TN 29 (07-02)

NL 00804.240 Miscellaneous SSI Paragraphs

1481. Situation Where Used:

IC and PE: Eligibility or payment terminated because of cessation of disability or blindness or voluntary withdrawal; or, eligibility for payment terminated more than 1 year retroactively, and no current eligibility.

Text:

If at any time in the future you think (1) , please contact us immediately about filing a new application. We cannot make payment for any month before the month in which (2) .

Fill-ins:

  1. Choice 1 - you qualify for payment

    Choice 2 - she qualifies for payment

    Choice 3 - he qualifies for payment

    Choice 4 - you qualify for the Supplemental Security Income program

    Choice 5 - she qualifies for the Supplemental Security Income program

    Choice 6 - he qualifies for the Supplemental Security Income program

  2. Choice 1 - you apply

    Choice 2 - she or someone on her behalf applies

    Choice 3 - he or someone on his behalf applies

1482. Situation Where Used:

IC and PE: Notice to newly selected representative payee, or notice to aged recipient about reporting responsibilities.

Text:

Payments may change if (1) circumstances change. Therefore, you are required to report any change in (2) situation that may affect (3) Supplemental Security Income payment. For example, you should tell us if (4) , if anyone else moves from or into (5) household, if (6) marital status changes, if income or resources for (7) or members of (8) household change (9) (10) or if (11) to work. Read the booklet—What You Have to Know About SSI—carefully for additional information about this requirement.

Fill-ins:

  1. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  2. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  3. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  4. Choice 1 - you move

    Choice 2 - she moves

    Choice 3 - he moves

  5. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  6. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  7. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

  8. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  9. Choice 1 - if you stop or start attending school regularly

    Choice 2 - if she stops or starts attending school regularly

    Choice 3 - if he stops or starts attending school regularly

    Choice 4 - Null

  10. Choice 1 - if your medical condition improves

    Choice 2 - if her medical condition improves

    Choice 3 - if his medical condition improves

    Choice 4 - Null

  11. Choice 1 - you go

    Choice 2 - he goes

    Choice 3 - he goes

1487. Situation Where Used:

IC and PE: Claimant/recipient applied for or receiving benefits from other Social Security program. Separate notices required.

Text:

This decision refers only to (1) claim for Supplemental Security Income payments. (2)

Fill-ins:

  1. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  2. Choice 1 - Any decision about your benefits under other Social Security programs will be sent to you in a separate notice.

    Choice 2 - Any decision about her benefits under other Social Security programs will be sent to you in a separate notice.

    Choice 3 - Any decision about his benefit under other Social Security programs will be sent to you in a separate notice.

    Choice 4 - Any decision about your benefits under the Social Security Disability Insurance program will be sent to you in a separate notice.

    Choice 5 - Any decision about her benefits under the Social Security Disability Insurance program will be sent to you in a separate notice.

    Choice 6 - Any decision about his benefits under the Social Security Disability Insurance program will be sent to you in a separate notice.

    Choice 7 - Null

1488. Situation Where Used:

IC: Standard reporting instructions. See paragraph 2453 for language used in PE situations.

Text:

(1) (2) SSI (3) may change if (4) circumstances change. Therefore, you are required to report any change in (5) situation that may affect (6) SSI. For example, you should tell us if:

  • (7)

  • anyone else moves from or into (8) household

  • (9) marital status changes

  • income or resources for (10) or members of (11) household change (12)

  • (14) to work (15)

This will help us (16) (17) correctly.

Please read the booklet "What You Need to Know When You Get SSI" carefully for additional information about this requirement.

Fill-ins:

  1. (Fill-in 1 only exists for Spanish translation.)

  2. Choice 1 – Your
    Choice 2 – Name possessive ('s)
    Choice 3 – Name ending in s possessive (')

  3. Choice 1 – payments
    Choice 2 – eligibility

  4. Choice 1 – your
    Choice 2 – her
    Choice 3 – his

  5. Choice 1 – your
    Choice 2 – her
    Choice 3 – his

  6. Choice 1 – your
    Choice 2 – her
    Choice 3 – his

  7. Choice 1 – you move
    Choice 2 – she moves
    Choice 3 – he moves

  8. Choice 1 – your
    Choice 2 – her
    Choice 3 – his

  9. Choice 1 – your
    Choice 2 – her
    Choice 3 – his

  10. Choice 1 – you
    Choice 2 – her
    Choice 3 – him

  11. Choice 1 – your
    Choice 2 – her
    Choice 3 – his

  12. Choice 1 – you stop or start attending school regularly
    Choice 2 – she stops or starts attending school regularly
    Choice 3 – he stops or starts attending school regularly
    Choice 4 – NULL

  13. Choice 1 – your medical condition improves
    Choice 2 – her medical condition improves
    Choice 3 – his medical condition improves
    Choice 4 – NULL

  14. Choice 1 – you go
    Choice 2 – she goes
    Choice 3 – he goes

  15. Choice 1 – you become a US citizen or if any facts that affect your eligibility as an alien change.
    Choice 2 – you become a US citizen or if any facts that affect your eligibility as an alien change.
    Choice 3 – she becomes a US citizen or if any facts that affect her eligibility as an alien change.
    Choice 4 – he becomes a US citizen or if any facts that affect his eligibility as an alien change.

    Choice 5 – period (.) used when choices 1-4 aren't used.

  16. Choice 1 – pay you
    Choice 2 – pay her
    Choice 3 – pay him
    Choice 4 – provide benefits

  17. (Fill-in 17 only exists for Spanish translation.)

1489. Situation Where Used:

IC and PE: Copy of notice is being sent to another person.

Text:

This information is also being sent to (1) .

Fill-ins:

Choice 1 - the representative payee

Choice 2 - (Name of other person)

1599. Situation Where Used:

The FO has determined that no title II benefits are payable or if the individual is receiving title II, that no additional title II benefits are payable. The FO inputs CLST in the CG field per SI 00601.030 to generate this paragraph on automated notices.

Text:

The application (1) filed for SSI was also a claim for Social Security benefits. We looked into this, and decided (2) can't get any Social Security benefits (3) . If you think we're wrong about this, you have the right to appeal. A case review, described later in this letter, is the only kind of appeal (4) can have regarding Social Security benefits.

Fill-ins:

  1. Choice 1 - you

    Choice 2 - she

    Choice 3 - he

  2. Choice 1 - you

    Choice 2 - she

    Choice 3 - he

  3. Choice 1 - except the benefit you are already getting.

    Choice 2 - except the benefit she is already getting.

    Choice 3 - except the benefit he is already getting.

    Choice 4 - Null

  4. Choice 1 - you

    Choice 2 - she

    Choice 3 - he

1615. Situation Where Used:

Award: Recipient in E01 status—Reminder on reporting responsibilities.

Text:

You are required to report any change in (1) situation that may affect (2) Supplemental Security Income eligibility. For example, you should tell us if (3) , if anyone else moves from or into (4) household, if marital status changes, if income or resources for (5) or members of (6) household change (7) (8) or if (9) to work. Read the booklet—What You Have To Know About SSI—carefully for additional information about this requirement.

Fill-ins:

  1. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  2. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  3. Choice 1 - you move

    Choice 2 - she moves

    Choice 3 - he moves

  4. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  5. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

  6. Choice 1 - your

    Choice 2 - her

    Choice 3 – his

  7. Choice 1 - if you stop or start attending school regularly

    Choice 2 - if she stops or starts attending school regularly

    Choice 3 - if he stops or starts attending school regularly

    Choice 4 - Null

  8. Choice 1 - if your medical condition improves

    Choice 2 - if her medical condition improves

    Choice 3 - if his medical condition improves

    Choice 4 - Null

  9. Choice 1 - you go

    Choice 2 - she goes

    Choice 3 - he goes

1620. Situation Where Used:

IC and PE: Recipient is eligible but no payment is due.

Text:

Even though (1) not due payments, (2) still considered to be eligible under the Supplemental Security Income program. (3) should report any event that might affect (4) eligibility or allow (5) to receive payments again.

Fill-ins:

  1. Choice 1 - you are

    Choice 2 - she is

    Choice 3 - he is

  2. Choice 1 - you are

    Choice 2 - she is

    Choice 3 - he is

  3. Choice 1 - You

    Choice 2 - She

    Choice 3 - He

  4. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  5. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

XVI295 Situation Where Used:

This referral paragraph emphasizes the availability of information on the Internet. It can be used on any SSI notice, but it must be used on all automated SSI financial eligibility notices (SSA-L8025; SSA-L8030; SSA-L8151 and SSA-L8100; SSA-L8155; SSA-L8165 and SSA-L8166).

Text:

If You Have Any Questions

For general information about SSI, visit our website at www.ssa.gov on the Internet. There you will also find the law and regulations about SSI eligibility and SSI payment amounts.

For general questions about SSI or specific questions about (1) case, you may call us toll-free at (2) (3) (4) (5). We can answer most questions over the phone. You can also write or visit any Social Security office. (6) (7)

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:

  1. Choice -1 your
    Choice -2 (Name possessive)

  2. Choice -1 1-800-772-1213
    Choice -2 NULL

  3. Choice -1 , or call your local Social Security office
    Choice -2 NULL

  4. Choice -1 toll free at
    Choice -2 at
    Choice -3 NULL

  5. Choice -1 (Title XVI Telephone # on DOORS, formerly TRIDE)
    Choice -2 NULL

  6. Choice -1 The office that serves your area is located at:
    Choice -2 NULL

  7. Choice -1 (Servicing FO's address on DOORS, formerly TRIDE)
    Choice -2 NULL

2453. Situation Where Used:

PE: Standard reporting instructions. See paragraph 1488 for language used in IC situations.

Text:

(1) (2) may change if (3) circumstances change. Therefore, you are required to report any change in (4) situation that may affect (5) Supplemental Security Income payment. For example, you should tell us if (6) , if anyone else moves from or into (7) household, if (8) marital status changes, if income or resources for (9) or members of (10) household change (11) (12) or if (13) to work.

Fill-ins:

  1. Choice 1 - Your

    Choice 2 - Her

    Choice 3 - His

  2. Choice 1 - payments

    Choice 2 - eligibility

  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 - you move

    Choice 2 - she moves

    Choice 3 - he moves

  7. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  8. Choice 1 - your

    Choice 2 - her

    Choice 3 – his

  9. Choice 1 - you

    Choice 2 - her

    Choice 3 – him

  10. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  11. Choice 1 - , if you start or stop attending school regularly

    Choice 2 - , if she starts or stops attending school regularly

    Choice 3 - , if he starts or stops attending school regularly

    Choice 4 – Null

  12. Choice 1 - , if your medical condition improves

    Choice 2 - , if her medical condition improves

    Choice 3 - , if his medical condition improves

  13. Choice 1 - you go

    Choice 2 - she goes

    Choice 3 - he goes

2507. Situation Where Used:

Record has been in suspense due to returned checks and recipient remains ineligible due to excess income.

Text:

If you think payment may be due (1) for earlier months or at any time in the future, please contact us immediately. If (2) not eligible to receive payment during a month before (3) , you will have to file a new application to receive payment. Since we cannot make payment for a month before the month in which application is filed, a delay in applying will result in a loss of payment for any months in which (4) otherwise eligible.

Fill-ins:

  1. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

  2. Choice 1 - you are

    Choice 2 - she is

    Choice 3 - he is

  3. Month/Year

  4. Choice 1 - you are

    Choice 2 - she is

    Choice 3 - he is

2508. Situation Where Used:

Use when we are suspending payment or eligibility, except for reasons of disability cessation, voluntary withdrawal, administrative inability to pay, or death. Use on a SSA-L8155-U2, Notice of Planned Action, under the caption, "Things to Remember."

NOTE: See paragraph SUSM52, which follows, to use in N20 manual notices.

Text:

If at any time in the future you think (1) for the Supplemental Income program, please contact us immediately. If (2) not eligible (3) during a month before (4) , you will have to file a new application (5) . Since we cannot make payment for a month before the month in which an application is filed, a delay in applying will result in a loss of payment for any months in which (6) otherwise eligible.

Fill-ins:

  1. Choice 1 - you qualify

    Choice 2 - she qualifies

    Choice 3 - he qualifies

  2. Choice 1 - you are

    Choice 2 - she is

    Choice 3 - he is

  3. Choice 1 - to receive payment

    Choice 2 - Null

  4. (Month/Year)

  5. Choice 1 - to receive payment

    Choice 2 - Null

  6. Choice 1 - you are

    Choice 2 - she is

    Choice 3 - he is

SUSM52. Situation Where Used:

Use this language for N20 manual notices. Use it in the same situation as for paragraph 2508 above.

Text:

If we (1) and (2) not become eligible again before (3) , (4) will have to file a new application to get SSI.

Fill-ins:

NOTE: When E01 or 1619(b) eligibility changes to N20, select from fill-in (1), choices 4-6.

  1. Choice 1 - stop your SSI

    Choice 2 - stop her SSI

    Choice 3 - stop his SSI

    Choice 4 - close your SSI case

    Choice 5 - close her SSI case

    Choice 6 - close his SSI case

  2. Choice 1 - you do

    Choice 2 - she does

    Choice 3 - he does

  3. Month/Year (one year from last month of eligibility)

  4. Choice 1 - you

    Choice 2 - she

    Choice 3 - he

2514. Situation Where Used:

Check returned from Treasury. Suspension.

Text:

Our records show that the (1) we sent (2) (3) (4) returned to the (5) . We will not send (6) any more checks until you get in touch with (7) local Social Security office.

Fill-ins:

  1. Choice 1 - check

    Choice 2 - checks

  2. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

    Choice 4 - your representative payee

  3. Choice 1 - for (Month/Year)

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

  4. Choice 1 - was

    Choice 2 - were

  5. Choice 1 - United States Treasury Department

    Choice 2 - Social Security Administration

  6. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

    Choice 4 - your representative payee

  7. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

2525. Situation Where Used:

Change is retroactive and does not affect ongoing payment.

Text:

This action does not change (1) current payment amount.

Fill-ins:

  1. Choice 1 - your

    Choice 2 - her

    Choice 3 – his

2527. Situation Where Used:

Suspension due to returned check.

Text:

The (1) we sent (2) (3) (4) returned to the (5) . We will not sent (6) any more checks until you get in touch with (7) local Social Security office.

Fill-ins:

  1. Choice 1 - check

    Choice 2 - checks

  2. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

    Choice 4 - your representative payee

  3. Choice 1 - for (Month/Year)

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

  4. Choice 1 - was

    Choice 2 - were

  5. Choice 1 - U.S. Treasury Department

    Choice 2 - Social Security Administration

  6. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

    Choice 4 - your representative payee

  7. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

2530. Situation Where Used:

PE: The recipient was erroneously terminated (T01). Payment is being reinstated.

Text:

We stopped (1) (2) by mistake. We regret this mistake and have corrected it.

Fill-ins:

  1. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

  2. Choice 1 - check

    Choice 2 - eligibility under the Supplemental Security Income program

2531. Situation Where Used:

PE: The recipient was erroneously terminated (T01). Notice to eligible spouse that his/her husband/wife has been reinstated.

Text:

We stopped the (1) for (2) spouse by mistake. We regret this mistake and have corrected it.

Fill-ins:

  1. Choice 1 - checks

    Choice 2 - eligibility under the Supplemental Security Income program

  2. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

2532. Situation Where Used:

PE: Incorrect date of death input. The input of the correct date of death results in a change in payment amount or eligibility.

Text:

We took (1) off (2) record by mistake. We regret this mistake and have corrected it.

Fill-ins:

  1. (Name of ineligible spouse or parent)

  2. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

2533. Situation Where Used:

PE: Incorrect date of death input. The input of the correct date of death results in a change in payment amount or eligibility.

Text:

(1) changed because we corrected, on our records, the date of death of (2) from (3) to (4).

Fill-ins:

  1. Choice 1 - Your Supplemental Security Income checks

    Choice 2 - Supplemental Security Income checks for (Name of recipient)

  2. (Name of deceased)

  3. (Month/Year)

  4. (Month/Year)

2534. Situation Where Used:

Death of one member of an eligible couple, or an ineligible spouse, parent(s), or essential person(s). Do not use this paragraph if the survivor is not in continuing payment status code C01 effective with the month after the month of the death.

Text:

(1) Because of the death of (2) in (3) , (4) .

Fill-ins:

  1. Choice 1 - Before (Month/Year), we used the money received and things owned by (Name of deceased) in figuring the amount of SSI payments for you.

    Choice 2 - Before (Month/Year), we used the money received and things owned by (Name of deceased) in figuring the amount of SSI payments for (Name of recipient).

    Choice 3 - Null

  2. (Name of deceased)

  3. (Month/Year of death)

  4. Choice 1 - your payments have been refigured

    Choice 2 - SSI payments for (Name of recipient) have been refigured

    Choice 3 - you cannot get SSI payments

    Choice 4 - (Name of recipient) cannot get SSI payments

NOTE: In fill-in 1 above, Month/Year = the month after the month of death. Choice 3 is used in fill-in 1 when the deceased was the ineligible spouse of a parent.

2750. Situation Where Used:

A determination is made which revises a previous determination.

Text:

This determination replaces all previous determinations for the above (1) .

Fill-ins:

  1. Choice 1 - period

    Choice 2 - periods

MISM50. Situation Where Used:

Duplicate claim filed by claimant on own behalf.Text:

The application (1) recently filed is a duplicate of the one that was previously filed. Therefore, the initial decision is still in effect and no change is being made on (2) record.

Fill-ins:

  1. Choice 1 - (Name of Applicant)

    Choice 2 - you

  2. Choice 1 - Your

    Choice 2 - (Name of Claimant's)

MISM51. Situation Where Used:

Duplicate claim filed on behalf of claimant.

Text:

The application (1) recently filed is a duplicate of the one already filed on behalf of
(2) . Therefore, the decision made on the previous claim is still in effect, and no change is being made on the record.

Fill-ins:

  1. (Name of Applicant)

  2. (Name of Claimant)

MISM52. Situation Where Used:

Claimant has appointed representative who is not the representative payee.

Text:

Enclosed is a copy of our decision concerning the SSI application of (1) .

Fill-ins:

  1. (Name of Claimant)

Closing Paragraph

MISM53. Situation Where Used:

Closing paragraph. Use on all manual notices if not already preprinted on the notice; e.g. SSA-L8030-U2. If preprinted, be sure to fill in Claims Representative's Name and telephone number.

Text:

If you have any questions, you may call, write, or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (Claims Representative's Name). (His/Her) telephone number is (XXX) XXX-XXXX.

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.

PENM50. Situation Where Used:

We are notifying a recipient or a representative payee that we plan to withhold a penalty from a SSI payment. In most cases, this language will be used after a discussion with the recipient about his/her reason for failing to report on time. The field office will assess a penalty if it cannot find good cause for the recipient's failure to report. Use on a SSA-L8166-U2, Important Information, with paragraph PENM52.

Text:

Information About (1) Payments

We plan to collect a penalty of (2) from (3) SSI for the following reasons:

· (4) did not report on time that (5) .

· (6) did not have a good reason for reporting this change late.

· We paid (7) too much SSI because (8) did not report the change to us on time.

Fill-ins:

  1. Choice 1 - Recipient's Name (possessive)
    Choice 2 - Your

  2. Choice 1 - $25 (if first time penalty assessed)
    Choice 2 - $50 (if second time penalty assessed)
    Choice 3 - $100 (if third or subsequent time penalty assessed)

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

  4. Choice 1 - You
    Choice 2 - She
    Choice 3 - He

  5. (Description of the change the recipient did not report or did not report timely.)

  6. Choice 1 - You
    Choice 2 - She
    Choice 3 - He

  7. Choice 1 - you
    Choice 2 - her
    Choice 3 - him

  8. Choice 1 - you
    Choice 2 - she
    Choice 3 - he

PENM51. Situation Where Used:

We are notifying a recipient or a representative payee that no penalty applies for the recipient's failure to report information that affected his/her SSI payment. This language will be used on a SSA-8165-U2, Important Information, along with paragraph PENM52.

Text:

We paid (1) too much Supplemental Security Income (SSI) because (2) did not report a change to us on time. We did not know (3) .

We have found that (4) had a good reason for not reporting the change (5) . Because of this, we will not collect a penalty from (6) SSI.

Fill-ins:

  1. Choice 1 - you
    Choice 2 - Recipient's name

  2. Choice 1 - you
    Choice 2 - she
    Choice 3 - he

  3. (Description of change)

  4. Choice 1 - you
    Choice 2 - she
    Choice 3 - he

  5. Choice 1 - on time (Use if change reported late.)
    Choice 2 - Null (Use if change not reported.)

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

PENM52. Situation Where Used:

Use under the caption, "Things To Remember" with paragraph PENM50 or PENM51.

Text:

It is important that (1) tell us right away about changes that could affect (2) SSI payments. (3) must report a change within 10 days after the month it happens. However, (4) should still report the change even if the 10 days have passed.

If (5) not report changes on time in the future, and (6) money from us (7) shouldn't have, we may have to collect a penalty of (8) , unless (9) a good reason for reporting late.

Please read the enclosed pamphlet "When You Get SSI...What You Need To Know." It tells you what changes to report and when to report.

(10)

Fill-ins:

  1. Choice 1 - you
    Choice 2 - she
    Choice 3 - he

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

  3. Choice 1 - You
    Choice 2 - She
    Choice 3 - He

  4. Choice 1 - you
    Choice 2 - she
    Choice 3 - he

  5. Choice 1 - you do
    Choice 2 - she does
    Choice 3 - he does

  6. Choice 1 - you get
    Choice 2 - she gets
    Choice 3 - he gets

  7. Choice 1 - you
    Choice 2 - she
    Choice 3 - he

  8. Choice