TN 4 (02-95)

NL 00803.050 Chart for Completing the SSA-L8151-U2, SSA-L8155-U2 and SSA-L8166-U2 Before a COLA

A. Procedure

Use the following chart to find the captions and paragraphs appropriate for the recipient's situation when a COLA is scheduled to take effect. Instructions in NL 00802.001B apply for using this chart. Instructions in NL 00803.020 apply to COLA notices. We labeled the captions with capital letters in alphabetic order as a place-keeping device.

B. Information about your payments

(Mandatory caption)

NL ReferenceParagraphUse
NL 00804.2202801Tells new amount due and effective date. (Mandatory for all notices when recipient is due payment.)
2803N01 - Recipient is ineligible due to excess income. (Use on SSA-L8155-U2 only.)
2804Recipient receives title II - SSI payment will decrease or stop. (Mandatory on all SSA-L8155-U2's.)
2805SSI payment will increase or be reinstated. (Mandatory on all SSA-L8151-U2's.)
COLM05Appeal pending - Record is in protected payment status. COLA results in increase or decrease in the protected payment level.
The following overpayment paragraphs are only used in COLA notices. Consider these paragraphs when an overpayment collection is in process: 2816, 2817, 2818, 2819 and 2820.
NL 00804.210 Consider the following standard overpayment paragraphs when you plan to initiate overpayment collection or overpayment collection is in process: 1015, 1018, 1016, 2042, 1017, and 2456.

C. Your payment is based on these facts

(Use when the recipient has income or deemed income).

NL ReferenceParagraphUse
NL 00804.2202836Lead-in paragraph for any income on the record.
2807Use this income lead-in only on the SSA-L8151-U2 when there is an increase or reinstatement of SSI and other income on the record changes.
2814Use when title II income will increase.
2815Use when title II income of spouse will increase.
NL 00804.1751232Describes type, period and amount of countable income. (Follows paragraph 2836 and 2807 above.)
1260Tells value of ISM.
1258Tells value of VTR.
1248Spouse or parent(s) has income deemed to recipient.
1234Sponsor has income deemed to recipient.

D. Information about medicaid

(Use only if one of the paragraphs below applies.)

NL ReferenceParagraphUse
NL 00804.1101150Mandatory for SSA-L8151-U2 if recipient is being reinstated and lives in a State where SSA makes Medicaid eligibility determinations or has moved to a State where SSA makes Medicaid eligibility