VTW001 – BENEFICIARY REQUESTS VOLUNTARY TAX WITHHOLDING
You asked that we withhold money from (1) benefits for voluntary Federal tax withholding.
You want (2) (3) (4) (5) (6) (7) (8) (9) (10)(11) (12) (13) (14) (15) (16) (17) (18)
(19).
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Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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Choice 2
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your
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Fill-in (2)
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numeric value for% plus the word “percent”
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Fill-in (3)
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Choice 1
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withheld
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Choice 2
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null
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Fill-in (4)
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Choice 1
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beginning
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Choice 2
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for
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Choice
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null
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Fill-in (5)
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Choice 1
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Voluntary Tax Withholding Start Date (VTW-START DATE) FOR 1ST EVENT
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Choice 2
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null
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Fill-in (6)
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Choice 1
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and
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Choice 2
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through
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Choice 3
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null
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Fill-in (7)
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Choice 1
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Voluntary Tax Withholding Stop Date (VTW-STOP- DATE) FOR 1ST EVENT
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Choice 1
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null
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Fill-in (8)
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Choice 1
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, (a comma)
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Choice 2
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null
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Fill-in (9)
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numeric value for% plus the word “percent”
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Fill-in (10)
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Choice 1
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withheld
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Choice 2
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null
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Fill-in (11)
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Choice 1
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beginning
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Choice 2
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for
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Choice
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null
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Fill-in (12)
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Choice 1
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Voluntary Tax Withholding Start Date (VTW-START DATE) FOR 2ND EVENT
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Choice 2
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null
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Fill-in (13)
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Choice 1
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and
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Choice 2
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through
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Choice 3
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null
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Fill-in (14)
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Choice 1
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Voluntary Tax Withholding Stop Date (VTW-STOP- DATE) FOR 1ST EVENT
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Choice 1
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null
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Fill-in (15)
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Choice 1
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and
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Choice 2
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null
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Fill-in (16)
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show numeric value for% plus the word “percent”
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Fill-in (17)
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Choice 1
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withheld
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Choice 2
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null
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Fill-in (18)
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Choice 1
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beginning
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Choice 2
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null
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Fill-in (19)
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Choice 1
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Voluntary Tax Withholding Start Date (VTW-START DATE) FOR 3rd EVENT
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Choice 2
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null
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VTW002 – VOLUNTARY TAX WITHHOLDING (VTW) W/H FROM CAMT AND MBP OR A SET PERIOD OF
TIME
We will withhold (1) from (2) benefit for (3). Thereafter, we will withhold (4) each
month. (5) (6).
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Fill-in values:
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Fill-in (1)
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Show VCAMT
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Fill-in (2)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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Choice 2
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your
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Fill-in (3)
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Show the ACD in format Month CCYY
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Fill-in (4)
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Show the CVWA in format 99,999.99
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Fill-in (5)
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Choice 1
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null
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Choice 2
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We will continue to withhold until
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Fill-in (6)
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Choice 1
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null
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Choice 2
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show the date that corresponds to the VRATE = 0 (zero) in the format Month CCYY
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VTW005 – WITHHOLDING REQUEST > MBP
Since the amount due (1) (2) (3) is not enough for voluntary Federal tax withholding,
we cannot honor your request.
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Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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you
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Fill-in (2)
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Choice 1
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through
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Choice 2
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for
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Fill-in (3)
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Show the ACD in format Month CCYY
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VTW006 - VOLUNTARY TAX WITHHOLDING (VTW) WITHHOLDING ENDS
As you asked, we will stop voluntary Federal tax withholding from (1) monthly Social
Security benefit beginning (2).
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Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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Choice 2
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your
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Fill-in (2)
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Show the VSTRT date that corresponds to the VRATE = 0 (seize) in format Month CCYY
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VTW007 – VOLUNTARY TAX WITHHOLDING (VTW) DEDUCTED FROM PMA PAYMENT
We withheld (1) for voluntary federal taxes from this payment.
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Fill-in values:
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Fill-in (1)
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Show the VPAMT in the format 999,999.99
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VTW010 – VOLUNTARY TAX WITHHOLDING (VTW) STOPS NO BENEFITS PAYABLE
Since (1) not receiving benefits, we cannot continue to withhold money for voluntary
Federal tax withholding. (2)
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Fill-in values:
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Fill-in (1)
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Choice 1
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you are
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is”
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Fill-in (2)
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Choice 1
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You will have to ask for voluntary tax withholding if you start receiving benefits.
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Choice 2
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You will have to ask for voluntary tax withholding if he starts receiving benefits.
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Choice 3
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You will have to ask for voluntary tax withholding if she starts receiving benefits.
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Choice 4
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We will start withholding the tax percentage amount you asked us to take when we can
pay benefits.
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VTW013 - VOLUNTARY TAX WITHHOLDING - WITHHOLDING CONTINUES
We will continue to withhold money for voluntary Federal tax withholding as (1) requested.
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Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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Beneficiary’s Given Name (BGN)
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Choice 3
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you
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VTW014 - MATURING ACTION VOLUNTARY TAX WITHHOLDING (VTW) DEDUCTED FROM BENEFITS
(1) will get benefits starting (2). (3) asked that we withhold money from (4) benefits
for voluntary Federal tax withholding when (5) payments started.
We will withhold money for voluntary Federal tax withholding as (6) requested starting
(7).
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Fill-in values:
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Fill-in (1)
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Choice 1
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You
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Fill-in (2)
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Month CCYY
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Fill-in (3)
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Choice 1
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You
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Choice 2
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He
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Choice 3
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She
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Fill-in (4)
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Choice 1
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your
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Choice 2
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his
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Choice 3
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her
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Fill-in (5)
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Choice 1
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your
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Choice 2
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his
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Choice 3
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her
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Fill-in (6)
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Choice 1
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you
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Choice 2
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he
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Choice 3
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she
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Fill-in (7)
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Month CCYY
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VTW015 - MATURING ACTIONS VOLUNTARY TAX WITHHOLDING (VTW) AND SMI BOTH DEDUCTED MBA
(1) will start getting benefits beginning (2). We told (3) earlier that when we started
paying (4) benefits we would adjust them for medical insurance premiums.
We will also start withholding money for voluntary Federal tax withholding as (5)
requested beginning (6).
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Fill-in values:
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Fill-in (1)
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Choice 1
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You
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Fill-in (2)
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Month CCYY
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Fill-in (3)
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Choice 1
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you
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Choice 2
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him
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Choice 3
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her
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Fill-in (4)
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Choice 1
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you
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Choice 2
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him
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Choice 3
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her
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Fill-in (5)
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Choice 1
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you
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Choice 2
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he
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Choice 3
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she
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Fill-in (6)
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Month CCYY
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VTW016 – PRE LAF C/D POST LAF S VOLUNTARY TAX WITHHOLDING (VTW) NO LONGER DEDUCTED
Because benefits are not currently payable, we cannot continue to honor your request
for voluntary Federal tax withholding.
VTW017 – VOLUNTARY TAX WITHHOLDING (VTW) STARTS BASED ON RESUMPTION OF BENEFITS
Because benefits are again payable, your request for voluntary Federal tax withholding
has been resumed at the requested rate.