Identification Number:
NL 00730 TN 34
Intended Audience:See Transmittal Sheet
Originating Office:Systems
Title:Title II Redesign (T2R) Notices Title II Postentitlement (PE) Actions
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part NL – Notices, Letters and Paragraphs
Chapter 007 – Letters and Paragraphs for Title II, Title XVI, and Title XVIII
Subchapter 30 – Title II Redesign (T2R) Notices Title II Postentitlement (PE) Actions
Transmittal No. 34, 08/27/2020

Audience

PSC: BA, CA, CCRE, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, NPR, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, BTE, CC, CCRE, CDT, CR, CTE, ERE, FDE, PETL, RECONE, RECONR, RECOVR;
OCO-ODO: BTE, CCE, CR, CST, CT, CTE, CTE TE, DE, DEC, DS, DSE, PAS, PETE, PETL, RC, RCOVTA, RECOVR;
FO/TSC: CS, CS TII, CSR, DRT, DT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OSE

Effective Date

Upon Receipt

Background

We are updating Program Operations Manual System (POMS) sections in NL 00730 effective with Title II Redesign’s (T2R) February 21, 2019 release.

The language changes and updates for notices in the attached sections are a direct result of updates requested by the Office of Income Security Programs (OISP), Office of Public Service and Operation Support (OPSOS), Office of Electronic Services and Technology (OEST) and Office of General Counsel (OGC). These changes were in support of the of Change, Asset and Problem Reporting System (CAPRS) issues, maintenance requests and the Removal of Social Security Numbers (RSSN) clearance package.

 

Summary of Changes

NL 00730.106 “C” Paragraphs and Captions

We updated the language and fill-ins for the UTI CFD004 to remove the claim number in accordance with the clearance package changes requested in support of the Social Security Number Removal Initiative (SSNRI). We also added a parenthesis in front of the Fill-in 4 indicator in the UTI text of CIC006 to correct a typographic error.

 

NL 00730.132 “P” Paragraphs and Captions

We corrected the description of the fill-in text for the UTI PAY092 to correctly explain what date is being generated in Fill-in 5 in support of a fix to a corrected CAPRS issue. We also updated the table formats for uniformity.

We also corrected the Choices shown for Fill-in 4 of the UTI PMT012 to reflect two choices instead of four.

 

NL 00730.106 “C” Paragraphs and Captions

List of “C” Paragraphs and Captions

A. “CDB” Universal Text Identifier – Childhood Disability Benefits

CDB003 – USED ON CHILDHOOD DISABILITY BENEFIT (CDB) AWARDS TO EXPLAIN TRIAL WORK PERIOD

If (1) (2) while (3) (4) still disabled, (5) may qualify for a trial work period to test (6) ability to work. During this period, (7) may work 9 months, sometimes more, and not lose Social Security disability payments because of the work, no matter how much (8).

To end the trial work period, the 9 months of work must take place in a 60-month period. The months do not have to be in a row. After the trial work period has ended, we will look at the work (9) did and decide if (10) (11) still disabled. The pamphlet described below has more information about the trial work period and other rules that may help (12) return to work.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

works

Choice 2

work

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

is

Choice 2

are

Fill-in (5)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (6)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (7)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (8)

 

Choice 1

he earns

Choice 2

she earns

Choice 3

you earn

Fill-in (9)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (10)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (11)

 

Choice 1

is

Choice 2

are

Fill-in (12)

 

Choice 1

him

Choice 2

her

Choice 3

your

B. “CDR” Universal Text Identifiers – Childhood Disability Review

CDR001 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD - MEDICAL EXAM IN 3 YEARS

Doctors and other trained staff decided that (1) (2) disabled under our rules.

But, this decision must be reviewed at least once every 3 years. We will send you a letter before we start the review. Based on that review, (3) benefits will continue if (4) still disabled, but will end if (5) no longer disabled.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (5)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

CDR002 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD - MEDICAL EXAM IN 5–7 YEARS

Doctors and other trained staff decided that (1) (2) disabled under our rules.

However, we must review all disability cases. Therefore, we will review (3) case in 5 to 7 years. We will send you a letter before we start the review.

Based on that review, (4) benefits will continue if (5) still disabled, but will end if (6) no longer disabled.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (6)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

CDR004 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD – DISABILITY NOT PERMANENT

The doctors and other trained personnel who decided that (1) (2) disabled expect (3) health to improve. Therefore, we will review (4) case in the future.

We will send you a letter before we start the review. Based on that review, (5) benefits will continue if (6) (7) still disabled, but will end if (8) (9) no longer disabled.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (6)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (7)

 

Choice 1

is

Choice 2

are

Fill-in (8)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (9)

 

Choice 1

is

Choice 2

are

CDR063 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) SUSPENDED - FAILURE TO COOPERATE

We cannot pay (1) benefits because our records show that (2) did not return information we asked for concerning (3) disability.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

CDR065 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) SUSPENDED - FAILURE TO COOPERATE

If we stop (1) Social Security disability benefits and you do not give us the information we asked for before (2), (3) will have to file a new application to get Social Security disability benefits again. If we do not hear from you by this date, we will send you another letter which will give you the information about (4) appeal rights.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

Fill-in (2)

Add 12 months to the first effective date in History data that corresponds to the
ongoing Continuing Disability Review (CDR) Failure to Cooperate (FTC) suspension
and display in the format Month CCYY

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

CDR066 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) TERMINATED FOR FAILURE TO COOPERATE

(1) no longer (2) for Social Security disability benefits beginning (3) because our records show that (4) did not return information we asked for during (5) continuing disability review.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

You

Fill-in (2)

 

Choice 1

qualifies

Choice 2

qualify

Fill-in (3)

Historical Date of Entitlement Termination (BCLM-DOETERM-REL) - this date
corresponds to the first effective date in History (HIST) data on the
post-MBR of the Continuing Disability Review (CDR) Failure to Cooperate (FTC) for
PIC A or W or the CDR FTC for PIC C in the format Month CCYY)

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

CDR067 – BENEFITS ARE TERMINATED DUE TO THE NUMBER HOLDER'S FAILURE TO COOPERATE OR DISABILITY CESSATION

We can no longer pay (1) benefits because (2) no longer qualifies for Social Security disability benefits beginning (3).

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

NH-NAME

Fill-in (3)

Historical Date of Entitlement Termination (BCLM-DOETERM-REL) that
corresponds to the first effective date in History (HIST) data for the Disability
Insurance Benefits Cessation (DIBCES) termination which is used for an
auxiliary when the Number Holder fails to cooperate

CDR083 – REQUEST FOR MEDICARE ONLY STATUTORY BENEFIT CONTINUATION FOR A BENEFICIARY WITH A FUTURE DATED DISABILITY CESSATION DATE (DBC)

In an earlier letter, we told (1) that (2) disability benefits would end. (3) no longer entitled to benefits as of (4). However, during the appeals process (5) requested to have Medicare coverage continued.

Fill-in values:

Fill-in (1)

 

Choice 1

you

Choice 2

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

Fill-in (2)

 

Choice 1

your

Choice 2

his
Choice 3 her

Fill-in (3)

 

Choice 1

You are

Choice 2

He is
Choice 3 She is

Fill-in (4)

 

Choice 1

Future dated DBC in Month CCYY format

Fill-in (5)

 

Choice 1

you

Choice 2

he

Choice 3

she

CDR084 – FAVORABLE REVERSAL OF THE MEDICAL CESSATION DECISION FOR A BENEFICIAIRY WITHOUT STATUTORY BENEFIT PAYMENT CONTINUATION

In an earlier letter, we told (1) that (2) disability benefits would end. Now, we decided that (3) still disabled and our previous notice should be disregarded.

Fill-in values:

Fill-in (1)

 

Choice 1

you

Choice 2

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (not possessive)

Fill-in (2)

 

Choice 1

your

Choice 2

his
Choice 3 her

Fill-in (3)

 

Choice 1

you are

Choice 2

he is
Choice 3 she is

CDR701 – PAYMENTS WILL CONTINUE AT THE SAME RATE AFTER A FAVORABLE REVERSAL OF THE MEDICAL CESSATION DECISION

We previously advised (1) that (2) disability benefits would terminate because (3) no longer entitled to benefits. However, during the appeals process (4) monthly benefit check(s) continued. It has been determined that (5) still disabled and our previous notice should be disregarded.

Fill-in values:

Fill-in (1)

 

Choice 1

you

Choice 2

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

Fill-in (2)

 

Choice 1

your

Choice 2

his
Choice 3 her

Fill-in (3)

 

Choice 1

you are

Choice 2

he is
Choice 3 she is

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (5)

 

Choice 1

you are

Choice 2

he is

Choice 3

she is

C. “CFD” Universal Text Identifiers – Conserved Funds

CFDC02 – CAPTION

If You Saved Any Money

CFD003 – CONSERVED FUNDS REQUESTED FROM FORMER PAYEE

While you were (1) payee, you may have saved some money for (2). If you have, you should return it to us unless you have already made other plans with us for handling it. The money you will need to return includes:

  • Saved and invested benefits.

  • Interest earned from these savings and investments.

  • Money you have left over from any checks we sent you.

  • Any checks you might receive after the date of this letter.

Fill-in values:

Fill-in (1)

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

Fill-in (2)

 

Choice 1

him

Choice 2

her

CFD004 – TELLS FORMER PAYEE HOW TO RETURN CONSERVED FUNDS

To do this, you can write us a check or money order. Make it out to the Social Security Administration. Be sure to write “Conserved Funds for (1)", and include (2) Social Security claim number on that check or money order. Please mail it in the enclosed envelope.

Fill-in values:

Fill-in (1)

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

Fill-in (2)

 

Choice 1 his
Choice 2 her

D. “CHK” Universal Text Identifiers – Information about Checks

CHKC05 – CAPTION

When We Begin Your Payments Again

CHKC09 – CAPTION

Your Benefits

CHKC10 – CAPTION

Information About Your Checks

E. “CIC” Universal Text Identifiers – Child in Care

CIC006 – AGED SPOUSE MONTHLY BENEFIT AMOUNT IS CHANGING BECAUSE A CHILD HAS LEFT THE SPOUSE’S CARE

We changed (1) monthly benefit to (2) beginning (3). We changed (4) benefit because (5) no longer (6) a child who is entitled to benefits in (7) care.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

Fill-in (2)

Monthly Benefit Amount (MBA) in the format $$$$$.¢¢

Fill-in (3)

Effective date of Monthly Benefit Amount (MBA) change in the format Month CCYY

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (6)

 

Choice 1

has

Choice 2

have

Fill-in (7)

 

Choice 1

his

Choice 2

her

Choice 3

your

CIC007 – AGED SPOUSE BENEFIT AMOUNT CHANGED DUE TO HAVING A CHILD IN CARE

We changed (1) monthly benefit to (2) beginning (3). We changed (4) benefit because (5) now (6) a child who is entitled to benefits in (7) care.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

Fill-in (2)

Monthly Benefit Amount (MBA) in the format $$$$$.¢¢

Fill-in (3)

Effective date of Monthly Benefit Amount (MBA) change in the format Month CCYY

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (6)

 

Choice 1

has

Choice 2

have

Fill-in (7)

 

Choice 1

his

Choice 2

her

Choice 3

your

CIC008 – AGED SPOUSE BENEFIT AMOUNT CHANGE DUE TO NOT HAVING A CHILD IN CARE BECAUSE THE CHILD IS NO LONGER ENTITLED

We changed (1) monthly benefit to (2) beginning (3). We changed (4) benefit because the child in (5) care is no longer entitled to benefits.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

Fill-in (2)

Monthly Benefit Amount (MBA) in the format $$$$.¢¢

Fill-in (3)

Effective date of Monthly Benefit Amount (MBA) change in the format Month CCYY

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

CIC012 – TELLS PARENT THAT CHILDHOOD DISABILITY BENEFITS (CDB) REVIEW IS EVERY 3 YEARS

You are entitled to benefits because doctors and other trained staff decided that your child is disabled under our rules. But, this decision must be reviewed at least once every 3 years. We will send you or your child a letter before we start the review. Based on that review, your benefits will continue if your child is still disabled, but will end if your child is no longer disabled.

CIC013 – TELLS PARENT THAT CHILDHOOD DISABILITY BENEFITS (CDB) REVIEW IS EVERY 5 TO 7 YEARS

You qualify for benefits because doctors and other trained staff found that you have a disabled child in your care. However, we must review all disability cases. Therefore, we will review your child's case in 5 to 7 years. We will send you a letter before we start the review. Based on that review, your benefits will continue if your child is still disabled, but will end if your child is no longer disabled.

CIC014 – CHILDHOOD DISABILITY BENEFITS (CDB) DISABILITY NOT PERMANENT

You are entitled to benefits because you have a disabled child in your care. The doctors and other trained personnel who made the disability decision expect your child's health to improve. Therefore, we will review your child's case in (1). We will send you a letter before we start the review. Based on that review, your benefits will continue if your child is still disabled. But they will end if your child is no longer disabled.

Fill-in values:                                                                           

Fill-in (1)

the future                                        

F. “CLO” Universal Text Identifiers – Closeout

CLOC01 – CAPTION

Other Social Security Benefits

CLO002 – EXPLAINS THE LIMITATION OF BENEFITS

(1) (2) can receive from us at this time. In the future, if you think (3) might qualify for another benefit from us, (4) will need to apply again.

Fill-in values:

Fill-in (1)

                    

Choice 1 This benefit is the only benefit

Choice 2

These benefits are the only benefits

Fill-in (2)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

you

Choice 2

he

Choice 3

she

CLO029 – BENEFICIARY IDENTIFICATION CODE (BIC) B ENTITLEMENT CONVERSION TO BIC D OR E

If (1) married more than once, please contact us. (2) may be able to get a higher benefit on the record of a prior spouse.

Fill-in values:                                                                                     

Fill-in (1)

 

Choice 1

you were                                          

Choice 2

he was

Choice 3

she was

Fill-in (2)

 

Choice 1

You

Choice 2

He

Choice 3

She

G. “COA” Universal Text Identifiers – Change of Address

COA004 – TAX TREATY WITH SWITZERLAND

We will deduct a 15 percent Federal income tax from (1) monthly benefits. This is because of a treaty with Switzerland which says we will tax Social Security benefits paid to residents of Switzerland at this rate.

Please let us know if (2) (3) address again.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

Beneficiary’s Given Name (BGN) (possessive)

Choice 3

your

Fill-in (2)

 

Choice 1

he changes

Choice 2

she changes

Choice 3

you change

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

COA005 – TAX TREATY - CHANGE TAX STATUS

We are no longer deducting Federal income tax from (1) benefits. We do not deduct this, if (2) a U.S. citizen, or if (3) in the United States, Canada, Egypt, Germany, Ireland, Israel, Italy, Japan, Romania or the United Kingdom.

Also, if an individual is a citizen and resident of India, all or part of that person's benefits can be exempt from this Federal income tax if those benefits are based on Federal, State, or local government employment.

Please let us know if (4) (5) address again.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

Fill-in (2)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (3)

 

Choice 1

he lives

Choice 2

she lives

Choice 3

you live

Fill-in (4)

 

Choice 1

he changes

Choice 2

she changes

Choice 3

you change

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

COA011 – CHANGE OF ADDRESS (COA) - DOMESTIC TO FOREIGN ADDRESS

We have changed (1) address as you asked. However, we will continue to send (2) payments to (3) financial institution. Please check the mailing address we used for (4). If it is not complete or if you move again, please let us know.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

Fill-in (2)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

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

Choice 2

you

H. “COP” Universal Text Identifier – Copy of Notice

COP001 – TELLS THE BENEFICIARY A COPY OF THE NOTICE IS BEING SENT TO HIS OR HER REPRESENTATIVE

We are sending a copy of this notice to (1) (2) (3) (4) (5).

Fill-in values:                                                                   

Fill-in (1)

your representative                                     

Fill-in (2)

Null

Fill-in (3)

Null

Fill-in (4)

Null

Fill-in (5)

Null

COP002 – TELLS THE AUTHORIZED REPRESENTATIVE THAT A COPY OF THE NOTICE WE SENT TO THE BENEFICIARY THEY REPRESENT IS ENCLOSED

Enclosed is a copy of a letter we sent to (1).

Fill-in values:                                                                   

Fill-in (1)

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

I. “CPS” Universal Text Identifiers – Critical Payment System

CPS001 – CRITICAL PAYMENT SYSTEM (CPS) PAID AND DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

Based on the information we have, (1) (2) previously paid benefits on this record. The amount deducted for these benefits paid will be shown under the heading What We Will Pay and When.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

was

Choice 2

were

CPS002 – CRITICAL PAYMENT SYSTEM (CPS) PAID AND DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

  • We deducted (1) for money (2) (3) already paid from the check (4) will receive on or about (5).

Fill-in values:

Fill-in (1)

 

Choice 1

Deductions/Additions History Amount that corresponds to Deductions/Additions
History Item Code 330 (Critical Payment Being Withheld)

Fill-in (2)

 

Choice 1

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

Choice 2

you

Fill-in (3)

 

Choice 1

was

Choice 2

were

Fill-in (4)

 

Choice 1

 

he

 

Choice 2

 

she

Choice 3

you

Fill-in (5)

Run Date plus 15 days in the format Month DD, CCYY

NL 00730.132 “P” Paragraphs and Captions

List of “P” Paragraphs and Captions

A. “PAY” Universal Text Identifiers - Payment

PAYB02 – PRIOR MONTH ACCRUAL AMOUNT (PAMT) PAID WITH CURRENT TITLE II REDESIGN RUN DATE

You will receive (1) around (2).

Fill-in values:

Fill-in (1)

Prior Month Accrual Amount (PAMT) in the Schedule Pay field on the post-MBR

Fill-in (2)

Run Date plus 15 days in the format Month DD, CCYY

PAYB04 – CURRENT OR DEFERRED PAYMENT AMOUNT DUE AND CURRENT AMOUNT (CAMT) > $0.00

You will receive (1) for (2) around (3).

Fill-in values:

Fill-in (1)

 

Choice 1

Payment amount in the format $$$$$.¢¢ or $$$$$ [Special Payment Amount (SPA) or Monthly Benefit Payable(MBP)]

Choice 2

Current Amount (CMA) in the format $$$$$.¢¢ or $$$$$

Fill-in (2)

 

Choice 1

Current Operating Month (COM) in the format Month CCYY

Choice 2

Deferred Payment Date (DPD) in the format Month CCYY

Fill-in (3)

 

Choice 1

Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current Operating Month (COM) check will be paid

Choice 2

Using the Payment Cycle Indicator (PCI), show the calendar date in which the Deferred Payment Date (DPD) check will be paid

PAYB09 – TELLS BENEFICIARY THEIR MONTHLY BENEFIT PAYMENT

(1) After that, you will receive (2) (3) (4) (5).

Fill-in values:

Fill-in (1)

Null

Fill-in (2)

Monthly Benefit Payable (MBP) in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

for

Choice 2

through

Choice 3

on or about the

Fill-in (4)

 

Choice 1

third

Choice 2

second Wednesday

Choice 3

third Wednesday

Choice 4

fourth Wednesday

Choice 5

Current Operating Month (COM) + 1 month in the format Month CCYY

Choice 6

Work Resumption Diary Date 1 (WRDD1) - 1 month in the format Month CCYY

Fill-in (5)

 

Choice 1

of each month

Choice 2

Null

PAYB15 – MATURING ACTIONS - PAYMENT MONTH

(1) will receive (2) around (3). This is the money, after all deductions, (4) due for (5).

Fill-in values:

Fill-in (1)

 

Choice 1

He

Choice 2

She

Choice 3

You

Fill-in (2)

Current Amount (CAMT) in the format $$$$$.¢¢

Fill-in (3)

Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current Operating Month (COM) check will be paid

Fill-in (4)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (5)

Show the Current Operating Month (COM) in the format Month CCYY

PAYB16 – MATURING ACTIONS SMI AND/OR VOLUNTARY TAX WITHHOLDING DEDUCTED BENEFITS

We withheld (1) (2) from this payment.

Fill-in values:

Fill-in (1)

 

Choice 1

Supplemental Medical Insurance Premium Due Amount (SMI-PREMIUM-AMOUNT) deducted in the format $$$$

Choice 2

Voluntary Tax Current Payment Withholding Amount (VCAMT) in the format $$$$

Choice 3

Total Supplemental Medical Insurance Premium Due Amount (SMI-PREMIUM-AMOUNT) plus the Voluntary Tax Current Payment Withholding Amount (VCAMT) in the format $$$$

Fill-in (2)

 

Choice 1

for medical insurance premiums

Choice 2

for voluntary tax withholding

Choice 3

for medical insurance premiums and for voluntary tax withholding

PAYC01 – CAPTION

What We Will Pay and When

PAYC07 – CAPTION

Information About (1) Payments

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

Your

PAYC12 – CAPTION

Why We Cannot Pay Current Benefits

PAYC27 – CAPTION

How (1) Benefits Can Be Paid

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

Your

PAY037 – PRIOR AERO ACTION DIFFERENCE IN CURRENT MONTHLY ACCRUAL (CMA) CHECK - SAME CURRENT OPERATING MONTH (COM)

You will receive (1) increase in benefits in a separate payment.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

PAY084 – BENEFICIARY'S NOTICE PAYEE CHANGE – CURRENT AMOUNT (CAMT) PAID

We are sending your regular monthly check of (1) to (2) around (3).

Fill-in values:

Fill-in (1)

 

Choice 1

Amount in the Special Payment Amount (SPA) in the format $$$$$.¢¢ or $$$$$$

Choice 2

Current Amount (CAMT) in the format $$$$$.¢¢ or $$$$$$

Choice 3

Monthly Benefit Payable (MBP) in the format $$$$$.¢¢ or $$$$$$

Fill-in (2)

New Payee's Name

Fill-in (3)

 

Choice 1

Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current Operating Month (COM) check will be paid

Choice 2

Using the Payment Cycle Indicator (PCI), show the calendar date in which the Deferred Payment Date (DPD) check will be paid

PAY085 – BENEFICIARY’S NOTICE - PAYEE CHANGE PRIOR MONTH ACCRUAL AMOUNT (PAMT) AND CURRENT AMOUNT (CAMT) BOTH PAID

We are sending (1) to (2) for you around (3). We will begin sending your regular monthly check of (4) to your payee around (5).

Fill-in values:

Fill-in (1)

Prior Month Accrual Amount (PAMT) > $0.00

Fill-in (2)

New Payee's Name

Fill-in (3)

Trigger Run Date (TR-RUN-DATE) plus 15 days in format Month DD, CCYY

Fill-in (4)

 

Choice 1

Amount in the Special Payment Amount (SPA) in the format $$$$$.¢¢ or $$$$$$

Choice 2

Current Amount (CAMT) in the format $$$$$.¢¢ or $$$$$$

Choice 3

Monthly Benefit Payable (MBP) in the format $$$$$.¢¢ or $$$$$$

Fill-in (5)

 

Choice 1

Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current Operating Month (COM) check will be paid

Choice 2

Using the Payment Cycle Indicator (PCI), show the calendar date in which the Deferred Payment Date (DPD) check will be paid

PAY092 – USED WITH PARAGRAPH PAY002 WHEN PAYING A PRIOR MONTHLY ACCRUAL (PMA) CHECK

This is the (1) money (2) (3) due (4) (5) (6) (7).

Fill-in values:

Fill-in (1)

Null

Fill-in (2)

 

Choice 1

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

Choice 2

Beneficiary’s Given Name (BGN)

Choice 3

you

Fill-in (3)

 

Choice 1

are

Choice 2

is

Fill-in (4)

through

Fill-in (5)

Show end the date associated with the Prior Month Accrual Amount (PAMT) in the format May 1998

Fill-in (6)

Null

Fill-in (7)

Null

PAY116 – BENEFITS TERMINATE CURRENT OPERATING MONTH (COM) + 1 – CURRENT AMOUNT (CAMT) PAID FOR CURRENT OPERATING MONTH (COM)

This is the last payment (1) will receive.

Fill-in values:

Fill-in (1)

 

Choice 1

Mr. plus Beneficiary Last Name (BLN)

Choice 2

Ms. plus Beneficiary Last Name (BLN)

Choice 3

you

PAY126 – BENEFICIARY'S NOTICE - PAYEE CHANGE – PRIOR MONTH ACCRUAL AMOUNT (PAMT) PAID

We are sending (1) to (2) for you around (3).

Fill-in values:

Fill-in (1)

Prior Month Accrual Amount (PAMT) > $0.00

Fill-in (2)

New Payee's Name

Fill-in (3)

Prior Month Accrual Amount Payment Date (PAMT- PAID-REL-D) associated with the Prior Month Accrual Amount (PAMT) > $0.00

PAY148 – DEFERRED FOR OVERDUE OVERPAYMENT OR PARTIAL RECOVERY ESTABLISHED

We are withholding (1) of (2) monthly benefits (3) (4) to recover (5).

Fill-in values:

Fill-in (1)

 

Choice 1

all

Choice 2

some

Choice 3 Monthly Recovery Amount (MRA) on the Post-MBR

Fill-in (2)

 

Choice 1

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

Choice 2

your

Fill-in (3)

 

Choice 1 beginning
Choice 2 Null

Fill-in (4)

 

Choice 1

Current Operating Month (COM) + 1 in the format Month CCYY

Choice 2

Current Operating Month (COM) in the format Month CCYY

Choice 3 Null

Fill-in (5)

 

Choice 1 an overpayment
Choice 2 past due medical insurance premiums
Choice 3 an overpayment and past due medical insurance premiums

PAY161 – LEDGER ACCOUNT FILE (LAF) = C AND CURRENT AMOUNT (CAMT) = $0.00

No payment is due at this time because of adjustments made to (1) benefits.

Fill-in values:

Fill-in (1)

 

Choice 1

his

Choice 2

her

Choice 3

your

PAY176 – PART B REFUND DUE TO INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) AND REFUND PAID AS A PRIOR MONTH ACCRUAL AMOUNT (PAMT) OR IN THE CURRENT AMOUNT (CAMT) CHECK

Based on the information we have, (1) (2) due a Medicare Part B premium refund.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

PAY218 – EXPLAINS THAT BENEFITS CANNOT CURRENTLY BE PAID

We cannot pay you (1) regular monthly benefit at this time.

Fill-in values:

Fill-in (1)

 

Choice 1

your

Choice 2

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

PAY219 – EXPLAINS THAT INCREASE ONLY APPLIES TO PAST BENEFITS – CURRENT MONTHLY BENEFIT REMAINS THE SAME

The increase applies only to past benefits. It does not affect (1) monthly payment of (2).

Fill-in values:

Fill-in (1)

 

Choice 1

your

Choice 2

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

Choice 3

his

Choice 4

her

Fill-in (2)

Net Amount of check to be issued

PAY220 – EXPLAINS THAT THE CHECK CONTAINS THE CURRENT MONTHLY BENEFIT PLUS ANY INCREASED AMOUNT DUE FOR PRIOR MONTHS

This payment includes (1) new monthly benefit amount. This payment also includes any increase in benefits we owe (2).

Fill-in values:

Fill-in (1)

 

Choice 1

your

Choice 2

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

Choice 3

his

Choice 4

her

Fill-in (2)

 

Choice 1

you

Choice 2

him

Choice 3

her

PAY221 – DUALLY ENTITLED BENEFICIARIES – RECEIVING A PIA INCREASE ON OWN ACCOUNT AND ONGOING MONTHLY PAYMENT AMOUNT REMAINS THE SAME

(1) will continue to receive the same amount each month. When we add the amounts of the two benefits together, the total amount does not change.

Fill-in values:

Fill-in (1)

 

Choice 1

You

Choice 2

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

Choice 3

He

Choice 4

She

PAY222 – DUALLY ENTITLED BENEFICIARIES – PIA CHANGES – PROVIDES AMOUNT DUE ON EACH RECORD

The new monthly benefit on (1) Social Security record will be (2). (3) new monthly benefit on the other record will be (4).

Fill-in values:

Fill-in (1)

 

Choice 1

your

Choice 2

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

Choice 3

his

Choice 4

her

Fill-in (2)

Smaller Actuarially Reduced Monthly Benefit Amount (SAMBA)

Fill-in (3)

 

Choice 1

Your

Choice 2

His

Choice 3

Her

Fill-in (4)

Larger Excess Monthly Benefit Amount (LEMBA)

B. “PMT” Universal Text Identifiers – Payment Cycling

PMT003 – LEDGER ACCOUNT FILE (LAF) C, S, OR D CYCLE DATE CHANGED

As requested, we are changing the day we make (1) monthly payments.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

PMT011 – AUXILARY NOTICE THAT EXPLAINS BENEFITS HAVE CHANGED DUE TO ANOTHER PERSON'S EARNINGS ON THE RECORD.

(1) payments can change based on the work and earnings of another person entitled on the same record.

Fill-in values:

Fill-in (1)

 

Choice 1

Your

Choice 2

Auxiliary’s First Name and Last Name (possessive)

PMT012 – CORRECT BENEFITS WERE NOT PAID IN THE CURRENT OR PRIOR YEAR(S) DUE TO THE WAGES OF SOMEONE ON THE RECORD

We paid (1) (2) (3) than we should have (4) (5).

Fill-in values:

Fill-in (1)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (2)

Incorrect/over/under payment amount

Fill-in (3)

 

Choice 1

less

Choice 2

more

Fill-in (4)

 

Choice 1

"for" + Year in the format CCYY

Choice 2

Null

Fill-in (5)

 

Choice 1

so far this year

Choice 2

Null

PMT013 – CORRECT BENEFITS WERE NOT PAID IN THE CURRENT YEAR AND IN ONLY ONE PRIOR YEAR DUE TO THE WAGES OF SOMEONE ON THE RECORD

We paid (1) (2) than we should have for (3) and (4) than we should have so far this year.

Fill-in values:

Fill-in (1)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (2)

 

Choice 1

less

Choice 2

more

Fill-in (3)

Year of Earnings Report (YOER) in the format CCYY

Fill-in (4)

 

Choice 1

less

Choice 2

more

PMT016 – PAYMENT CYCLE REQUEST DENIED

We are not changing the day we make (1) monthly payments. This means that you will continue to receive (2) monthly payments on or about the third of each month.

We must make payment on the third of the month to everyone entitled to Social Security whenever anyone on that record:

  • receives Supplemental Security Income (SSI) payments, or railroad retirement payments, or

  • has income and/or resources considered when we determine whether an SSI claimant is eligible for benefits, or

  • moves outside the U.S., or

  • has Medicare premiums paid by the state, or

  • has payments garnished.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

Fill-in (2)

 

Choice 1

Beneficiary Given Name (BGN) (possessive)

Choice 2

your

PMT017 – PRE-MBR PAYMENT CYCLE INDICATOR (PCI) = 2, 3, OR 4, POST-MBR PCI = 1

We are changing the date we make (1) monthly payments. (2) new payment date will be the third of the month. We will also change the payment date of everyone on this record to the third of the month.

We must make payment on the third of the month when anyone on this record:

  • receives railroad retirement or Supplemental Security Income (SSI) payments,

  • has income or resources used to decide if someone else is eligible for SSI,

  • moves outside the U.S.,

  • has Medicare premiums paid by the State,

  • has payments garnished, or

  • is entitled on more than one record.

Fill-in values:

Fill-in (1)

 

Choice 1

your

Choice 2

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

Fill-in (2)

 

Choice 1

your

Choice 2

his

Choice 3

her

PMT018 – REFER TO WORKSHEET HEADER NL 00730.149C.2.

PMT019 – REFER TO WORKSHEET HEADER NL 00730.149C.3.

PMT020 – REFER TO WORKSHEET HEADER NL 00730.149C.4.

PMT022 – REFER TO WORKSHEET HEADER NL 00730.149C.5.

PMT025 – REFER TO WORKSHEET HEADER NL 00730.149C.6.

PMT027 – ADVISES ALL BENEFICIARIES ON THE RECORD IN LEDGER ACCOUNT FILE (LAF) C, D OR S THAT SOCIAL SECURITY ADMINISTRATION HAS CHANGED PAYMENT CYCLE DATE BASED UPON ENTITLEMENT ON MORE THAN ONE RECORD

We are changing the day we make (1) monthly payments due to entitlement on more than one record.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

your

C. “PRI” Universal Text Identifiers - Prisoners

PRI011 – PRISON SUSPENSION PRIOR TO 2/1995

We may be able to pay (1) up to February 1995 if (2) in a rehabilitation program while (3) imprisoned. Two things must be true about the program:

  • It must be approved for (4) by the court; and

  • It must be designed to make it possible for (5) to work after (6) release.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he was

Choice 2

she was

Choice 3

you were

Fill-in (3)

 

Choice 1

he was

Choice 2

she was

Choice 3

you were

Fill-in (4)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (5)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (6)

 

Choice 1

his

Choice 2

her

Choice 3

your

PRI014 – PRISON SUSPENSION 2/1995 – 3/2000

We cannot pay (1) because (2) imprisoned for the conviction of a crime that can carry a sentence of more than one year. We cannot pay (3) even if (4) actual sentence is shorter.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (3)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (4)

 

Choice 1

him

Choice 2

her

Choice 3

your

PRI015 – PRISON SUSPENSION < 2/1995

We cannot pay (1) because (2) imprisoned before February 1995 for the conviction of a crime considered to be a felony. Beginning February 1995, the law changed. Now, we cannot pay Social Security benefits if (3) imprisoned for conviction of a crime that can carry a sentence of more than one year. We cannot pay (4) benefits even if (5) actual sentence is shorter.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he was

Choice 2

she was

Choice 3

you were

Fill-in (3)

 

Choice 1

he was

Choice 2

she was

Choice 3

you were

Fill-in (4)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (5)

 

Choice 1

his

Choice 2

her

Choice 3

your

PRI016 – NUMBER HOLDER PRISON SUSPENSION - AUXILIARIES CAN BE PAID

Even though we cannot pay (1), we can pay other members of (2) family if they are entitled on (3) record.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

PRI017 – BENEFITS MAY BE PAID ONCE OUT OF PRISON

We may be able to pay (1) when (2) released. Please get in touch with us after (3) released. Then we will review your case to see if we can pay (4).

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (3)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (4)

 

Choice 1

him

Choice 2

her

Choice 3

you

PRI030 – PRISON SUSPENSION 4/2000 ON

We cannot pay (1) because (2) imprisoned for the conviction of a crime.

Fill-in values:

 

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

PRI047 – MENTAL SUSPENSION < 4/2000

We cannot pay (1) because (2) charged with a crime that can carry a prison sentence of more than one year. Because of (3) mental condition, (4) criminal case resulted in a court order that (5) confined in an institution and (6) stay is being paid for with public funds.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he was

Choice 2

she was

Choice 3

you were

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

he be

Choice 2

she be

Choice 3

you be

Fill-in (6)

 

Choice 1

his

Choice 2

her

Choice 3

your

PRI048 – MENTAL SUSPENSION = 4/2000

We cannot pay (1) because (2) confined to an institution as a result of a court order in connection with a criminal case and (3) stay is being paid for with public funds.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

PRI049 – USED FOR AN ONGOING OR EMBEDDED FUGITIVE FELON SUSPENSION

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 (1) (2) into one of these categories.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

fall

Choice 2

falls

PRI059 – USED TO NOTIFY BENEFICIARIES CURRENTLY SUBJECT TO PRISONER MONTHLY SUPENSION PROVISIONS THAT WE ARE HOLDING PAST DUE MONTHLY BENEFITS

We cannot pay back benefits to people who are:

  • convicted of a crime and imprisoned for more than 30 days, or

  • confined for more than 30 days to an institution at public expense because of a court order.

Contact us when (1) (2) released. We may be able to pay the back benefits then.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

PRI060 – USED TO NOTIFY BENEFICIARIES CURRENTLY SUBJECT TO FUGITIVE FELON, OR PROBATION OR PAROLE VIOLATION MONTHLY SUSPENSION PROVISIONS THAT WE ARE HOLDING PAST DUE MONTHLY BENEFITS

We cannot pay back benefits while (1) (2):

  • fleeing to avoid prosecution, custody, or confinement for a crime that is punishable by death or a prison term of over 1 year, or

  • violating probation or parole under Federal or State law.

Please contact us when (3) (4) the arrest warrant or (5) probation or parole violation ends. We may be able to pay the back benefits then.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

is

Choice 2

are

Fill-in (3)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

resolves

Choice 2

resolve

Fill-in (5)

 

Choice 1

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

Choice 2

your

PRI061 – USED IN RESUMPTION NOTICES TO INFORM BENEFICIARIES, WHEN RETROACTIVE BENEFITS ARE POSTED TO RECORD, THAT WE CAN RESUME BENEFITS DUE TO NO LONGER BEING SUBJECT TO CURRENT PRISONER, FUGITIVE FELON, COURT-ORDERED CONFINEMENT, OR PROBATION OR PAROLE VIOLATION MONTHLY SUSPENSION PROVISIONS

We can pay (1) monthly benefits again because (2) (3) no longer:

  • a prisoner,

  • confined to an institution at public expense because of a court order,

  • a fugitive felon, or

  • a probation or parole violator.

Fill-in values:

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (3)

 

Choice 1

is

Choice 2

are


NL 00730 TN 34 - Title II Redesign (T2R) Notices Title II Postentitlement (PE) Actions - 8/27/2020