TN 2 (11-06)

NL 00755.900 Exhibits of Fugitive Felon Paragraphs and Captions

NOTE: On April 1, 2009, SSA changed its policy of not paying fleeing felons. Follow the instructions below only for felony warrants with offense codes 4901, 4902, or 4999. Follow the Martinez settlement instructions in GN 02613.860 GN 02613.885 for all other felony warrant codes.

On March 18, 2011, upon remand from the Second Circuit, the District Court for the Southern District of New York certified a nationwide class in Clark v. Astrue that includes all individuals whose benefits or payments we suspended or denied after October 29, 2006. Given the pending litigation, including continuing litigation about the class certification, at this time we are not suspending or denying payments based solely on a report of a probation or parole violation warrant. Follow the instructions in EM-11032, dated May 9, 2011 for processing cases with probation or parole violation warrants with offense codes: 5011, 5012, 8101, 8102, or 9999 or “Blank” and an offense charge symbol of “probation or parole violation.”

We will make additional changes to this section, as necessary, in the future.

For Martinez Title II and Title XVI notice information, see the references indicated in the chart in this section below:

Martinez Paragraphs and NoticesReference

Title II Martinez Post-2006 Paragraphs and Captions

Title II Martinez Settlement Post-2006 Generic Notice

GN 02613.867 A

GN 02613.867A and
GN 02613.867B

Title XVI Martinez Post-2006 Notices

  • Martinez RZ Redetermination Letter

GN 02613.875A.3.

Title II Martinez Pre-2007 Paragraphs and Captions

Title II Martinez Settlement Pre-2007 Informational Notice

GN 02613.869B

GN 02613.869A and
GN 02613.869C

Title XVI Martinez Pre-2007 Notices

  • Title XVI Martinez Pre-2007 Generic Notice

GN 02613.880F

A. Exhibit - Fugitive Felon/Probation or Parole Violator Paragraphs for Initial Award Plus Suspension Notice

1. Fugitive Felon Paragraphs and Captions to Include in the Initial Award Plus Suspension Notice

a. Good Cause Determination Was Made at the Time of the Application

UTI# on DPS and AURORA

Language for Paragraph or Caption

DPS

FUG049

*F1 monthly benefit is *F2 beginning *F3.

We cannot pay benefits to *F4 beginning *F5 because *F6 an outstanding arrest warrant for a *F7.

Fill-Ins:

*F1-1 Pronoun (Your/Client Name Possessive)
*F2-1 $$$$.00 (MBA at date of entitlement)
*F3-1 MMCCYY (date of entitlement to Title II benefits)

*F4-1 Pronoun (you/Client Name)
*F5-1 MMCCYY (date suspension begins)
*F6-1 Pronoun (you have/he has/she has/Client Name has)
*F7-1 felony crime
*F7-2 violation of probation or parole under Federal or State law

AURORA

WCP034

*F1 monthly benefit is $*F2 *F3 *F4 *F5 *F6.

Fill-Ins:

*F1-1 BGN plus BLN
*F1-2 Your
*F2-1 Amount
*F3-1 for
*F4-1 MM/CCYY
*F5-1 and
*F5-2 through
*F5-3 Null
*F6-1 MM/CCYY
*F6-2 Null

DPS

FUG056

AURORA

FUG056

Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F1 *F2 into one of these categories.

Fill-Ins:

*F1-1 Pronoun (you/he/she/Client Name)
*F2-1 fall

*F2-2 falls

DPS

FUG050

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/client/beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

*F4 –3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

*F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant.

*F5-1 null

*F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

*F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant.

AURORA

FUG050

CAUTION: PSC staff should review the instructions found in (NL 00755.330 B.1.a.); (NL 00755.330B.1.b.) and (NL 00755.330D) for the limited use of this good cause denial paragraph.

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/client/beneficiary Name has))
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

DPS

INFCO1

AURORA

INFC01

The Information We Have

DPS

FUG029

AURORA

FUG029

Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest for a *F5 crime on *F6.

The warrant information we have is:

Warrant number: *F7
Originating case number: *F8
National Crime Information Center number: *F9

Social Security cannot provide further information about the warrant. Please contact the *F10 directly.

Fill-Ins:

*F1-1 Warrant Issuing Agency Name
*F2-1 address of Warrant Issuing Agency
*F3-1 telephone number of Warrant Issuing Agency
*F4-1 Pronoun (your/Client Name Possessive)
*F5-1 nonviolent and non drug-related
*F5-2 violent
*F5-3 drug related
*F5-4 probation/parole violation that was a nonviolent and non drug-related
*F5-5 probation or parole violation that was a violent
*F5-6 probation or parole violation that was drug related
*F5-7 NULL
*F6-1 MM/CCYY (date of the warrant)
*F7-1 Warrant number
*F8-1 Originating case number
*F9-1 National Crime Information Center number
*F10-1 Warrant Issuing Agency Name

DPS

PAYC27

AURORA

PAYC27

How *F1 Benefits Can Be Paid

Fill-Ins:

*F1-1 Pronoun (Your/Client/Beneficiary Name Possessive)

DPS

FUG030

AURORA

FUG030

We will pay *F1 if you contact us at any time,*F2 and can show us within 90 days from the date that you contact us that any of the following apply:

The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name.

*F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges.

The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn.

*F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges.

Fill-Ins:*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 meet all of the SSI eligibility requirements,
*F2-2 Null (if Title II benefits)
*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F4-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F5-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F12-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

DPS

FUG031

AURORA

FUG031

If none of the above apply, we also may pay *F1 if you contact us within 12 months from the date of this letter, *F2 and can show us that:

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F3 paroled or put on probation was both nonviolent and not drug related.

                   And

*F4 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                  And

The law enforcement agency that issued the warrant reports that it will not extradite *F5 for the charges on the warrant or that it will not take action on the warrant for *F6 arrest.

                  Or

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F7 paroled or put on probation was both nonviolent and not drug related.

                  And

F8 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                  And

The only existing warrant was issued 10 or more years ago.

                 And

*F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11 incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security has appointed a representative payee to handle *F14 benefits or *F15 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

 

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 meet all of the SSI eligibility requirements/,
*F2-2 Null (for Title II benefits)

*F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F4-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F5-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F8-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F9-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F12-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F13-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F14-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F15-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

AURORA

FUG504

DPS

FUG504

*F1 entitled to receive monthly *F2 benefits beginning *F3.

Fill-Ins:

*F1 – 1 Pronoun (You are/Client is/Beneficiary Name is)

*F2 – 1 (retirement/survivors/disability/supplemental security income)

*F3 – 1 (MM/CCYY--date of fugitive felon/probation or parole violator suspension/date of entitlement to benefits)

AURORA

PAYC01

DPS PAYC01

What We Will Pay and When

DPS

BENC08

Information About Your Benefits

AURORA

BENC09

About *F1 Benefits

Fill-Ins:

*F1-1 Your
*F1-2 beneficiary's surname possessive

b. Good Cause Determination is Pending at the Time of Application of Claim

UTI # DPS and AURORA

Language for Paragraphs and Captions

DPS

FUG507

AURORA

FUG507

You have told us that there is a good cause for not satisfying the outstanding warrant but we need information from you to prove this. Once you submit the information necessary for us to decide if *F1 shown good cause for not satisfying the outstanding warrant, we will send you another letter to let you know if we can start paying *F2 Social Security benefits.

Fill-Ins:

*F1 – 1 Pronoun (you have/he has/she has)

*F2 – 1 Pronoun (you/him/her)

2. Miscellaneous Paragraphs and Captions to Use in the Initial Award Plus Suspension Notice

UTI # DPS and AURORA

Language for Paragraph

DPS

INFC08

AURORA

INFC08

Things To Remember

DPS

PRI023

AURORA

CLO022

Even though *F1 benefits will stop, we can pay other members of the family if they are entitled on *F2 record.

Fill-Ins:

*F1-1 Pronoun (your/Client/Beneficiary Name Possessive)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

B. Exhibit - of Proposed Suspension Paragraphs and Captions-Post-adjudicative

UTI# on DPS and AURORA

Language for Paragraph

DPS

FUG056

AURORA

FUG056

Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F1 *F2 into one of these categories.

Fill-Ins:

*F1-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F2-1 fall
*F2-2 falls

DPS

SUS210

AURORA

SUS210

Based on the information we have, we should have stopped the Social Security benefits beginning *F1.

Fill-Ins:

*F1-1 MM/CCYY

AURORA

FUG048

We are writing to tell you that we plan to stop *F1 Social Security benefits. Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F2 into one of these categories.

 Based on the information we have, we should have stopped the Social Security benefits beginning *F3.

Fill-Ins:

*F1-1 beneficiary’s name (possessive)
*F1-2 your
*F2-1 she falls
*F2-2 he falls
*F2-3 you fall
*F3-1 MM/CCYY (Date of suspension)

DPS

INFC01

AURORA

INFC01

The Information We Have

DPS

FUG029

AURORA

FUG029

Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest for a *F5 crime on *F6.

The warrant information we have is:

Warrant number: *F7
Originating case number: *F8
National Crime Information Center number: *F9

Social Security cannot provide further information about the warrant. Please contact the *F10 directly.

Fill-Ins:

*F1-1 Warrant Issuing Agency Name
*F2-1 Warrant Issuing Agency address
*F3-1 Warrant Issuing Agency telephone number
*F4-1 Pronoun (your/Client/Beneficiary Name Possessive)
*F5-1 nonviolent and non drug-related
*F5-2 violent
*F5-3 drug related
*F5-4 probation/parole violation that was a nonviolent and non drug-related)
*F5-5 probation or parole violation that was a violent
*F5-6 probation or parole violation that was drug related)
*F5-7 NULL

*F6-1 MM/CCYY(date of the warrant)
*F7-1 Warrant number
*F8-1 Originating case number
*F9-1 National Crime Information Center number
*F10-1 Warrant Issuing Agency Name

DPS

PAYC27

AURORA

PAYC27

How *F1 Benefits Can Be Paid

Fill-Ins:

*F1-1 Pronoun (Your/Client/Beneficiary Name Possessive)

DPS

FUG030

AURORA

FUG030

We will pay *F1 if you contact us at any time*F2 and can show us within 90 days from the date that you contact us that any of the following apply:

The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name.

*F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges.

The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn.

*F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 , meet all of the SSI eligibility requirements,
*F2-2 Null (if Title II benefits)
*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F4-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F5-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F12-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

DPS

FUG031

AURORA

FUG031

If none of the above apply, we also may pay *F1 if you contact us within 12 months from the date of this letter *F2 and can show us that:

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F3 paroled or put on probation was both nonviolent and not drug related.

                         And                          

*F4 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.                          

                   And

The law enforcement agency that issued the warrant reports that it will not extradite *F5 for the charges on the warrant or that it will not take action on the warrant for *F6 arrest.

                   OR

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F7 paroled or put on probation was both nonviolent and not drug related.

                   And

*F8 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                   And

The only existing warrant was issued 10 or more years ago.

                   And

*F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11 incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security has appointed a representative payee to handle *F14 benefits or *F15 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Fill-Ins:
*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 , meet all of the SSI eligibility requirements,
*F2-2 Null (if Title II benefits)
*F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F4-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F5-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F8-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F9-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F12-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive))

DPS

MESC02

AURORA

MESC02

*F13-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F14-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F15-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

What You Can Do

DPS

PAY157

AURORA

PAY157

Our records show that *F1 already *F2 the following requirement(s) for *F3 benefits to be paid:

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 meet
*F2-2 meets

*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

DPS

FUG032

AURORA

FUG032

The crime for which the warrant was issued was both nonviolent and not drug related.

NOTE: Do not use this paragraph for offense codes 5011 or 5012.

DPS

FUG033

AURORA

FUG033

The original crime(s) for which *F1 paroled or put on probation was both nonviolent and not drug related.

Fill-Ins:

*F1-1 Pronoun (you were/Client/Beneficiary Name was)

NOTE: Use this paragraph for offense codes 5011 or 5012.

DPS

FUG034

AURORA

FUG034

*F1 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

Fill-Ins:

*F1-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)

DPS

FUG035

AURORA

FUG035

The law enforcement agency that issued the warrant reports that it will not extradite *F1 for the charges on the warrant or that it will not take action on the warrant for *F2 arrest.

Fill-Ins:

*F1-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

DPS

FUG036

AURORA

FUG036

The only existing warrant was issued 10 or more years ago.

DPS

FUG037

AURORA

FUG037

*F1 medical condition impairs *F2 mental capacity to resolve the warrant.

Fill-Ins:

*F1-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

DPS

FUG038

AURORA

FUG038

Social Security has appointed a representative payee to handle *F1 benefits.

Fill-Ins:

*F1-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

DOC

FUG039

AURORA

FUG039

*F1 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Fill-Ins:

*F1-1 Pronoun (You are/Client/Beneficiary Name is)

DPS

PAY158

AURORA

PAY158

However, we do not have all the information we need to pay benefits. If you contact us within 12 months from the date of this letter, we will pay *F1 benefits if you can show us within 90 days from the date you contact us that:

Fill-Ins:

*F1-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

DPS

FUG042

AURORA

FUG042

The probation or parole violation was both nonviolent and not drug related and, the original crime(s) for which *F1 paroled or put on probation was both nonviolent and not drug related. To prove this, submit an official court document that explains the criminal charges on which *F2 originally convicted. Such documents include, but are not limited to a docket, a conviction notice, or a plea agreement.

Fill-Ins:

*F1-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F2-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

DPS

FUG040

AURORA

FUG040

The crime for which the warrant was issued is both nonviolent and not drug related. To prove this, submit an official copy of the arrest warrant. Such documents include, but are not limited to a docket, a conviction notice or a plea agreement.

DPS

FUG041

AURORA

FUG041

The original crime for which *F1 paroled or put on probation was both nonviolent and not drug related. To prove this, submit an official court document that explains the criminal charges on which *F2 originally convicted. Such documents include but are not limited to a docket, a conviction notice, or a plea agreement.

Fill-Ins:

*F1-1 Pronoun (you were/Client/Beneficiary Name was)
*F2-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

DPS

FUG043

AURORA

FUG043

*F1 neither been convicted of nor pled guilty to any other felony crime since the warrant was issued on *F2. To prove this, give us a statement as to whether *F3 been convicted of or pled guilty to any such crimes since *F4.

Fill-Ins:

*F1-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F2-1 MM/CCYY
*F3-1 Pronoun (you have/he has/she has/Client/Beneficiary Name has)
*F4-1 MM/CCYY (date of suspension)

DPS

FUG044

AURORA

FUG044

The law enforcement agency that issued the warrant is unwilling to act on it. To prove this, submit an official document from the law enforcement agency that issued the warrant stating that it will not extradite *F1 for the charges on the warrant or that it will not take action on the warrant for *F2 arrest.

Fill-Ins:

*F1-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

DPS

FUG045

AURORA

FUG045

*F1 incapable of managing *F2 benefits or *F3 legally incompetent. To prove this, submit a copy of the court order that appointed a conservator or guardian to handle *F4 affairs or that declared *F5 legally incompetent.

Fill-Ins:

*F1-1 Pronoun (You are/He is/She is/Client/Beneficiary Name is)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F3-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is))
*F4-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

*F5-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

DPS

FUG046

AURORA

FUG046

                         Or

*F1 residing in a long-term care facility, such as a nursing home or mental treatment /care facility. To prove this, submit a statement that *F2 residing in such a facility.

Fill-Ins:

*F1-1 Pronoun (You are/Client Name/Beneficiary is)
*F2-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

DPS

CAPC40

AURORA

CAPC40

If We Don't Hear From You

DPS

ALS039

If we do not hear from you within *F1 days from the date of this letter, we will assume the information in this letter is correct and will stop *F2 Social Security benefits.

We will send another letter at that time. It will explain the change in *F3 benefits, the amount of any overpayment, and how to appeal our decision.

You will have 60 days to ask for an appeal.

The 60 days will start the day after you receive the next letter.

Fill-Ins:

*F1-1 30

*F1 2 10

*F2-1 Pronoun (your/his/her/Client Name Possessive) *F3-1 Pronoun (your/his/her/Client Name Possessive)

AURORA

BRR029

If we do not hear from you within *F1 days from the date of this letter, we will assume the information in this letter is correct and will stop *F2 Social Security benefits.

We will send another letter at that time. It will explain the change in *F3 benefits, the amount of any overpayment, and how to appeal our decision.

You will have 60 days to ask for an appeal.

The 60 days will start the day after you receive the next letter.

Fill-Ins:

*F1-1 30 (due process period)

*F1-2 10 (due process period)
*F2-1 Pronoun (your/his/her/Beneficiary Name Possessive)
*F3-1 Pronoun (your/his/her/Beneficiary Name Possessive)

DPS

INFC08

AURORA

INFC08

Things To Remember

DPS

PRI023

AURORA

CLO022

Even though *F1 benefits will stop, we can pay other members of the family if they are entitled on *F2 record.

Fill-Ins:

*F1-1 Pronoun (your/Client/Beneficiary Name Possessive)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

DPS

REFC01

AURORA

REFC01

If You Have Any Questions

DPS

REF003

AURORA

REF003

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
*F01. We can answer most questions over the phone. If you are
deaf or hard of hearing, you may call our 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:

       

*F2
*F3
*F4
*F5

        

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

*F1-1 FO Phone Number
*F2-1 FO street address
*F2-2 city, state and zip code
*F3-1 FO Address
*F4-1 FO Address
*F5-1 FO Address

C. Exhibit- Fugitive Felon Good Cause Paragraphs and Captions

1. Initial Award Plus Suspension Notice Good Cause Paragraphs

UTI # on DPS and AURORA

Language for Paragraph or Caption

FUG052

We will pay *F1 if you contact us at any time and can show us that any of the following apply:

  • The warrant was issued incorrectly in *F2 name because someone stole *F3 identity. To prove this submit a copy of the police report *F4 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F5 name.

  • *F6 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F7 found not guilty of the criminal charges or a copy of the court decision showing that *F8 found not guilty of the criminal charges.

  • The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

  • The warrant for *F9 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn.

  • *F10 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F11 cleared of the criminal charges.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F4-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F5-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F6-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F7-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F10-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F11-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

FUG031

If none of the above apply, we also may pay *F1 if you contact us within 12 months from the date of this letter, *F2 and can show us that:

  • The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F3 paroled or put on probation was both nonviolent and not drug related.

                         And

  • *F4 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                         And

  • The law enforcement agency that issued the warrant reports that it will not extradite *F5 for the charges on the warrant or that it will not take action on the warrant for *F6 arrest.

                        Or

  • The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F7 paroled or put on probation was both nonviolent and not drug related.

                       And

  • *F8 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                      And

  • The only existing warrant was issued 10 or more years ago.

                      And

  • *F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11 incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security has appointed a representative payee to handle *F14 benefits or *F15 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name) )
*F2-1 Meet all of the SSI eligibility requirements,
*F2-2 Null (if Title II case)
*F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) )
*F4-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F5-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

 

*F8-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F9-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F12-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F13-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F14-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F15-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

2. Fugitive Felon Advance Notice of Proposed Suspension

UTI # on DPS and AURORA

Language for Paragraph or Caption

FUG030

We will pay *F1 if you contact us at any time,*F2 and can show us within 90 days from the date that you contact us that any of the following apply:

  • The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name.

  • *F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges.

  • The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

  • The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn.

  • *F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 meet all of the SSI eligibility requirements,
*F2-2 Null (if Title II case)

*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F4-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) )
*F5-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F12-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

FUG031

If none of the above apply, we also may pay *F1 if you contact us within 12 months from the date of this letter *F2 and can show us that:

  • The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F3 paroled or put on probation was both nonviolent and not drug related.

                              And

  • *F4 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                             And

  • The law enforcement agency that issued the warrant reports that it will not extradite *F5 for the charges on the warrant or that it will not take action on the warrant for *F6 arrest.

                            Or

  • The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F7 paroled or put on probation was both nonviolent and not drug related.

                            And

  • *F8 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                           And

  • The only existing warrant was issued 10 or more years ago.

                         And

  • *F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11 incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security has appointed a representative payee to handle *F14 benefits or *F15 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name) )
*F2-1 meet all of the SSI eligibility requirements,
*F2-2 Null (if Title II case)
*F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) )
*F4-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F5-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

 *F8-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F9-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F12-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F13-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F14-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F15-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is).

3. Suspension Notice Good Cause Paragraphs

UTI # on DPS and AURORA

Language for Paragraph or Caption

FUG052

We will pay *F1 if you contact us at any time and can show us that any of the following apply:

The warrant was issued incorrectly in *F2 name because someone stole *F3 identity. To prove this submit a copy of the police report *F4 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F5 name.

*F6 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F7 found not guilty of the criminal charges or a copy of the court decision showing that *F8 found not guilty of the criminal charges.

The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

The warrant for *F9 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn.

*F10 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F11 cleared of the criminal charges.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

*F4-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F5-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F6-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F7-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F10-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F11-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

FUG053

If none of the above apply, we also may pay *F1 benefits if you contact us within 12 months from *F2 and can show us that:

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F3 paroled or put on probation was both nonviolent and not drug related.

                          And

*F4 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                         And

The law enforcement agency that issued the warrant reports that it will not extradite *F5 for the charges on the warrant or that it will not take action on the warrant for *F6 arrest.

                         Or

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F7 paroled or put on probation was both nonviolent and not drug related.

                        And

*F8 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                        And

The only existing warrant was issued 10 or more years ago.

                         And

*F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11 incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security has appointed a representative payee to handle *F14 benefits or *F15 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of Fugitive Felon Notice of Advanced Suspension)

*F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F4-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has))
*F5-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F8-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has
*F9-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

 
*F12-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F13-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F14-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F15-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

4. Closed Period of Suspension Notices Good Cause Paragraphs

UTI # on DPS and AURORA

Language for Paragraph or Caption

FUG054

F1 will not be overpaid for the months that *F2 had an outstanding felony warrant for a crime or a warrant for a probation or parole violation if you contact us at any time and can show us that any of the following apply:

The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name.

*F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges.

The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn.

*F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges.

Fill-Ins:

*F1-1 Pronoun (You/Client/Beneficiary Name))
*F2-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F4-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F5-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was
*F12-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

FUG055

If none of the above applies, we also may not consider *F1 overpaid *F2 for the months of *F3 if you contact us within 12 months from the date of this notice and can show us that:

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F4 paroled or put on probation was both nonviolent and not drug related.

                  And

*F5 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                   And

The law enforcement agency that issued the warrant reports that it will not extradite *F6 for the charges on the warrant or that it will not take action on the warrant for *F7 arrest.

                   Or

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F8 paroled or put on probation was both nonviolent and not drug related.

                   And

*F9 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                   And

The only existing warrant was issued 10 or more years ago.

                  And

*F10 medical condition impairs *F11 mental capability to resolve the warrant; or *F12 incapable of managing *F13 benefits; or *F14 legally incompetent; or Social Security has appointed a representative payee to handle *F15 benefits or *F16 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 $$$$.00 (amount of overpayment)
*F3-1 MM/CCYY through MM/CCYY (overpayment period)

*F4-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F5-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F6-1 Pronoun (you/him/her/Client/Beneficiary Name)

*F7-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F10-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)

 *F11-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F12-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F13-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F14-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F15-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F16-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

5. Paragraphs and Captions That Explain What Evidence or Proof is Necessary to Qualify for Good Cause

UTI # on DPS and AURORA

Language for Paragraph or Caption

MESC02

What You Can Do

PAY157

Our records show that *F1 already *F2 the following requirement(s) for *F3 benefits to be paid:

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name))
*F2-1 meet
*F2-2 meets
*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

FUG032

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related.

FUG033

The original crime(s) for which *F1 paroled or put on probation was both nonviolent and not drug related.

Fill-Ins:

*F1-1 Pronoun (you were/Client/Beneficiary Name was)

FUG034

*F1 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

Fill-Ins:

*F1-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)

FUG035

The law enforcement agency that issued the warrant reports that it will not extradite *F1 for the charges on the warrant or that it will not take action on the warrant for *F2 arrest.

Fill-Ins:

*F1-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

FUG036

The only existing warrant was issued 10 or more years ago.

FUG037

*F1 medical condition impairs *F2 mental capacity to resolve the warrant.

Fill-Ins:

*F1-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

FUG038

Social Security has appointed a representative payee to handle *F1 benefits.

Fill-Ins:

*F1-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

FUG039

*F1 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Fill-Ins:

*F1-1 Pronoun (You are/Client/Beneficiary Name is)

PAY158

However, we do not have all the information we need to pay benefits. If you contact us within 12 months from the date of this letter, we will pay *F1 benefits if you can show us within 90 days from the date you contact us that:

Fill-Ins:

*F1-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

FUG042

The probation or parole violation was both nonviolent and not drug related and, the original crime(s) for which *F1 paroled or put on probation was both nonviolent and not drug related. To prove this, submit an official court document that explains the criminal charges on which *F2 originally convicted. Such documents include, but are not limited to a docket, a conviction notice, or a plea agreement.

Fill-Ins:

*F1-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F2-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

FUG040

The crime for which the warrant was issued is both nonviolent and not drug related. To prove this, submit an official copy of the arrest warrant. Such documents include, but are not limited to a docket, a conviction notice or a plea agreement.

FUG041

The original crime for which *F1 paroled or put on probation was both nonviolent and not drug related. To prove this, submit an official court document that explains the criminal charges on which *F2 originally convicted. Such documents include but are not limited to a docket, a conviction notice, or a plea agreement.

Fill-Ins:

*F1-1 Pronoun (you were/Client/Beneficiary Name was)
*F2-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

FUG043

*F1 neither been convicted of nor pled guilty to any other felony crime since the warrant was issued on *F2. To prove this, give us a statement as to whether *F3 been convicted of or pled guilty to any such crimes since *F4.

Fill-Ins:

*F1-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F2-1 MMCCYY
*F3-1 Pronoun (you have/he has/she has/Client/Beneficiary Name has)
*F4-1 MMCCYY

FUG044

The law enforcement agency that issued the warrant is unwilling to act on it. To prove this, submit an official document from the law enforcement agency that issued the warrant stating that it will not extradite *F1 for the charges on the warrant or that it will not take action on the warrant for *F2 arrest.

Fill-Ins:

*F1-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

FUG045

*F1 incapable of managing *F2 benefits or *F3 legally incompetent. To prove this, submit a copy of the court order that appointed a conservator or guardian to handle *F4 affairs or that declared *F5 legally incompetent.

Fill-Ins:

*F1-1 Pronoun (You are/He is/She is/Client/Beneficiary Name is)
*F2-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F3-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is))
*F4-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)

*F5-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

FUG046

                                Or

*F1 residing in a long-term care facility, such as a nursing home or mental treatment /care facility. To prove this, submit a statement that *F2 residing in such a facility.

Fill-Ins:

*F1-1 Pronoun (You are/Client/Beneficiary Name is)
*F2-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

D. Exhibit - Fugitive Felon/Probation or Parole Violator Suspension Paragraphs

1. DPS Fugitive Felon/Probation or Parole Violator Suspension Paragraphs and Captions

UTI # ON DPSLanguage for Paragraph

FUG049

*F1 monthly benefit is *F2 beginning *F3.

We cannot pay benefits to *F4 beginning *F5 because *F6 an outstanding arrest warrant for a *F7.

Fill-Ins:

*F1-1 Pronoun (Your/Client Name Possessive)
*F2-1 $$$$.00 (Monthly benefit amount)
*F3-1 MM/CCYY

*F4-1 Pronoun (you/Client Name)
*F5-1 MM/CCYY
*F6-1 Pronoun (you have/he has/she has/Client Name has)
*F7-1 felony crime
*F7-2 violation of probation or parole under Federal or State law

DPS

FUG050

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/client/beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

*F4 –3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

*F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant.

*F5-1 null

*F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

*F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant.

FUG051

We cannot pay benefits to *F1 for the months of *F2 because during that period *F3 had an outstanding arrest warrant for a *F4.

Fill-Ins:

*F1-1 Pronoun (you/Client Name)
*F2-1 MM/CCYY through MM/CCYY (suspension period)
*F3-1 Pronoun (you/he/she/Client Name)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

2. AURORA Fugitive Felon/Probation or Parole Violator Suspension Paragraphs

UTI # On AURORA

Language for Paragraph

FUG048

We are writing to tell you that we plan to stop *F1 Social Security benefits. Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F2 into one of these categories.

Based on the information we have, we should have stopped the Social Security benefits beginning *F3.

Fill-Ins:

*F1-1 Pronoun (your/client/beneficiary name Possessive)
*F1-2 your
*F2-1 she falls
*F2-2 he falls
*F2-3 you fall
*F3-1 MM/CCYY (Date of suspension)

FUG050

CAUTION: PSC staff should review the instructions found in (NL 00755.330 B.1.a.); (NL 00755.330B.1.b.) and (NL 00755.330D) for the limited use of this good cause denial paragraph.

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (beginning date of suspension)
*F3-1 Pronoun (you have/he has/she has/Client/Beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

FUG051

We cannot pay benefits to *F1 for the months of *F2 because during that period *F3 had an outstanding arrest warrant for a *F4.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY through MM/CCYY (suspension period)
*F3-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

SUS210

Based on the information we have, we should have stopped the
 Social Security benefits beginning *F1.

Fill-Ins:

*F1-1 MM/CCYY (Date of suspension)

E. Exhibit - Fugitive Felon or Probation or Parole Violator Overpayment Paragraphs and Captions

1. Paragraphs and Captions for a Fugitive Felon/Probation or Parole Violator Suspension Notice with An Overpayment

UTI # on DPS and AURORA

Language for Paragraph or Caption

DPS

FUG050

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/client/beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

*F4 –3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

*F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant.

*F5-1 null

*F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

*F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant.

AURORA

FUG050

CAUTION: PSC staff should review the instructions found in (NL 00755.330 B.1.a.); (NL 00755.330B.1.b.) and (NL 00755.330D) for the limited use of this good cause denial paragraph.

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/Client/Beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

FUG056

Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F1 *F2 into one of these categories.

Fill-Ins:

*F1-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F2-1 fall

*F2-2 falls

INFC01

The Information We Have

FUG057

Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest for a felony crime or a violation of Federal or State probation or parole on *F5.

The warrant information we have is:

Warrant number: *F6
Originating case number: *F7
National Crime Information Center number: *F8

Social Security cannot provide further information about the warrant. Please contact the *F9 directly.

Fill-Ins:

*F1-1 Warrant Issuing Agency
*F2-1 Warrant Issuing Agency address
*F3-1 Warrant Issuing Agency telephone number
*F4-1 Pronoun (your/Client Name Possessive)
*F5-1 MMCCYY
*F6-1 Warrant Number
*F7-1 Originating Case Number
*F8-1 NCIC number
*F9-1 Warrant Issuing Agency

OPTC04

How *F1 Can Avoid Being Overpaid

Fill-Ins:

*F1-1 Pronoun (You/Client/Beneficiary Name)

FUG054

F1 will not be overpaid for the months that *F2 had an outstanding felony warrant for a crime or a warrant for a probation or parole violation if you contact us at any time and can show us that any of the following apply:

The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name.

*F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges.

The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn.

*F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges.

Fill-Ins:

*F1-1 Pronoun (You/Client/Beneficiary Name)
*F2-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F4-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F5-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F12-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

FUG055

If none of the above applies, we also may not consider *F1 overpaid *F2 for the months of *F3 if you contact us within 12 months from the date of this notice and can show us that:

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F4 paroled or put on probation was both nonviolent and not drug related.

                         And

*F5 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                         And

The law enforcement agency that issued the warrant reports that it will not extradite *F6 for the charges on the warrant or that it will not take action on the warrant for *F7 arrest.

                         Or

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F8 paroled or put on probation was both nonviolent and not drug related.

                         And

*F9 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                         And

The only existing warrant was issued 10 or more years ago.

                         And

*F10 medical condition impairs *F11 mental capability to resolve the warrant; or *F12 incapable of managing *F13 benefits; or *F14 legally incompetent; or Social Security has appointed a representative payee to handle *F15 benefits or *F16 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

 

Fill-Ins:

*F1-1 Pronoun (you/Client Name)
*F2-1 $$$$.00 (amount of overpayment)
*F3-1 MM/CCYY through MM/CCYY (period of suspension)
*F4-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F5-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F6-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F7-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)*F10-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F12-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F13-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F14-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F15-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F16-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

OPT135

Since we did not stop *F1 payments until *F2, *F3 paid *F4 too much in benefits.

Fill-Ins:

*F1-1 Pronoun (your/Client/Beneficiary Name Possessive)
*F2-1 MM/CCYY
*F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F4-1 $$$$.00 (overpayment amount)

2. Paragraphs and Captions for a Fugitive Felon/Probation or Parole Violator Closed Period Suspension Notice with An Overpayment

UTI # on DPS and AURORA

Language for Paragraph or Caption

FUG051

We cannot pay benefits to *F1 for the months of *F2 because during that period *F3 had an outstanding arrest warrant for a *F4.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY through MMCCYY (overpayment period)
*F3-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

FUG056

Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F1 *F2 into one of these categories.

Fill-Ins:

*F1-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F2-1 fall

*F2-2 falls

INFC01

The Information We Have

FUG057

Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest for a felony crime or a violation of Federal or State probation or parole on *F5.

The warrant information we have is:

Warrant number: *F6
Originating case number: *F7
National Crime Information Center number: *F8

Social Security cannot provide further information about the warrant. Please contact the *F9 directly.

Fill-Ins:

*F1-1 Warrant Issuing Agency

*F2-1 address of the Warrant Issuing Agency
*F3-1 telephone number of the Warrant Issuing Agency
*F4-1 Pronoun (your/Client/Beneficiary Name Possessive))
*F5-1 MMCCYY
*F6-1 Warrant Issuing Agency
*F7-1 Originating case number
*F8-1 NCIC number
*F9-1 Warrant Issuing Agency

OPTC04

How *F1 Can Avoid Being Overpaid

Fill-Ins:

*F1-1 Pronoun (You/Client/Beneficiary Name)

FUG054

F1 will not be overpaid for the months that *F2 had an outstanding felony warrant for a crime or a warrant for a probation or parole violation if you contact us at any time and can show us that any of the following apply:

The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name.

*F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges.

The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn.

*F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges.

Fill-Ins:

*F1-1 Pronoun (You/Client/Beneficiary Name)
*F2-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F4-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F5-1 Pronoun (you/he/she/Client/Beneficiary Name)
*F6-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F7-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (You were/He was/She was/Client/Beneficiary Name was)
*F12-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)

FUG055

If none of the above applies, we also may not consider *F1 overpaid *F2 for the months of *F3 if you contact us within 12 months from the date of this notice and can show us that:

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F4 paroled or put on probation was both nonviolent and not drug related.

                  And

*F5 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                  And

The law enforcement agency that issued the warrant reports that it will not extradite *F6 for the charges on the warrant or that it will not take action on the warrant for *F7 arrest.

                 Or

The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F8 paroled or put on probation was both nonviolent and not drug related.

                  And

*F9 neither been convicted of nor pled guilty to another felony crime since the date of the warrant.

                  And

The only existing warrant was issued 10 or more years ago.

                   And

*F10 medical condition impairs *F11 mental capability to resolve the warrant; or *F12 incapable of managing *F13 benefits; or *F14 legally incompetent; or Social Security has appointed a representative payee to handle *F15 benefits or *F16 residing in a long-term care facility, such as a nursing home or mental treatment/care facility.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 $$$$.00 (amount of overpayment)
*F3-1 MMCCYY through MMCCYY
*F4-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F5-1 Pronoun (You have/He has/She has/Client Name has)
*F6-1 Pronoun (you/him/her/Client/Beneficiary Name)
*F7-1 Pronoun (your/his/her/Client /Beneficiary Name Possessive)
*F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F9-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)
*F10-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive)
*F11-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F12-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F13-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F14-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)
*F15-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive)
*F16-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is)

OPT136

Since we did not stop *F1 payments for the period *F2, *F3 paid *F4 too much in *F5.

Fill-Ins:

*F1-1 Pronoun (your/Client/Beneficiary Name Possessive)
*F2-1 MM/CCYY through MM/CCYY
*F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was)
*F4-1 $$$$.00 (amount of overpayment)

*F5-1Title II benefits
*F5-2 SSI

3. Deferred Overpayment Paragraphs and Captions for Fugitive Felon or Probation or Parole Violator Notices

UTI # on DPS and AURORA

Language for Paragraph or Caption

OPT027

Because we did not stop *F1 checks *F2 *F3, *F4 *F5 paid *F6 too much in benefits.

Fill-Ins:

*F1-1 Pronoun (your/his/her/Client/Beneficiary Name possessive/their)
*F2-1 timely/until
*F3-1 null/MM/CCYY (month suspension begins)
*F4-1 Pronoun (you/he/she/client/beneficiary name/they)
*F5-1 was/were
*F6-1 $$$$.xx (overpayment amount)

FUG505

We will wait until we learn of the final outcome regarding (F1) criminal charges before we determine whether (F2) must repay the money (F3) received for the months of (F4) because of (F5) outstanding warrant.

If (F6) found not guilty or acquitted of the criminal charges or the criminal charges are dismissed, (F7) will not be considered overpaid. If (F8) found guilty of the criminal charges, we will notify you when we will begin collection of the overpayment.

Fill-Ins:

*F1-1 Pronoun (your/Beneficiary Name Possessive)
*F2-1 Pronoun (you/he/she/Beneficiary Name)
*F3-1 Pronoun (you/he/she/beneficiary Name)
*F4-1 MM/YYYY to MM/YYYY (beginning month of the fugitive felon suspension period to the month the warrant was last unsatisfied)

*F5-1 Pronoun (your/his/her/Beneficiary Name Possessive)
*F6-1 Pronoun (you are/he is/she is/Beneficiary Name is)
*F7-1 Pronoun (you/he/she/Beneficiary Name)
*F8-1 Pronoun (you are/he is/she is/Beneficiary Name is)

REP002

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. If you hire someone, we must approve the fee before he or she can collect it.

ALSC06

Do You Think We Are Wrong About The Overpayment?

FUG506

You have certain rights with respect to this overpayment and its recovery.

Right to Appeal: If you disagree in any way with this overpayment determination, you have the right, within 60 days of the date you receive this notice, to request that the determination be reconsidered. If you request this independent review of the overpayment determination, please submit any additional information you have which pertains to the overpayment.

Right to Request Waiver: You also have the right to request a determination concerning the need to recover the overpayment. An overpayment must be refunded or withheld from benefits unless both of the following are true:

The overpayment was not your fault in any way, and

You could not meet your necessary living expenses if we recovered the overpayment, or recovery would be unfair for some other reason.

If you request waiver, we may need a statement of your assets and monthly income and expenses.

The attached form SSA-3105, Important Information About Your Appeal and Waiver Rights, explains your appeal and waiver rights in detail. You may contact any Social Security office for help with completing the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration) and/or waiver (SSA-632-13K, Overpayment Recovery Questionnaire).

Even if you do not want to request reconsideration or waiver, please call, write or visit any Social Security office if you have questions or need more information. Please take this letter with you if you do visit an office.

F. Exhibit - Fugitive Felon or Probation or Parole Violator Reinstatement/Resumption/Good Cause Approval/Good Cause Denial Paragraph

1. Title II Fugitive Felon Reinstatement/Resumption/Good Cause Approval/Denial Paragraph

This paragraph will be used in the following situations:

  • Good cause established (mandatory or discretionary)--benefits resumed effective with the suspension date;

  • Good cause denied—because the beneficiary could not establish mandatory or discretionary good cause or did not satisfy his/her outstanding warrant (no change in payment status unless suspension applies). (See NL 00755.900F.2. for additional good cause denial reasons language.)

  • Warrant satisfied--reinstatement effective with date the warrant was satisfied; and

  • Individual incorrectly identified in EVS match--benefits resumed effective with the suspension date. 

If you are issuing a reinstatement notice, this paragraph is placed under the Caption Information About [Your] Benefits (DPS caption BENC08). If you are using paragraph FUG502 for a payment resumption notice or a good cause denial notice, this paragraph is used under the Caption Our Decision (DIBC03). See the examples illustrating the FUG502 paragraph in NL 00755.320B.1.d. for good cause approvals and NL 00755.330C.2. for good cause denials.

2. FUG 502-- Fugitive Felon Reinstatement/Resumption/Good Cause Approval/Denial Paragraph

UTI # on DPS and AURORA

Language for Paragraph or Caption

FUG502

Based on the information __(*F1)__, we __(*F2)__ __(*F3)__ __(*F4)__ __(*F5)__ __(*F6)__ __(*F7)__ because _(*F8)_ __(*F9)__

Fill-Ins:

*F1-1 Pronoun (we have/you have provided us)
*F2-1 can (use for reinstatements or resumptions) -
*F2-2 cannot (use for good cause denial or suspensions)
*F3-1 pay benefits
*F3-2 grant good cause for not satisfying the outstanding warrant
*F4-1 beginning
*F4-2 for
*F5-1 MM/CCYY
*F6-1 and

*F6-2 through

*F6-1 null

*F7-1 MM/CCYY

*F7-2 null

*F8-1-Pronoun (you were/he was/she was)(your/his/her) (you have/he has/she has) (you are)/he is/she is) (you do not have/he does no have/she does not have)

*F8-2- null

*F9-1 Pronoun(your/his/her) warrant was issued incorrectly because of an identity issue

*F9-2 Pronoun (you were/he was/she was)found not guilty of the criminal offense

*F9-3 Pronoun (your/his/her) criminal charges were dismissed

*F9-4 Pronoun (your/his/her) warrant was withdrawn

*F9-5 Pronoun (your/his/her) criminal charges were otherwise cleared

*F9-6 law enforcement is not taking action on the warrant

*F9 7 Pronoun (you do have/he does have/she does have) a mental condition impairing the capability to resolve the warrant

*F9-8 Pronoun (you do have/he does have/she does have) a representative payee

*F9 9 Pronoun (you are/he is/she is) residing in a long-term care facility

*F9 10 Pronoun (you have/she has/she has) satisfied the warrant

*F9 11 Pronoun (your/his/her) warrant was issued correctly

*F9 12 Pronoun (you were/he was/she was) found guilty of the criminal offense

*F9 13 Pronoun (your/his/her) criminal charges were not dismissed

*F9 14 Pronoun (your/his/her) warrant was not withdrawn

*F9 15 Pronoun (your/his/her) criminal charges were not otherwise cleared

*F9 16 (null) law enforcement is taking action on the warrant

*F9 17 Pronoun (you do not have/he does not have/she does not have) a mental condition impairing the capability to resolve the warrant

*F9 18 Pronoun (you do not have/he does not have/she does not have) a representative payee

 

*F9 19 Pronoun (you are/he is/she is) not residing in a long-term care facility

*F9 20 Pronoun (you were/he was/she was) incorrectly identified in connection with this warrant.

3. Good Cause Denial Paragraph (Other)

UTI # on DPS or AURORA

Language for Paragraph or Caption

DPS

FUG050

NOTE: This revised version of this paragraph is currently only available for use in DPS.

We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5.

Fill-Ins:

*F1-1 Pronoun (you/Client/Beneficiary Name)
*F2-1 MM/CCYY (date of suspension)
*F3-1 Pronoun (you have/he has/she has/client/beneficiary Name has)
*F4-1 felony crime
*F4-2 violation of probation or parole under Federal or State law

*F4–3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant.

*F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant.

*F5-1 null

*F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty.

*F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause fo