TN 23 (02-16)

NL 00730.149 Fact and Worksheets

A. AETH01 Factsheet and Worksheets Captions and UTI's

AETH01 – HEADER

How Work Affects Your Social Security

AETC07 – CAPTION

 The Yearly Earnings Limit  

AETC08 – CAPTION

A Special Rule That Applies To Earnings In One Year

AETC09 – CAPTION

If Your Expected Earnings Change

AET045 – EXPLANATION ON HOW EARNINGS CAN AFFECT A BENEFICIARY WHEN HE OR SHE IS UNDER FULL RETIREMENT AGE.

When you get Social Security retirement benefits before you reach full retirement age, there is a limit to the amount you can earn and still receive benefits. And, if other family members get benefits on your Social Security record, your earnings may affect the total family benefits.

Once you are full retirement age or older, there is no limit on the amount you can earn while you and your family receive benefits.

AET046 – EXPLANATION OF BENEFIT WITHHOLDING

Each year, there is a limit to the amount you can earn for the year and still qualify for full benefits. If you earn over the allowed amount for the year, we usually withhold $1 in benefits for every $2 you earn above the limit.

When we know that you expect to earn over the limit, we withhold benefits. At the end of the year, when we know how much you actually earned, we pay any additional benefits that you are due. Or if we paid you too much in benefits, we ask you to pay us back. However, in the year you turn full retirement age, we only withhold $1 for every $3 you earn above the limit:

AET047 – EXPLANATION OF THE SPECIAL ONE-YEAR RULE EARNINGS TEST

Sometimes, people who retire in mid-year have already earned more than the yearly earnings limit before they retire. That's why there's a special rule that applies to earnings for one year, usually the first year of retirement. Under this rule, you can receive a full Social Security payment for any whole month you are "retired," regardless of your yearly earnings. This year, a person under full retirement age is considered retired if he:

  • Works for wages and earns (1) or less in a month; or

  • Works less than 45 hours a month in self-employment.

Fill-in values:

 

Fill-in (1)

 

Choice 1

LMETY Monthly earnings limit in format $$$$$.¢¢

Choice 2

Year of Earnings Report (YOER) monthly earnings calculated in the format $$$$$.¢¢

BRR013 – UTI INFORMS THE BENEFICIARY TO REPORT ANY CHANGES IN EARNINGS

To help us pay you correctly, please report any change in your earnings to us. If you see that your earnings will be different from your last report or your earlier estimate, please call or visit any Social Security office to let us know.

B. AETH02 Factsheet and Worksheet Captions and UTI's

AETH02 – HEADER ON THE FACT SHEET

How to Estimate Earnings

AETC10 – CAPTION

If You Work For Wages

AETC11 – CAPTION

If You Are Self-Employed

AETC12 – CAPTION

If You Work For Wages and Are Self-Employed

If You Work For Wages and Are Self-Employed

AET048 – WORKSHEET ON HOW TO ESTIMATE EARNINGS

If (1) (2) self-employed in (3), you need to estimate (4) net earnings from self-employment for the year. Then, prorate that amount by the number of months before (5).

To prorate, divide (6) estimated net earnings for the year by 12 (the number of months in a year). This will give (7) average estimated net earnings per month. Multiply this number times the number of months before (8).

For example, if you estimate (9) net earnings for the year at $48,000 and (10) (11) (12) in (13), here is how you would prorate (14) net earnings:

$48,000 12 = $4,000 X (15) = (16)

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)

Current Operating Year (COY) in the format CCYY

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 2

your

Fill-in (5)

Full Retirement Age (FRA) month

Fill-in (6)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (7)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (8)

Full Retirement Age (FRA) month

Fill-in (9)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (10)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (11)

 

Choice 1

turns

Choice 2

turn

Fill-in (12)

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 (13)

Full Retirement Age (FRA) month

Fill-in (14)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (15)

Number of months prior to the Full Retirement Age (FRA) month as a numeric value

Fill-in (16)

4000 times the number determined in Fill-in (15)

AET049 – FACTSHEET UTI ON HOW TO ESTIMATE EARNINGS

If (1) (2) for wages and (3) self-employed in (4), add (5) wages for the months before (6) to (7) estimated prorated net earnings from self-employment for that same period. Or if you estimate a net loss from self-employment for any of the months before (8), subtract that amount from (9) wages.

Fill-in values:

 

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

works

Choice 2

work

Fill-in (3)

 

Choice 1

is

Choice 2

are

Fill-in (4)

Current Operating Year (COY) in the format CCYY

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (6)

Full Retirement Age (FRA) month

Fill-in (7)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (8)

Full Retirement Age (FRA) month

Fill-in (9)

 

Choice 1

his

Choice 2

her

Choice 3

your

AET050 – FACTSHEET UTI ON HOW TO ESTIMATE EARNINGS

If (1) (2) for wages, you can check (3) pay stub to find out how much (4) earned in (5) before attaining full retirement age in (6).

Look at the pay stub for the last pay period before (7).

(8) earnings include:

(9) total gross wages, plus any tips (10) received, plus any contributions (11) made to a tax-deferred savings plan not counted in (12) gross wages.

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

work

Choice 2

works

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (5)

Current Operating Year (COY) in the format CCYY

Fill-in (6)

Full Retirement Age (FRA) month

Fill-in (7)

Full Retirement Age (FRA) month

Fill-in (8)

 

Choice 1

Your

Choice 2

His

Choice 3

Her

Choice 4

BGN (possessive)

Fill-in (9)

 

Choice 1

Your

Choice 2

His

Choice 3

Her

Fill-in (10)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (11)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (12)

 

Choice 1

your

Choice 2

his

Choice 3

her

C. BENH01 Factsheet and Worksheet Captions and UTI's

BENH01 – HEADER ON THE FACTSHEET

Your Monthly Benefits

PMT018 – FACTSHEET UTI USED AFTER THE HEADER BENHO1

Below we show the monthly changes to (1) benefit amount (2) (3).

The dollar amounts in the column “Monthly Amounts Credited” are the amounts we thought (4) due each month based on information we had at the time. Based on the information we now have, we have corrected the amounts that (5) due during this time. We used these "Corrected Monthly Amounts" to decide whether we paid (6) too much or too little.

Fill-in values:

 

Fill-in (1)

 

Choice 1

your

Choice 2

Null

Choice 3

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

Fill-in (2)

 

Choice 1

for

Choice 2

between

Choice 3

from

Fill-in (3)

Changed month(s) using one of the formats below.

Choice 1

Month CCYY

Choice 2

Month CCYY plus the word “and” plus Month CCYY

Choice 3

Month CCYY plus the word “through” plus Month CCYY

Fill-in (4)

 

Choice 1

you were

Choice 2

he was

Choice 3

she was

Fill-in (5)

 

Choice 1

you were

Choice 2

he was

Choice 3

she was

Fill-in (6)

 

Choice 1

you

Choice 2

him

Choice 3

her

PMT019 – FACTSHEET UTI THAT IS USED AS THE HEADING FOR THE “YOUR MONTHLY BENEFITS” CHART

Months Monthly Amounts Corrected Monthly

Credited/Paid Amounts

PMT020 – FACTSHEET UTI THAT SHOWS THE SINGLE MONTHLY BENEFIT CREDITED (MBC) CHANGES FOR THE “YOUR MONTHLY BENEFITS” CHART

(1) (2) (3)

Fill-in values:

 

Fill-in (1)

 

Choice 1

Start date of the occurrence of change Month CCYY

Choice 2

Month CCYY the word “through” plus Month CCYY

Fill-in (2)

Pre-MBR Monthly Benefit Credited (MBC) for this occurrence

Fill-in (3)

Post-MBR Monthly Benefit Credited (MBC) for this occurrence

PMT022 – CLOSING PARAGRAPH OF FACTSHEET UTI BENH01

The amounts credited or paid to (1) may not match the payments (2) actually received. This is because there may have been reasons in (3) case why we could not pay (4) this amount. For example, we may have withheld Medicare premiums or money because of another debt.

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

you

Choice 2

he

Choice 3

she

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

you

Choice 2

him

Choice 3

her

PMT025 – FACTSHEET UTI THAT SHOWS THE MONTHLY BENEFIT CREDITED (MBC) CHANGES WHEN THE CHANGE IS FOR MORE THAN ONE MONTH ON THE “YOUR MONTHLY BENEFITS” CHART

(1)

(2) (3) (4)

Fill-in values:

 

Fill-in (1)

Start date of this occurrence of change in the format Month CCYY plus the word “through”

Fill-in (2)

Month CCYY

Fill-in (3)

Pre-MBR Monthly Benefit Credited (MBC)

Fill-in (4)

Post-MBR Monthly Benefit Credited (MBC)

D. ERNH01 Factsheets and Worksheets Captions and UTI's

ERNH01 – THIS UTI IS THE HEADING ON THE FACT SHEET. NOTE: THIS FACT/WORKSHEET INCLUDING ALL THE UTI'S WITHIN CAN APPEAR ONLY ON A WORKING BENEFICIARY NOTICE

How We Figured (1) (2) For (3)

Fill-in values:

 

Fill-in (1)

 

Choice 1

His

Choice 2

Her

Choice 3

Your

Fill-in (2)

 

Choice 1

Incorrect Payment

Choice 2

Underpayment

Choice 3

Overpayment

Choice 4

Payment

Fill-in (3)

Year of Earnings Report (YOER) as a numeric value in the format CCYY

ERNC06 – CAPTION

Result Of (1) (2) Earnings

Fill-in values:

 

Fill-in (1)

 

Choice 1

His

Choice 2

Her

Choice 3

Your

Fill-in (2)

 

Choice 1

Expected

Choice 2

Null

ERN016 – FACTSHEET UTI THAT GIVES THE BENEFICARY HIS OR HER ESTIMATED EARNINGS FOR AN OPEN YEAR

You told us that you expect to earn (1) (2).

Fill-in values:

 

Fill-in (1)

Provide ellipsis

Example: (………)

Fill-in (2)

Post-MBR Amount of Reported Earnings (AORE)

ERN019 – FACTSHEET UTI THAT GIVES THE BENEFICIARY ACTUAL EARNINGS FOR A PRIOR YEAR

You earned (1) (2)

Fill-in values:

 

Fill-in (1)

Provide ellipsis

Example: (………)

Fill-in (2)

Post-MBR Amount of Reported Earnings (AORE)

AET051 – FACTSHEET UTI THAT GIVES THE ANNUAL LIMIT AMOUNT

Less the (1) earnings limit of (2) (3)

Fill-in values:

 

Fill-in (1)

Year of Earnings Report (YOER) in the format CCYY

Fill-in (2)

Provide ellipsis

Example: (………)

Fill-in (3)

Annual earnings limit

AET037 – FACTSHEET UTI THAT GIVES THE BENEFICIARY'S EARNINGS OVER THE ANNUAL EARNINGS LIMIT FOR A YEAR

The amount you (1) above the allowed amount is (2) (3).

Fill-in values:

 

Fill-in (1)

 

Choice 1

expect to earn

Choice 2

earned

Fill-in (2)

Provide ellipsis

Example: (………)

Fill-in (3)

Earnings over the exempt amount

AET052 – FACTSHEET UTI THAT GIVES THE BENEFICIARY'S BENEFIT OFFSET DUE AMOUNT DUE TO EARNINGS OVER THE ANNUAL EARNINGS LIMIT FOR A YEAR

We deduct $1 in benefits for every (1) you earn over the allowed amount. The amount we should (2) from your benefits based on your (3) earnings (rounded down to a whole dollar) (4).

Fill-in values:

 

Fill-in (1)

 

Choice 1

$3

Choice 2

$2

Fill-in (2)

 

Choice 1

withhold

Choice 2

have withheld

Fill-in (3)

 

Choice 1

expected

Choice 2

Null

Fill-in (4)

Provide ellipsis

Example: (…)

Fill-in (5)

Excess earnings

WDS010 – FACTSHEET UTI EXPLAINS TO THE BENEFICIARY THAT BENEFITS NEED TO BE WITHHELD FOR THE ENTIRE YEAR DUE TO THEIR ANNUAL EARNINGS

The amount we should withhold based on (1) expected earnings is more than (2) total benefits of (3).

Fill-in values:

 

Fill-in (1)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (2)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (3)

Provide ellipsis

Example: (…)

Fill-in (4)

Total annual benefits

WDS014 – FACTSHEET UTI THAT IS USED WITH UTI WDS010 EXPLAINS TO THE BENEFICIARY THAT BENEFITS NEED TO BE WITHHELD FOR THE ENTIRE YEAR DUE TO HIS OR HER ANNUAL EARNINGS

(So we need to withhold all your benefits this year (1).)

Fill-in values:

 

Fill-in (1)

 

Choice 1

and the benefits of others on your record

Choice 2

Null

WDS012 – FACTSHEET UTI THAT IS USED FOR ESTIMATED EARNINGS YEARS AND EXPLAINS TO THE WORKING BENEFICIARY THAT WHEN THE EXACT AMOUNT OF EARNINGS IS PROCESSED ANY UNDERPAYMENT WILL BE PAID AND ANY OVERPAYMENT WILL BE CHARGED

At the end of the year, when we know how much (1) actually earned, we will pay (2) any benefits due. Or if we paid too much, we will ask (3) to pay us back.

Fill-in values:

 

Fill-in (1)

 

Choice 1

you

Choice 2

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

Choice 3

he

Choice 4

she

Fill-in (2)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (3)

 

Choice 1

you

Choice 2

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

Choice 3

him

Choice 4

her


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900730149
NL 00730.149 - Fact and Worksheets - 02/29/2016
Batch run: 02/29/2016
Rev:02/29/2016