TN 29 (07-02)

NL 00804.115 Titles, Lead-ins, and Payment Summary -- SSI Paragraphs

1011. Situation Where Used:

Lead-in on all SSA-L8025-U2's.

IC: Same or different amount due each month for period covered by SSA-8025 (includes period of noneligibility and eligibility covered by the same SSA-8025).

Text:

Beginning

Through

Monthly Amount Payable

(1)

(2)

(3) (4) (5)

(1)

(Month/Day/Year)

(2)

Choice 1 - (Month/Day/Year)

 

Choice 2 - continuing

(3)

$$$.¢¢

(4)

Choice 1 - this includes $$$.¢¢

 

Choice 2 - Null

(5)

Choice 1 - from the State of (State Name)

 

Choice 2 - from the District of Columbia

 

Choice 3 - Null

1012. Situation Where Used:

IC: Allowance—amount of first check. Payment due for first of next month and no change of rate for future months. Overpayment may or may not be involved.

PE: Retroactive payment due (either in addition to or without ongoing check). No adjustment for prior payment or for overpayment.

Text:

We (1) sending (2) a check for (3) . (4) (5)

(1)

Choice 1 -

are

 

Choice 2 -

will be

(2)

Choice 1 -

(you)

 

Choice 2 -

(your) bank or other financial institution

 

Choice 3 -

(your) representative payee

(3)

$$$.¢¢

 

(4)

Choice 1 -

This is money due (you) for (Month/Year).

 

Choice 2 -

This is money due (you) for (Month/Year) through (Month/Year).

 

Choice 3 -

This is money that was due (your) spouse for (Month /Year).

 

Choice 4 -

This is money that was due (your) spouse for (Month /Year) through (Month/Year).

 

Choice 5 -

Null

(5)

Choice 1 -

Null

 

Choice 2 -

No further payments will be sent to (you) at this time.

 

Choice 3 -

(You) are not due any payments in (Month/Year). However, (you) will receive a payment of $$$.¢¢ on (Month /Day/Year).

 

Choice 4 -

We will also be sending (you) a check for $$$.¢ ¢ on (Month/Day/Year). This is the amount due (you) for (Month/Year). Your check in (Month/Year) will be for $$$.¢¢.

 

Choice 5 -

We will also be sending (you) a check for $$$.¢ ¢ on (Month/Day/Year). This is the amount due (you) for (Month/Year).

 

Choice 6 -

We will also be sending (you) a check for $$$.¢ ¢ on (Month/Day/Year). This is the amount due (you) for (Month/Year). No further payments will be sent to (you) at this time.

1025. Situation Where Used:

The recipient has received advance payments, a one-time payment, and/or presumptive disability payments, all of which offset the retroactive payment due.

Text:

After taking into account the (1) advanced to (you) against (your) benefits and the additional payments of (2) which (you) already received, (3) .

(1)

$$$.¢¢

 

(2)

$$$.¢¢

 

(3)

Choice 1 -

$$$.¢¢ is the rest of the payment due (you) for (Month/Year)

 

Choice 2 -

$$$.¢¢ is the rest of the payment due (you) for (Month/Year) through (Month/Year)

 

Choice 3 -

(you) are due $$$.¢¢

1026. Situation where Used:

Standard on all initial claims notices, SSA-L8025's and SSA-L8030's.

*Application Filed*(Month/Day/Year)

1027. Situation Where Used:

Standard on all SSA-L8025's. Under this heading the appropriate type of payment is shown as follows:

*Type of Payment*

Award made to an individual.

  • Individual—age 65 or older

    Individual—age 65 or older and blind

    Individual—age 65 or older and disabled

    Individual—age 65 or older, blind, and disabled

    Individual—blind

    Individual—disabled

    Individual—blind and disabled

Award being made to child.

  • Child—disabled

    Child—blind

    Child—blind and disabled

Award being made to member of an eligible couple.

  • Member of couple—age 65 or older

    Member of couple—age 65 or older and blind

    Member of couple—age 65 or older and disabled

    Member of couple—age 65 or older, blind, and disabled

    Member of couple—disabled

    Member of couple—blind

    Member of couple—blind and disabled

1028. Situation Where Used:

This heading is displayed immediately under "Application Filed." The appropriate type of claim will be shown as follows:

*Type of Claim*

Denial being made to an adult claimant who filed as an individual.

  • Individual—age 65 or older

    Individual—age 65 or older and blind

    Individual—age 65 or older and disabled

    Individual—age 65 or older, blind, and disabled

    Individual—blind

    Individual—disabled

    Individual—blind and disabled

Denial being made to claimant who filed as member of an eligible couple.

  • Member of couple—age 65 or older

    Member of couple—age 65 or older and blind

    Member of couple—age 65 or older and disabled

    Member of couple—age 65 or older, blind, and disabled

    Member of couple—blind

    Member of couple—disabled

    Member of couple—blind and disabled

Denial being made to claimant who filed as a child.

  • Child—blind

    Child—disabled

    Child—blind and disabled

1031. Situation Where Used:

Standard on all SSA-L8030's except when claim is denied under the abbreviated application process.

Text:

After a careful review of (1) case, we have determined that (2) not eligible to receive Supplemental Security Income payments under the provisions of title XVI of the Social Security Act. The rest of this letter will tell you more about our decision.

(1)

Choice 1 - your

 

Choice 2 - the

(2)

Choice 1 - you are

 

Choice 2 - (Name of Claimant) is

1033. Situation Where Used:

IC: This is the lead-in paragraph whenever the application is denied under the abbreviated application process.

Text:

(You) cannot get Supplemental Security Income for the reason given below.

1034. Situation Where Used:

Standard on all SSA-L8025's.

Text:

This is to notify you that (1) eligible to receive Supplemental Security Income payments under the provisions of title XVI of the Social Security Act. The rest of this letter will tell you more about our decision.

(1)

Choice 1 - you are

 

Choice 2 - (Name of Claimant) is

1392. Situation Where Used:

Lead-in on disability notices.

A person can get Supplemental Security Income checks because of blindness or because of disability.

1479. Situation Where Used:

IC and PE: Retroactive check due (either in addition to or without ongoing payment).

Text:

(1) should receive the check no later than (2) . (3) (4)

(1)

Choice 1 - (You)
Choice 2 - Your bank or other financial institution
Choice 3 - Your representative payee

(2)

(Month/Day/Year)

(3)

Choice 1 - (Your)
Choice 2 - Null

(4)

Choice 1 - regular monthly check of ($$$.¢¢) will then be issued about the first day of the month.
Choice 2 - Null

1480. Situation Where Used:

One-time payment collected from retroactive payment—no additional retroactive payment due; or, presumptive disability paid and final approval before 3 months were up; or, advance payment received and completely offset.

Text:

Because we already paid (you) (1) (2) , (you) are not due any more money for that (3) .

(1)

$$$.¢¢

(2)

Choice 1 - for (Month/Year)

 

Choice 2 - for (Month/Year) through (Month/Year)

(3)

Choice 1 - month

 

Choice 2 - period

1484. Situation Where Used:

Advance or one-time payment or presumptive disability payment collected from retroactive payment—additional amount due.

Text:

Because we already paid (you) (1) (2) , (3) is the rest of the payment due (you)
(4) .

(1)

$$$.¢¢

(2)

Choice 1 - for (Month/Year)

 

Choice 2 - for (Month/Year) through (Month/Year)

 

Choice 3 - in advance

(3)

$$$.¢¢

(4)

Choice 1 - for that month

 

Choice 2 - for that period

 

Choice 3 - for (Month/Year)

1486. Situation Where Used:

IC and PE: Only ongoing check due. No retroactive involvement.

Text:

(Your) regular monthly check of (1) will be sent to (2) about the first day of the month.

(1)

$$$.¢¢

(2)

Choice 1 - (you)

 

Choice 2 - (your) bank or other financial institution

 

Choice 3 - (your) representative payee

1600. Situation Where Used:

Award—eligible but no payment due because of countable income.

Text:

This is to notify you that (1) eligible under the Supplemental Security Income program. Even though (you) are eligible, no payments can be made at this time because of income (2) (3) .

(1)

Choice 1 - you are

 

Choice 2 - (Name of Recipient) is

(2)

Choice 1 - for (Month/Year)

 

Choice 2 - for (Month/Year) through (Month/Year)

 

Choice 3 - for (Month/Year) on

(3)

Choice 1 - ,

 

Choice 2 - and

 

Choice 3 - .

1616. Situation Where Used:

This is the lead-in paragraph in E01 situations.

Text:

(You) have monthly income which must be considered in figuring (your) eligibility as follows:

2002. Situation Where Used:

PE: Lead-in—First paragraph on an SSA-L8100, SSA-L8151, SSA-L8155, and SSA-L8166 when income change is continuing. Use with paragraph 2019. For situations with one-time income posted, use paragraph 2003.

Text:

We are writing to tell (1) about changes in (your) Supplemental Security Income (2) . (3) (4) The rest of this letter will tell (you) more about this change.

(1)

Choice 1 -

your

 

Choice 2 -

(recipient's name)'s

 

Choice 3 -

(recipient's name)s'

(2)

Choice 1 -

record

 

Choice 2 -

payments

(3)

Choice 1 -

The following chart shows the SSI money due (you) for the months we changed.

 

Choice 2 -

Null

(4)

Choice 1 -

As (you) can see from the chart, we are only changing (your) payments for future months.

 

Choice 2 -

As (you) can see from the chart, we are only changing (your) payments for months in the past.

 

Choice 3 -

As (you) can see from the chart, we are changing (your) payments for both past and future months.

 

Choice 4 -

Null

2003. Situation Where Used:

First paragraph on SSA-L8155 when there is a change in the payment amount for the current computation month (CCM) only. Also used when income increased for CCM only and payment changes for a past month(s). This paragraph is used only for eligible individuals. Use with paragraph 2020. See paragraph 2002 when one-time income is not involved.

Text:

We are writing to tell you about changes in (1) Supplemental Security Income (SSI) payment. The following chart shows the SSI money due (you) for the (2) we changed. (3) . The rest of this letter will tell you more about this change.

(1)

Choice 1 -

your

 

Choice 2 -

recipient's name plus 's

 

Choice 3 -

recipient's name plus '

(2)

Choice 1 -

month

 

Choice 2 -

months

(3)

Choice 1 -

As you can see from the chart we are only changing (your) payment for (month/year).

 

Choice 2 -

As you can see from the chart, we are changing (your) payment for both past months and for (month/year).

2013. Situation Where Used:

Standard on all PE notices. Notice sent to eligible individual, child, or member of a couple.

Text:

*Type of (1) *

(2)

(1)

Choice 1 - Payment

 

Choice 2 - Eligibility

(2)

Choice 1 - Individual - Age 65 Or Older

 

Choice 2 - Individual - Blind

 

Choice 3 - Individual - Age 65 Or Older And Blind

 

Choice 4 - Individual - Disabled

 

Choice 5 - Individual - Age 65 Or Older And Disabled

 

Choice 6 - Individual - Blind And Disabled

 

Choice 7 - Individual - Age 65 Or Older, Blind, And Disabled

 

Choice 8 - Member of Couple - Age 65 Or Older

 

Choice 9 - Member of Couple - Blind

 

Choice 10 - Member of Couple - Age 65 Or Older And Blind

 

Choice 11 - Member of Couple - Disabled

 

Choice 12 - Member of Couple - Age 65 Or Older And Disabled

 

Choice 13 - Member of Couple - Blind And Disabled

 

Choice 14 - Member of Couple - Age 65 Or Older, Blind, And Disabled

 

Choice 15 - Child - Blind

 

Choice 16 - Child - Disabled

 

Choice 17 - Child - Blind And Disabled

2016. Situation Where Used:

PE: Change in payment amount or eligibility for 1 or more months; or same amount is due each month since the effective month of change and through the month following issuance of the notice; or different monthly amounts payable in period covered by notice. (This includes periods of eligibility and noneligibility covered by the same notice.) Also used when notice is sent to new representative payee—no change in amount.

Text:

(1) will be (2) as follows:

From

Through

Amount Due Each Month

(3)

(4)

(5) (6) (7)

(1)

Choice 1 - Your payments

 

Choice 2 - The payments of (Name of recipient)

(2)

Choice 1 - changed

 

Choice 2 - Null

(3)

Choice 1 - (Month/Year)

(4)

Choice 1 - (Month/Year)

 

Choice 2 - Continuing

(5)

Choice 1 - $$$.¢¢

(6)

Choice 1 - This includes $$$.¢¢

 

Choice 2 - Null

(7)

Choice 1 - from the State of (Name State)

 

Choice 2 - from the District of Columbia

2019. Situation Where Used:

Suspended payment: Use on a SSA-L8155-U2, Notice of Planned Action, under the caption, "[Your/Recipient's Name] Payments Will Be Changed As Follows" when payment is reduced on continuing basis and an advance notice is required. Use with paragraph 2002.

Suspend payment: Used on a SSA-L8155-U2, Notice of Planned Action, under the caption, "[Your/Recipient's Name] Payments Will Be Changed as Follows" when N20 (failure to cooperate) is input after Goldberg/Kelly cutoff date.

NOTE: See paragraph SUSM50, which follows, to use in manual notices.

Text:

We will (1) shown above beginning (2) . (3)

(1)

Choice 1 -

stop (your) payment as

 

Choice 2 -

reduce (your) payment as

(2)

(Month/Year)

 

(3)

Choice 1 -

We have not taken action to stop (your) next check since (you) may decide to appeal this decision within 10 days of receiving this notice. However, (you) may have to pay back the money (you) are not eligible to receive.

 

Choice 2 -

We have not taken action to reduce your next check since (you) may decide to appeal this decision within 10 days of receiving this notice. However, (you) may have to pay back the money (you) are not eligible to receive.

 

Choice 3 -

Null

SUSM50. Situation Where Used:

Use this language for manual notices. Use it in the same situation as for paragraph 2019 above.

IMPORTANT—When sending a notice that addresses only N20 for the current computation month (CCM), do not use the payment chart, paragraph 2016 (NL 00804.115). However, continue to use paragraph 2016 in all other situations.

Text:

We will (1) (your) (2) (3) beginning (4) . (5)

(1)

Choice 1 -

stop

 

Choice 2 -

reduce

(2)

Choice 1 -

payment

 

Choice 2 -

eligibility

(3)

Choice 1 -

as shown above (Choose when using payment chart, paragraph 2016.)

 

Choice 2 -

null (When the only change the notice] addresses is N20 for CCM and paragraph 2016 is not selected.)

(4)

Month/Year

 

(5)

Choice 1 -

We have not stopped the next payment since (you) may appeal this decision within 10 days from the date (you) get this letter. However, (you) may have to pay back any money (you) are not due.

 

Choice 2 -

We have not reduced the next payment since (you) may appeal this decision within 10 days from the date (you) get this letter. However, (you) may have to pay back any money (you) are not due.

 

Choice 3 -

Null

2021. Situation Where Used:

PE: A one-time payment of unearned income was received for CCM's budget month. SSI payment is protected by Goldberg-Kelly and is paid at the old (higher) rate.

Text:

Even though (1) for (2) , we will not (3) (your) payment of (4) . This is to give (you) time to appeal this decision. However, (you) may have to pay back any money (you) are not eligible to receive. We will let (you) know later if payment for (5) changes. (6)

(1)

Choice 1 -

(you) are not due any money

 

Choice 2 -

(you) are due only $$$.¢¢

(2)

(Month/Year)

 

(3)

Choice 1 -

stop

 

Choice 2 -

reduce

(4)

$$$.¢¢

 

(5)

(Month/Year)

 

(6)

Choice 1 -

In spite of the above, we must withhold all of the amount we would have sent because excess payments were previously received.

 

Choice 2 -

In spite of the above, we will send $$$.¢¢ and withhold $$$.¢ ¢ because excess payments were previously received.

 

Choice 3 -

Null

2022. Situation Where Used:

Payment is being adjusted. Advance notice is required. The notice being generated is an SSA-L8155.

A one-time payment of unearned income was received for CCM's budget month. Although payment for CCM should be reduced or terminated, it will be protected by Goldberg/Kelly and paid at the old rate.

Text:

Even though (1) for (2) , we would (3) (4) payment. This was to give (you) time to appeal this decision. However, because (you) were overpaid previously, we must (5) withhold (6) (7) . We will let (you) know later if payment for (8) changes.

(1)

Choice 1 - (you) are not due any money

 

Choice 4 - (you) are due only $$$.¢¢

(2)

(Month/Year)

(3)

Choice 1 - not have stopped

 

Choice 2 - not have reduced

 

Choice 3 - have sent

(4)

Choice 1 - your

 

Choice 2 - (you) a

 

Choice 3 - your representative payee a

(5)

Choice 1 - continue to

 

Choice 2 - Null

(6)

Choice 1 - all of the $$$.¢¢

 

Choice 2 - $$$.¢¢ and will send $$$.¢¢

(7)

Choice 1 - to your bank or other financial institution

 

Choice 2 - Null

(8)

(Month/Year)

2509. Situation Where Used:

Retroactive payment due (either in addition to or without ongoing payment). Adjustment for prior payment for some month(s) covered by check.

Text:

Because we already paid (you) (1) (2) (3) (4) , (5) is the rest of the new payment due (you) for that (6) .

(1)

$$$.¢¢

 

(2)

Choice 1 -

for (Month/Year)

 

Choice 2 -

for (Month/Year) through (Month/Year)

(3)

Choice 1 -

and another $$$.¢¢ of the money due (you) for

 

Choice 2 -

Null

(4)

Choice 1 -

this month was withheld to collect excess payments for other periods

 

Choice 2 -

these months were withheld to collect excess payments for other periods

(5)

$$$.¢¢

 

(6)

Choice 1 -

month

 

Choice 2 -

period

2510. Situation Where Used:

Only ongoing payment due. Amount due for retroactive months equals excess paid for other months.

Text:

Because we already paid (you) (1) (2) and this was the amount (you) were eligible to receive, (you) are not due any more money for that (3) .

(1)

$$$.¢¢

(2)

Choice 1 - for (Month/Year)

 

Choice 2 - for (Month/Year) through (Month/Year)

(3)

Choice 1 - month

 

Choice 2 - period

2511. Situation Where Used:

Retroactive payment due (either in addition to or without ongoing check). Adjustment for prior payment (used with paragraphs 1479 and 1046).

Text:

Because (1) , the money due (you) (2) (3) , was withheld to collect excess payments for other months, (4) is the rest of the payment due (you) for that (5) .

(1)

$$$.¢¢

(2)

Choice 1 - for (Month/Year)

 

Choice 2 - for (Month/Year) through (Month/Year)

(3)

Choice 1 - ,

 

Choice 2 - and

 

Choice 3 - Null

NOTE: Repeat fill-ins 2 and 3 as needed.

(4)

$$$.¢¢

(5)

Choice 1 - month

 

Choice 2 - period

2524. Situation Where Used:

Amount and destination of ongoing payment due.

Text:

(Your) regular monthly check of (1) will be sent to (2) about the first day of (3) .

(1)

$$$.¢¢

(2)

Choice 1 - (you)
Choice 2 - your bank or other financial institution
Choice 3 - your representative payee

(3)

(Month/Day/Year)

2020. Situation Where Used:

Use on SSA-L8155's when income is increased for CCM only (one-time income). Use with paragraph 2003. See paragraph 2019 when there is a one-time income which causes payment suspension for CCM.

Text:

(1)

(1)

Choice 1 -

We will reduce (your) payments as shown above for month/year.

 

Choice 2 -

We have not taken action to reduce (your) next check since you may decide to appeal this decision within 10 days of receiving this notice. However, you may have to pay back the money (you) are not eligible to receive.

 

Choice 3 -

Null

WKS001 Situation Where Used:

This paragraph is used on the first page of the Notice of Award (SSA-L8025), Notice of Change in Payment (SSA-L8100 & SSA-L8151), Important Information (SSA-L8165/ SSA-L8166) and Notice of Planned Action (SSA-8155) when the notice includes a computation worksheet showing how we figured a person's SSI.

Text:

We explain how we figured the monthly payment amounts shown below on (1) of this letter. The explanation shows how (2) income, other than any SSI payments, affects (3) SSI payment. It also shows how we decided how much of (4) income affects (5) payment amount. (6)

(1)

Choice-1 the last page
Choice-2 the last page
Choice-3 the last page(s)

(2)

Choice-1 your
Choice-2 her
Choice-3 his

(3)

Choice-1 your
Choice-2 her
Choice-3 his

(4)

Choice-1 your
Choice-2 her
Choice-3 his

(5)

Choice-1 your
Choice-2 her
Choice-3 his

(6)

Choice-1 We include explanations only for months where payment amounts change.
Choice-2 Null

NOTE: See SI 02005.100 for additional information on the use of this paragraph, including a sample notice.

WKS004 Situation Where Used:

This paragraph is used on the first page of the Notice of Disapproved Claim (SSA-L8030) when the notice includes a computation worksheet showing how we figured a person's SSI payment and the person is not eligible for monthly payments.

Text:

We explain how we decided (1) not eligible for monthly payments on (2) of this letter. The explanation shows how (3) income affects (4) SSI payment.

(1)

Choice-1 you are
Choice-2 she is
Choice-3 he is

(2)

Choice-1 the last page
Choice-2 the last pages
Choice-3 the last page(s)

(3)

Choice-1 your
Choice-2 her
Choice-3 his

(4)

Choice-1 your
Choice-2 her
Choice-3 his

NOTE: See SI 02005.100 for additional information on the use of this paragraph, including a sample notice.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900804115
NL 00804.115 - Titles, Lead-ins, and Payment Summary -- SSI Paragraphs - 11/20/2006
Batch run: 01/27/2009
Rev:11/20/2006