCTION FACTOR (ARF)

We changed (1) monthly benefit to (2) starting (3). We gave (4) credit for benefits that we did not pay at the full rate before (5) reached (6).

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

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢

Choice 2

Show the NA-HIST-POST-MBA in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY

Choice 2

NA-HIST-START month in the format Month CCYY

Fill-in (4)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (5)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (6)

 

Choice 1

age 60

Choice 2

age 62

Choice 3

full retirement age

RIN048 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - DELAYED RETIREMENT CREDIT (DRC)

We raised (1) monthly benefit amount beginning (2) to (3). We changed (4) benefit amount to give (5) credit for the past months that (6) delayed receiving retirement benefits.

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

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY

Choice 2

TDA-RETAP-EVENT-DATE that corresponds to the TDA-EVENT-INDICATOR = A602 in the format Month CCYY

Fill-in (3)

 

Choice 1

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢

Choice 2

TDA-RETAP-EVENT-DATE that corresponds with TDA-EVENT-INDICATOR = A602 in the format $$$$$.¢¢

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (5)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (6)

 

Choice 1

you

Choice 2

he

Choice 3

she

RIN049 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO INCORRECT MBA

We changed (1) monthly benefit to (2) as of (3). We found that (4) prior amount was incorrect.

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

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢

Choice 2

NA-HIST-POST-MBA in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY

Choice 2

NA-HIST-START month in the format Month CCYY

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

RIN053 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO DUAL ENTITLEMENT (BENEFITS COMBINED OR DECOMBINED)

We changed (1) monthly benefit amount to (2) starting (3). We changed the amount because (4) also entitled on another record.

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)

Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) on the MBA change in the format $$$$$$¢¢

Fill-in (3)

Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY

Fill-in (4)

 

Choice 1

you are

Choice 2

he is

Choice 3

she is

RIN059 – PRIMARY INSURANCE AMOUNT (PIA) CHANGE DUE TO CREDITABLE MILITARY SERVICE

We are changing (1) benefits to give (2) credit for time (3) spent in military service. This time was not included when we figured (4) benefit before.

Fill-in values:

 

Fill-in (1)

 

Choice 1

your

Choice 2

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

Choice 3

his

Choice 4

her

Fill-in (2)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

RIN060 – IDENTIFIES SPECIFIC YEAR(S) OF EARNINGS CREDITED TO THE NUMBER HOLDER, RESULTING IN A PRIMARY INSURANCE AMOUNT (PIA) INCREASE

We changed (1) benefit amount to give (2) credit for (3) (4) earnings. We did not include these earnings when we figured (5) benefit amount before.

Fill-in values:

 

Fill-in (1)

 

Choice 1

your

Choice 2

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

Choice 3

his

Choice 4

her

Fill-in (2)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

Year of earnings in format CCYY

Choice 2

Year of earnings and year of earnings in format CCYY and CCYY

Choice 3

Year of earnings, year of earnings and year of earnings in format CCYY, CCYY and CCYY

Choice 4

Year of earnings, year of earnings, year of earnings and year of earnings in format CCYY, CCYY, CCYY and CCYY

Choice 5

Null

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

RIN061 – DUALLY ENTITLED BENEFICIARY RECEIVING PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON THE OTHER RECORD – NO INCREASE DUE ON OWN PIA

We reviewed our records to see if (1) due more money. We increased (2) benefits to give (3) credit for the earnings of (4) spouse that we did not count before.

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”

Choice 3

he is

Choice 4

she is

Fill-in (2)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (3)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

RIN062 – DUALLY ENTITLED BENEFICIARY RECEIVING PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN ACCOUNT – BENEFITS ON OTHER RECORD ARE ENDING BECAUSE BENEFICIARY’S OWN BENEFIT IS LARGER

We reviewed our records and found that we can increase (1) benefits. We increased (2) benefits because we gave (3) credit for earnings that we did not count before.

(4) benefits on (5) own record and as a (6) on another record. Since (7) benefits are now higher on (8) own record, we stopped the benefits (9) on the other record.

Fill-in values:

 

Fill-in (1)

 

Choice 1

your

Choice 2

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

Choice 3

his

Choice 4

her

Fill-in (2)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (3)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (4)

 

Choice 1

You receive

Choice 2

He receives

Choice 3

She receives

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (6)

 

Choice 1

spouse

Choice 2

parent

Choice 3

surviving spouse

Choice 4

divorced spouse

Choice 5

surviving former spouse

Fill-in (7)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (8)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (9)

 

Choice 1

you receive

Choice 2

he receives

Choice 3

she receives

RIN063 – DUALLY ENTITLED BENEFICIARY’S ONGOING MONTHLY PAYMENT AMOUNT REMAINS THE SAME OR IS SLIGHTLY DIFFERENT DUE TO ROUNDING – SMALLER PRIMARY INSURANCE AMOUNT (PIA) AND BENEFIT INCREASE ON OWN RECORD WHILE LARGER PIA ON OTHER RECORD REMAINS THE SAME BUT THE AMOUNT PAYABLE DECREASES

Since we increased the amount we pay (1) on (2) own record, we decreased the amount we pay (3) on another record.

Fill-in values:

 

Fill-in (1)

 

Choice 1

you

Choice 2

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

Choice 3

him

Choice 4

her

Fill-in (2)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (3)

 

Choice 1

you

Choice 2

him

Choice 3

her

RIN064 – DUALLY ENTITLED BENEFICIARY RECEIVES PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN RECORD AND ON THE OTHER RECORD

We increased the benefits on both Social Security records. To get the amount we can pay (1), we subtract the new benefit on (2) own record from the new benefit on the other record.

Fill-in values:

 

Fill-in (1)

 

Choice 1

you

Choice 2

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

Choice 3

him

Choice 4

her

Fill-in (2)

 

Choice 1

your

Choice 2

his

Choice 3

her

RIN065 – DUALLY ENTITLED BENEFICIARY RECEIVES PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN ACCOUNT – ONGOING MONTHLY PAYMENT AMOUNT REMAINS THE SAME OR IS SLIGHTLY DIFFERENT DUE TO ROUNDING – SMALLER PIA AND BENEFIT INCREASE ON OWN ACCOUNT WHILE LARGER PIA ON OTHER RECORD REMAINS THE SAME BUT AMOUNT PAYABLE DECREASES

Since we increased the amount we pay (1) on (2) own record, we decreased the amount we pay (3) on (4) spouse’s record.

Fill-in values:

 

Fill-in (1)

 

Choice 1

you

Choice 2

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

Choice 3

him

Choice 4

her

Fill-in (2)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (3)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

RIN066 – MONTHLY BENEFIT AMOUNT (MBA) DECREASED BECAUSE ACTUAL EARNINGS WERE LESS THAN THE EXPECTED EARNINGS ORIGINALLY USED TO CALCULATE THE PRIMARY INSURANCE AMOUNT (PIA)

We reviewed (1) record and found that (2) earnings changed. These changes caused (3) monthly benefit amount to decrease effective (4).

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

Fill-in (4)

 

Choice 1

Post-MBR History Effective Date (EFD) associated with the first Primary Insurance Amount Effective Date (PIED) occurrence of Primary Insurance Amount (PIA) decrease in the format Month CCYY

F. RPA Universal Text Identifier – Representative Payee Annual Accounting

RPAC01 – CAPTION

It Is Important To Keep Track Of This Money

G. RPY Universal Text Identifiers – Representative Payee

RPY002 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF PAYEE DEVELOPMENT (DEVPYE) OR DEATH OF PAYEE (DTHPYE)

If you know someone who can be your payee, please call us at either of the telephone numbers shown at the end of this letter. We will consider this person for your new payee. Also, if you believe you are able to manage your own money, please let us know. Call us within the next 30 days if you do not hear from us. You may be able to get some payments directly while we make our decision.

RPY003 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF PAYEE DEVELOPMENT (DEVPYE) OR DEATH OF PAYEE (DTHPYE)

If you know someone who can be your payee, please call us at either of the telephone numbers shown at the end of this letter. We will consider this person for your payee. Also, call us within the next 30 days if you do not hear from us. You may be able to keep getting some payments directly while we make our decision.

RPY015 – FORMER PAYEE NOTICE

Thank you for your willingness to serve as a representative payee. We have decided that it would be best for (1) to have (2) checks sent to another payee.

Fill-in values:

 

Fill-in (1)

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

Fill-in (2)

 

Choice 1

his

Choice 2

her

RPY016 – FORMER PAYEE NOTICE

We have decided that it would be best for (1) to have (2) checks sent to (3).

Fill-in values:

 

Fill-in (1)

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

Fill-in (2)

 

Choice 1

his

Choice 2

her

Fill-in (3)

 

Choice 1

him

Choice 2

her

RPY038 – PAYEE CHANGE TO SELF

We will begin to send your checks directly to you. The rest of this letter will give you more information about your benefits.

RPY039 – NEW PAYEE SELECTED

We have chosen you to be (1) representative payee. The rest of this letter will give you information about the checks you will receive while you are the payee.

Fill-in values:

 

Fill-in (1)

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

RPY041 – NEW PAYEE SELECTED

Please read the enclosed pamphlet, “A Guide for Representative Payees.” It lists the things you will need to know because you have been chosen as payee.

RPY042 – NEW PAYEE SELECTED

You will need to keep track of how you use all of the money we send you for (1). Each year we will ask you to report on how you used the money. We call this a representative payee accounting.

Fill-in values:

 

Fill-in (1)

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

RPY048 – NEW PAYEE SELECTED - NO BENEFITS PAYABLE

We have chosen you to be (1) representative payee. However, we cannot pay benefits at this time.

Fill-in values:

 

Fill-in (1)

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

RPY073 – PAYEE CHANGE - BENEFICIARY'S NOTICE

We have chosen (1) to be your representative payee. Your payee will receive your checks each month and will use this money for your needs.

Fill-in values:

 

Fill-in (1)

New Payee Name

RPY086 – BENEFICIARY DIES - PAYEE TOLD ABOUT CONSERVED FUNDS

You may have saved some Social Security money for (1). Any money that you have saved, plus any interest on that money, belongs to (2) estate.

Fill-in values:

 

Fill-in (1)

BGN plus BKN

Fill-in (2)

 

Choice 1

his

Choice 2

her

RPY087 – BENEFICIARY DIES - PAYEE TOLD OF DISPOSITION OF FUNDS

You need to do one of these things:

  • Give this money to the legal representative of the estate, or

  • If there is no legal representative, contact the state probate court. They will be able to tell you what to do with the money, or

  • If there is no legal representative, and you live outside the United States, contact the authorities who control the estate's money. They will be able to tell you what to do with the money.

H. RRB Universal Text Identifier – Railroad Board

RRBC01 – CAPTION

What The Railroad Retirement Board Will Do

I. RSD Universal Text Identifier – Not Qualified For Medicare

RSD003 – MEDICARE DISALLOWANCE - RESIDENCY

(1) cannot qualify for Medicare because (2) did not live in any of the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa or the Northern Mariana Islands at the time (3) applied for Medicare.

Fill-in values:

 

Fill-in (1)

 

Choice 1

He

Choice 2

She

Choice 3

You

Fill-in (2)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900730136
NL 00730.136 - R Paragraphs and Captions - 10/13/2016
Batch run: 10/13/2016
Rev:10/13/2016