Identification Number:
NL 00730 TN 29
Intended Audience:See Transmittal Sheet
Originating Office:Systems OITEBS
Title:Title II Redesign (T2R) Notices Title II Postentitlement (PE) Actions
Type:POMS Transmittals
Program:
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. 29, 11/27/2018

Audience

FO/TSC: CS, CS TII, CSR, DRT, DT, FR, OA, OS, RR, TA, TSC-CSR;
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;

Originating Component

OITEBS

Effective Date

Upon Receipt

Background

We are updating Program Operations Manual System (POMS) sections in NL 00730 effective with Title II Redesign’s (T2R) August 24, 2018 release.

Language changes for notices in the attached sections are a direct result of updates requested by the Office of Income Security Programs (OISP) and the Centers for Medicare & Medicaid Services (CMS) in support of the Processing Center (PC) Automation Initiative. This initiative involves modifying and adopting existing language to automate the processing of notices that are currently completed by technicians through the AURORA notice application.

 

Summary of Changes

NL 00730.010 Title II Redesign (T2R) Notices Not Generated

We moved the information from Subsection J to Subsection I because we now have the language and capabilities to generate a complete notice when an overpayment gets transferred from the LAF AD record to the LAF C record. This change resulted in the elimination of Subsection J.

 

NL 00730.020 Title II Redesign (T2R) Notice Documentation

We updated the criteria for generating notice completion codes of R002 and L because we now have access to the beneficiary address not found on the MBR as well as the address for attorney/non-attorney representatives who are the primary representative with an approval for direct payment registered. We are also eliminating the notice completion codes of R027 and I035 because we now have the language and data needed to generate a complete notice.

 

NL 00730.108 “D” Paragraphs and Captions

We corrected the language, fill-ins and choices for the UTI DSL038.

 

NL 00730.130 “O” Paragraphs and Captions

We added the UTI OPT302 to explain that an overpayment is being transferred from one record to the other when dual entitlement is involved. We also updated the language in OPT248 at the request of OISP to clarify the explanation of the overpayment. In addition, we updated the titles and formatting of the tables for uniformity. This includes the addition of a new title for section B and the quotation marks around the “O” in the Subchapter title and the UTI category in the section titles.

 

NL 00730.138 “S” Paragraphs and Captions

We added the UTI SSAH32 which will be used to place the attorney/non-attorney representative’s name and mailing address on certain T2R notices.

 

NL 00730.010 Title II Redesign (T2R) Notices Not Generated

The T2R notice process does not generate a notice for every T2R update. This section explains when T2R does not generate a notice.

T2R does not generate a notice when one or more of these events occur:

A. Based on maturity

  • When automatic Medicare enrollments based on an Initial Enrollment Period (IEP) are annotated to the Master Beneficiary Record (MBR) prior to maturity, the Centers for Medicare and Medicaid Services (CMS) sends an Initial Enrollment Period (IEP) package to the beneficiary. T2R sends a notice when the Hospital Insurance (HI)/Supplemental Medical Insurance (SMI) actions mature

  • When there are withdrawals with a future effective date. Notices are sent when the actions mature.

  • When there are terminations for HI/SMI with a diary date. Notices are sent when the actions mature.

  • If the pre-MBR ledger account field (LAF) is in the status of active Title XVIII only (U), the Post-MBR LAF shows health insurance benefits (HIB)/SMIB is terminated (X7) and there are no changes in the last occurrence of HI or SMI data when comparing the Pre and Post-MBRs. T2R does not build a notice for MBR LAF U or X7 situations because it advises the beneficiary of the HI/SMI termination dates when we place the beneficiary in LAF U. The Enroll Process changes the LAF to X7 because the HI/SMI termination dates matured.

  • If advance filing actions or deferred status actions mature to current pay with no SMI or voluntary tax withholding (VTW) deduction from the beneficiary’s check and no payment cycle indicator (PCI) changes. This action does not require a notice because T2R sends a letter when we award the benefits and we place the beneficiary in advance file status or deferred status. When the advance filing or deferred to current pay actions mature, there is nothing to tell the beneficiary about the maturity; however, T2R may generate a notice for other MBR changes.

B. Duplication of information

  • If the premium-HI penalty rate reduces to the basic premium-HI amount. This action does not require a notice because the Centers for Medicare and Medicaid Services (CMS) advises the uninsured Beneficiary Identification Code (BIC) who is not qualified for automatic health insurance benefits (M) in the CMS premium billing notice of the change in the HI premium amount.

  • If the General Enrollment Period (GEP) enrollment annotated to the MBR for a beneficiary is in an LAF status of current pay, suspension, or deferral (C, S, or D) and the SMI start date is greater than current operating month (COM), plus one month. T2R will send a notice when SMI premium deduction starts.

  • When the Medicare Advantage organization code changes and there is no change in the Medicare Advantage reduction amount. This action does not require a notice because the beneficiaries receive a letter from their new Medicare Advantage Plan when they enroll.

C. No rate change

  • When there is a conversion of Medicare entitlement based on age and the SMI premium is the SMI base rate. This action does not require a notice because the SMI premium rate is not changing.

  • When users input a change in the third-party state code for open third-party coverage, and the state coverage is continuous, CMS does not require us to advise the beneficiary of the change in state code.

  • When there is an MBR annotation-only action (via MONET). Annotation-only actions do not require a notice although T2R may generate a notice based on other updated MBR changes.

D. T2R notices that stopped generating in June 2004

  • When the Post-MBR LAF status is in current pay through the Railroad Retirement Board (LAF E) or the historical reason for suspension or termination (HRFST) is Railroad Board (RAILRD), no notice is required per Office of Income Security Programs (OISP) policy; when the Railroad Retirement Board (RRB) receives the interface record from us, the RRB will advise the beneficiary accordingly.

  • When the Post-MBR LAF status is a delayed claim, a claim terminated from delayed status, a technical disallowance, or a medical denial (PB, PT, N or ND). T2R never sends a notice to a beneficiary in a delayed or denied status.

E. T2R notices that stopped generating in November 2005

When all of the following exist:

  • Pre-MBR LAF = Terminated (T) with any subscript (e.g., T1, T3, etc.),

  • Post-MBR LAF = T (with any subscript),

  • Pre-MBR Historical Date of Entitlement Termination (BCLM-DOETERM) equals the post-MBR BCLM-DOETERM-REL date, and

  • The system made updates to the deductions additions history (DAH) data on the post-MBR.

  • There is no Prior Month Accrual being paid.

  • There is no new overpayment accrual or the new overpayment accrual amount is less than or equal to the total overpayment(s) of other beneficiaries on the record.

The T2R Summary process will update occurrences of DAH data showing net amount due = $0.00 and the current Monthly Benefit (MBC) = $0.00 for a terminated beneficiary. The T2R notice process recognizes that a notice is not required for this situation.

F. T2R notices that stopped generating in November 2006

  • When the Rep Payee System (RPS) sends T2R an annotation only for an RPS change (this includes dual entitlement processing for the non-input dual entitlement (D/E) record).

  • When Income-Related Monthly Adjustment Amount (IRMAA) data updates annually to the MBR prior to the Benefit Rate Increase (BRI) Operation, we do not need to send a notice because the new SMI rate is not effective until Current Operating Month (COM) 12 when BRI runs.

G. T2R notices that stopped generating in May 2008

  • For the non-input D/E record, if the pre-MBR LAF status is adjusted for dual entitlement (AD) or LAF S (with any subscript) and the Post-MBR LAF = AD or LAF S (any) and both the prior month accrual amount (PAMT) and current amount (CAMT) equals zero ($0.00). In addition, if present, there is no change in the special payment amount (SPA), beneficiary over/underpayment data (BOUD) or overpayment recovery amount (OPRA) values.

  • When the Pre-MBR HRFST is not a disabled beneficiary in suspense status due to the provisions of the four-state $2.00 for $1.00 demo project (DMPRD3). In addition, the Post-MBR HRFST equals DMPRD3 for any effective date.

NOTE: Since the T2R system can process multiple events at the same time, not generating a notice for one event does not prevent a notice from generating for another event. For example, an MONET action does not generate a notice and an SMI maturity generates a notice.

H. T2R notices that stopped generating in September 2012

When the only updates to the MBR is annotation only data along with the removal of a Mid-Year Mailer Indicator.

I. T2R notices that stopped generating in September 2015

The Regular Transcript Attainment and Selection Process (RETAP) selects and terminates beneficiaries who are at least 115 years old who have been in suspense for at least 7 consecutive years. T2R does not generate a notice for beneficiaries in LAF T9 with HRFST of AGETRM.

NL 00730.020 Title II Redesign (T2R) Notice Documentation

A. Introduction

Target Notice Architecture (TNA) does not produce a folder copy of the T2R notice. We store T2R notice information in the Online Retrieval System (ORS).

B. Description of Universal Text Identifier (UTI)

TNA uses UTIs to compose, format, and sequence the T2R notices. The notice consists of a heading, captions, paragraphs, a signature, addresses, and enclosures. The UTI is a six-part alphanumeric code that identifies the specific paragraphs or captions T2R selects for various parts of the notice.

C. Completion codes

T2R notice process generates the following completion codes, which are on the first page of the notice in the lower left corner:

Completion Code

Code

Informational Code Description

Complete (C)

 

Notice is complete and requires no further action.

Systems Bad (S)

001

T2R cannot complete a notice in a fully automated fashion and manual intervention is required. Asterisks appear for fill-in values that cannot be determined or T2R did not generate an introductory UTI.

Instructions:

The technician needs to

  • complete the fill-in values, and

  • include an appropriate introductory paragraph.

Review (R)

Notice is complete but needs additional information.

 

002

The Post-MBR shows a change in payee, the Person Information database does not contain an address for the beneficiary, and the Representative Payee Data (REPD) line shows:

  • Type of Payee (TOP) is not equal to A (Self-SEL),

  • Custody Code (CC) is not equal to V (in payee’s custody),

  • Competency Code (CMC) = Y, and

  • The beneficiary is age 18 or older.

Instructions:

  • The technician reviews and sends the notice to the beneficiary to inform him or her of the new payee.

  • The technician can obtain the beneficiary’s address from the Representative Payee System (RPS) or Supplemental Security Income Record (SSR).

 

020

There is a new hospital insurance (HI) occurrence with HI-TYPE = P (PREMIUM), a new Supplementary Medical Insurance (SMI) occurrence and no Hospital Insurance Premium (HIPR), or Supplementary Medical Insurance Premium (SMPR).

Instructions:

The technician reviews the action as well as the notice. If HI/SMI is open, there should be an HIPR or SMPR occurrence on the Post-MBR.

Incomplete (I)

 

The notice needs additional language added. The code is generated if the following conditions are met:

 

003

A HI/SMI occurrence based on Disability Insurance Benefits (DIB) is established. The T2R enrollment process establishes the DIB HI (free) and SMI granting equitable relief based on the time limitation for CMS payment of Part B (SMI) bills for medical claim services.

Instructions:

The technician needs to add the AURORA (manual notice system) paragraph “Supplementary Medical Insurance based on Disability” (SMID) to the notice.

 

004

A beneficiary requests waiver of equitable relief for SMI (meaning the beneficiary wants the earlier SMI coverage).

Instructions:

The technician needs to add the AURORA (manual notice system) paragraph “Supplementary Medical Insurance based on Disability” (SMID) to the notice.

 

007

This is used for three scenarios:

The Post-MBR History Reason for Suspension or Termination (HRFST) = OTHTRM.

The HRFST = CHDTRM and there is a changed Child in Care (CIC) occurrence with the CIC-ENDRSN = Other Child Termination Reason (O).

The HRFST = Disability Insurance Benefits Cessation (DIBCES) and there is a changed CIC occurrence with the CIC-ENDRSN = Other Child Termination Reason (O).

Instructions:

The technician needs to determine the specific termination reason and add dictated language to the notice.

 

008

The Post-MBR History Reason for Suspension or Termination (HRFST) = CHDTRM and there is a change in more than one occurrence of Child in Care (CIC) Data. All the occurrences of changed CIC Data show the same CIC-END date with the CIC-ENDRSN = Death (D) and there is more than one deceased beneficiary.

Instructions:

The technician needs to add a paragraph using the names of all deceased beneficiaries (PIC C’s). This paragraph explains to the BIC B or BIC E that SSA terminated benefits because named C’s were the last children in their care.

 

009

The Post-MBR History Reason for Suspension or Termination (HRFST) = Miscellaneous (MISCEL) for any effective date that the pre-MBR does not show with the HRFST = MISCEL.

Instructions:

The technician needs to review the case to determine the reason SSA suspended the beneficiary and add dictated language to the notice.

 

011

On the Post-MBR, if a Prior Month Accrual Amount (PAMT) is present and is > $0.00, the PAMT-PAID date equals the Run Date and no UTIs generate under Caption INFC17. If ADJ048 or HIB111 generates, process as a complete notice.

Instructions:

The technician needs to determine why we are paying the Prior Monthly Accrual (PMA) and add language to the notice.

 

012

A new overpayment was established and The Historical Date of Entitlement Termination (BCLM-DOETERM) on the Post-MBR is earlier than the BCLM-DOETERM date on the Pre-MBR for the same occurrence of Beneficiary Claim Data (BCLM). We cannot use the language in UTI OPT122 when the termination changes to an earlier date.

Instructions:

The technician needs to review the case and include information about the termination date changing to an earlier date.

 

013

The Payee Name and Address Legend (PNAL) data does not contain the word “For.” T2R uses the RPY073 to tell the beneficiary the name of the new payee. The RPY073 UTI value for Fill-in 1 is the new payee’s name.

Instructions:

The technician needs to fill-in the new payee’s name.

 

014

The Payee Name and Address Legend (PNAL) data does not contain the word “For.” T2R uses PAY084 when the beneficiary has a new payee and a Current Amount (CAMT) check is paid. The PAY084 UTI value for Fill-in 2 is the new payee’s name.

Instructions:

The technician needs to fill in the new payee’s name.

 

015

The Payee Name and Address Legend (PNAL) data does not contain the word “For.” T2R uses the PAY085 UTI when a beneficiary has a new payee and a Prior Month Accrual Amount (PAMT) and a Current Amount (CAMT) check are paid. The PAY085 value for Fill-in 2 is the new payee’s name.

Instructions:

The technician needs to fill in the new payee’s name.

 

016

The Payee Name and Address Legend (PNAL) data does not contain the word “For.” T2R generates PAY126 when a beneficiary has a new payee, we paid a Current Amount (CAMT) check, and benefits are terminating Current Operating Month (COM) + 1. The PAY126 value for Fill-in 2 is the New Payee’s Name.

Instructions:

The technician needs to fill in the new payee’s name.

 

018

T2R terminated benefits for History Reason for Suspension or Termination (HRFST) = CHDTRM and the CIC-END date is not equal to Historical Date of Entitlement Termination (BCLM-DOETERM). The T2Redesign Enrollment and Eligibility process will use the HRFST = CHDTRM. In certain situations, the BCLM-DOETERM date does not equal the CIC-END date.

Instructions:

The technician needs to explain why the termination date does not equal the CIC-END date.

EXAMPLE: In Current Operating Month (COM) 05/04, HA dies 04/04.

Pre-MBR shows HC1 terminated HRFST = CMARRY.

Pre-MBR shows HB2 suspended HRFST = CERTEL (B2 is age 62) with CIC-END date.

Post-MBR shows HB2 terminated 04/04 HRFST = CHDTRM with CIC-END date.

 

019

Benefits are suspended with History Reason for Suspension or Termination (HRFST) = LEGIS2. The HRFST is used for interim processing until full automation is implemented.

Instructions:

The technician needs to review the notice to include appropriate Legislative language.

 

021

More than one beneficiary dies and the Beneficiary Dates of Death (BDOD) are not equal; or there are more than three dead beneficiaries and their BDODs are equal. T2R suppresses the UTI OPT133 under Caption INFC17.

Instructions:

The technician needs to fill-in the deceased beneficiaries names and dates of death when either of these situations occur.

 

022

Reverse Jurisdiction Start is present and the Monthly Benefit Amount (MBA) is still reduced; however, no Amount of Offset Stop Date (AMOF-STOP) is on the post-MBR.

Instructions:

The technician needs to explain why the MBA is still in offset.

 

025

There are more than 20 Medicare Advantage Reduction Data (MARD) occurrences from the first point of change on.

Instructions:

The technician must determine the correct MARD occurrences. Add UTIs MHP013, MHP014, MHP008 and MHP018 to the notice to explain the reduction of Part B premium due to Medicare Advantage.

NOTE: When the T2R notice process generates a complete automated notice with MHP013, MHP014 and MHP008, if there are MARD occurrences on the pre-MBR that are now wiped out, the T2R notice attempts to include the wiped out occurrences in MHP008. For a wipe out, MHP008 shows the reduction amount as $0.00 and the Supplementary Medical Insurance (SMI) amount after reduction reflects the beneficiary’s full SMI rate.

 

026

The History Reason for Suspension or Termination (HRFST) = TWPFRD for an ongoing or embedded period of suspension.

Instructions:

The Fraudulent Unit in the Processing Centers needs to add special language to the T2R notice.

 

028

The Master Beneficiary Record (MBR) is updated with a new open Hospital Insurance (HI) occurrence with the HI-TYPE = P, a new open Supplementary Medical Insurance (SMI), a new open SMI Third-Party (SMTP) occurrence, and the SMI Start date is earlier than the SMTP Start date.

Instructions:

The technician needs to determine if the beneficiary owes SMI premiums in addition to the HI premiums for months prior to the third-party start date.

 

029

The Income-Related Monthly Adjustment Amount (IRMAA) affects the Supplementary Medical Insurance (SMI) premium amount and there are more than two SMI premium rates and effective dates. UTI HIB005 currently only allows for two rates and dates.

Instructions:

The technician needs to provide all SMI rates and corresponding effective dates.

 

030

The T2R notice process determines that Income-Related Monthly Adjustment Amount (IRMAA) affects the Supplementary Medical Insurance (SMI) premium amount but after comparing the IRMAA amounts there is no change and Deductions and Additions History (DAH) data shows DAH-ITEM 175 or 180 (Part B refund).

Instructions:

The technician needs to determine if the Medicare Part B refund indicated in DAH data is due to IRMAA since there is no change in the Part B premium amount.

 

031

Premium Relief data is present on the Post-MBR and the Relief Establish date equals the Post-Entitlement (PE) run date. The Relief Reason is not equal to Income-Related Monthly Adjustment Amount (IRMAA) or IRMAA D.

Instructions:

The technician needs to explain the reason(s) we are offering relief for the Supplementary Medical Insurance (SMI) premiums due.

 

032

Going from a Variable Supplemental Medical Insurance (VSMI) rate to a non-VSMI rate and T2R does not generate the UTI HIB005. In addition, VSMI data is deleted or a VSMI-TERM date updates to the post-MBR.

Instructions:

The technician needs to review the notice to include information about the change in rate.

 

033

There is more than one occurrence with the History Reason for Suspension or Termination (HRFST) = WINFAL.

Instructions:

The technician needs to explain the Start and Stop dates of each WINFAL occurrence.

 

034

There are more than four Annual Earnings Limit amounts.

Instructions:

The technician needs to provide all the Annual Earnings amounts and date changes.

 

036

More than four Annual Earnings (AORE) amounts that change to zero ($0.00) exist.

Instructions:

The technician needs to provide all the years that change to zero ($0.00).

Appointed Representative (L)

 

We issue a copy of the beneficiary’s notice to an appointed representative. This code is generated when:

  • Supplemental Security Income (SSI) Windfall is processed and,

  • An appointed representative is present and,

  • The Registration, Appointment and Services for Representatives (RASR) system does not show the representative as the active principal representative who is approved for direct payment.

NOTE: T2R produced and released a complete notice to the beneficiary. A copy of that notice is in AURORA.

Instructions:

The technician should review the notice and process through Aurora. A cover letter addressed to the appointed representative on the notice should be the only change to the notice.

If the beneficiary has more than one representative, the technician sends only one copy to the principal representative per GN 03910.040D.

NOTE: Due to the Print Mail Cost-Savings project, implemented in May 2013, do not generate ENC003 (enclosures) on the attorney copies of notices.

Manual (M)

 

You must prepare a manual notice because the T2R notice program cannot explain the processing situation. In most situations, you need to use dictated language to explain the T2R action. We list the conditions that require preparation of a manual notice below.

 

101

Limited group payer

When a group payer pays for a limited period of Medicare, prepare a manual notice. The notice needs to explain the group payer buy-in and buy-out period and the effect this period has on the beneficiary’s HI/SMI coverage.

 

102

Third-party wipe out processed

When a third-party wipe out action is processed, the technician needs to prepare a manual notice. Prepare a notice to explain that the third-party data is being deleted because it was erroneously established (refer to wipeout processing in SM 03040.245B.3).

 

103

Medicare withdrawal processed

When the pre-MBR has an open HI/SMI occurrence and the post-MBR is updated with an HI-NONCOVRSN = X, with the HI-BASIS = End-Stage Renal-Disease (E); or an SMI-NONCOVRSN = X with the SMI-BASIS = E. Prepare a manual notice when the HI/SMI BASIS is not E. The notice needs to explain that a Medicare withdrawal was processed.

 

104

Monthly Benefit Amount is less than the supplemental medical insurance premium amount (LESSDO) and the beneficiary is in LAF S9 with past premiums due

When the beneficiary goes from current pay status (LAF C) to suspended (LAF S9) with History Reason for Suspension or Termination (HRFST) of LESSDO (Monthly Benefit Amount is less than the Supplementary Medical Insurance premium amount), and owes past SMI premiums. Prepare a manual notice to explain the S9 suspension and the amount of any premiums due. T2R can only address the S9 suspension when it is effective with the current operation month. For instruction on processing LESSDO cases refer to SM 00850.475.

NOTE: If BENH01 is included on the manual notice, review to determine if BEN125 should be added to the notice.

 

105

Multiple third-party closed periods posted

If multiple third-party actions are processed and the updated MBR shows two or more closed third-party periods either being established or changed for the same coverage type, prepare a manual notice to explain the closed periods of coverage. In addition, provide the beneficiary with information regarding medical expenses for the closed periods.

 

106

Special Payment Amount Overpayment Disposition Amount (OPA) posted to Beneficiary Over/Underpayment Data (BOUD) – Termination status to termination status

When the pre-MBR has a Special Payment Amount (SPA) overpayment and the beneficiary is in terminated status (LAF = T (any except T1)) with post-MBR Beneficiary Over/Underpayment Data (BOUD) where the Due Process Overpayment (DPO) is equal to the pre-MBR DPO plus SPA and there is no change in the Historical Date of Entitlement Termination (BCLM-DOETERM) on the pre- and post-MBR, prepare a manual notice to advise the beneficiary of the overpayment posted to BOUD. In these situations, the SPA overpayment was incorrect and the technician should have posted the overpayment to BOUD. The T2R Summary Business Function recognizes this and is now posting the overpayment to BOUD. The T2R notice process has to assume that we never advised the beneficiary of the SPA overpayment.

 

107

Suspension for withdrawal claim

If benefits are suspended with History Reason for Suspension or Termination (HRFST) = WITHDR and the Beneficiary’s Date of Death (BDOD) = zeroes on the post-MBR, prepare a manual notice to send Exhibit 3700 to the beneficiary.

 

108

New Overpayment Disposition Amount (OPA) and prior OPA under protest

If T2R is establishing a new overpayment and the post-MBR Beneficiary Over/Underpayment Data (BOUD) has a Protest Indicator not equal to blank, prepare a manual notice. The data needed to explain when the new overpayment adjustment would start is not on the updated MBR. Due Process Recovery Date (DPRD) should not be posted with a Protest code.

 

109

Multiple fugitive felon occurrences changed

If there is more than one changed fugitive felon (FFEL) occurrence when comparing pre-MBRs and post-MBRs, the technician needs to determine the changed occurrences and prepare a manual notice that addresses the particular warrant date(s). The T2R notice process only has language for one changed occurrence.

 

110

Warrant issuing agency name is blank

If the warrant-issuing agency name is blank or not available to the T2R notice process, the technician needs to determine the agency’s name and prepare a manual notice.

 

111

Master Beneficiary Record Originating Agency Identifier (ORI) and warrant data do not match on Fugitive Felon SSA Control File (FFSCF)

If the Fugitive Felon (FFEL) data and the Fugitive Felon SSA Control File (FFSCF) data do not match, the technician in the Program Service Center needs to determine the FFSCF data that corresponds to the FFEL occurrence. Prepare a manual notice based on the FFEL update.

 

112

Workers’ Compensation/Public Disability Benefits stop and no Amount of Offset (AMOF) data present

If the T2R notice process has determined that we are no longer reducing or withholding the Monthly Benefit Amount (MBA) because of WC/PDB and the post-MBR does not contain Amount of Offset (AMOF) data (the AMOF data should be present on the MBR when WC/PDB stops), the technician needs to review the MBR and prepare a manual notice that contains dictated language to explain the action.

 

113

Fugitive Felon (FFEL) suspension – no change in FFEL occurrences

If The T2R system suspends benefits based on the History Reason for Suspension or Termination (HRFST) of Fugitive Felon (FUGFEL), and the FFEL data was previously updated to the MBR when the beneficiary was placed in suspense for PRISON then the T2R notice process cannot determine what FFEL occurrence the suspension corresponds to because there is no change in pre-FFEL and post-FFEL data. The technician needs to determine the appropriate FFEL occurrence that corresponds to the fugitive felon suspension and prepare a manual notice.

 

114

Title II Interactive Computation Facility (ICF) input – Workers’ Compensation data deleted on post-MBR

If Injury or Illness (INIL) Data is present on the Pre-MBR and all INIL occurrences are deleted on the Post-MBR, the technician needs to review the case to determine why Workers’ Compensation (WC) data was deleted. Prepare a manual notice to advise the beneficiary of the findings. If payments have not changed, do not send a manual notice, see DI 52165.015B.6.

 

115

Multiple Annual Report Data (ARD) lines for the same Year of Earnings Report (YOER)

T2R cannot process foreign work and domestic work for the same year. Since there are no UTIs to explain foreign work, the technician will review the case and prepare a manual notice explaining all changes to the beneficiary.

NL 00730.108 “D” Paragraphs and Captions

List of “D” Paragraphs and Captions

 

A. “DIB” Universal Text Identifiers – Disability

DIBC02 – CAPTION

The Basis For Our Decision

B. “DID” Universal Text Identifiers – Direct Deposit

DIDC01 – CAPTION

If You Change Your Account

DID030 – ESTABLISH OR CHANGE IN DIRECT DEPOSIT

As you requested on or about (1) we changed (2) direct deposit information. We will send (3) Social Security payments to the new financial institution or account you selected.

You should keep the old account open until we send a payment to the new account. It usually takes us 1 to 2 months to change where we send payments.

Please let us know right away if your address changes so we can send any future letters to your new address. Also let us know if you change the bank account where we send (4) payments.

Fill-in values:

Fill-in (1)

Show the Bank Data Change Date (BDCD) in format Month DD, CCYY

Fill-in (2)

 

Choice 1

your

Choice 2

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

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

DID031 – DIRECT DEPOSIT CANCELLED (BID DATA DELETED)

Effective (1), (2) payments will no longer be sent to a financial institution.

Fill-in values:

Fill-in (1)

 

Choice 1

Historical Date of Entitlement Start (BCLM-DOE-START-REL) in the format Month CCYY

Choice 2

Current Operating Month (COM) in the format Month CCYY

Fill-in (2)

 

Choice 1

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

Choice 2

your

C. “DSL” Universal Text Identifiers – Disallowance

DSL038 – DISALLOWANCE INTRODUCTION

We are writing to tell you that (1) not qualify for (2) (3).

Fill-in values:

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “does”

Choice 2

you do

Fill-in (2)
Choice 1 U.S.
Choice 2 Null

Fill-in (3)

Type of benefit (e.g., Medicare)

NL 00730.130 "O" Paragraphs and Captions

A. O Paragraphs and Captions

ONS003 – EXPLANATION TO THE DISABLED ADULT CHILD WHEN HE OR SHE BECAME ENTITLED TO DISABILITY BENEFITS

We found that (1) became disabled under our rules on (2).

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)

Date of entitlement

B. "OPT" Paragraphs and Captions

OPTC01 – CAPTION

Overpayment Information

OPT029 – NEW OVERPAYMENT – OVERPAYMENT NOT DUE TO TERMINATION

We paid (1) (2) for (3). Since we should have paid (4) (5) for (6), we paid (7) (8) more than (9) (10) due.

Fill-in values:

 

Fill-in (1)

 

Fill-in (1)

 

Choice 1

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

Choice 2

you

Fill-in (2)

Sum of the Monthly Benefit Credited (MBCs) on the pre-MBR starting with the internal Business Start Date and ending with Current Operating Month (COM) minus 1 month in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

Internal Business Start Date in format Month CCYY

Choice 2

Internal Business Start Date plus “and” plus Current Operating Month (COM) minus 1 month in the format Month CCYY

Choice 3

Internal Business Start Date plus “through” plus Current Operating Month (COM) minus 1 month in the format Month CCYY

Fill-in (4)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (5)

Sum of the Monthly Benefit Credited (MBCs) on the pre-MBR starting with the internal Business Start Date and ending with Current Operating Month (COM) minus 1 month in the format $$$$$.¢¢

Fill-in (6)

 

Choice 1

Internal Business Start Date in format Month CCYY

Choice 2

Internal Business Start Date plus “and” plus Current Operating Month (COM) minus 1 month in the format Month CCYY

Choice 3

Internal Business Start Date plus “through” plus Current Operating Month (COM) minus 1 month in the format Month CCYY

Fill-in (7)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (8)

Difference between Trigger Record New Overpayment Amount (TR-NEW-OPA-AMOUNT) and total Trigger Record Other Beneficiary Overpayment Amount (TR-OTH-BENE-OPA) in the format $$$$$.¢¢

Fill-in (9)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (10)

 

Choice 1

was

Choice 2

were

OPT064 – EXPLAINS TO A WORKING BENEFICIARY THERE IS AN OVERPAYMENT ON HIS OR HER RECORD FOR ONE YEAR BECAUSE THE EARNINGS THEY REPORTED IS DIFFERENT FROM WHAT SSA RECORDS SHOW

We recently found that the earnings (1) for (2) and the earnings information we have do not match. (3) told us (4) earned (5) in (6) but our records show that (7) earned (8). If our records are correct, we paid (9) (10) too much.

Fill-in values

 

Fill-in (1)

 

Choice 1

”reported for” plus Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

“reported for you”

Fill-in (2)

Year in the format CCYY

Fill-in (3)

 

Choice 1

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

Choice 2

You

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (5)

Amount of reported earnings (AORE)

Fill-in (6)

Year of Earnings Report (YOER) in the format CCYY

Fill-in (7)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (8)

Amount of reported earnings (AORE)

Fill-in (9)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (10)

Overpayment amount

OPT065 – EXPLAINS TO A WORKING BENEFICIARY THAT BECAUSE THE EARNINGS PREVIOUSLY POSTED FOR MULTIPLE YEARS ARE LESS THAN THE EARNINGS ON THE MASTER EARNINGS RECORD, THERE ARE OVERPAYMENTS FOR MULTIPLE YEARS

We recently found that the earnings reported for (1) for the years shown below and the earnings on our records do not match. If our records are correct, we paid (2) (3) too much.

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

you

Choice 2

him

Choice 3

her

Fill-in (3)

Overpayment amount in the format $$$$$.¢¢

OPT084 – EXPLAINS TO A WORKING BENEFICIARY THAT BECAUSE THE EARNINGS PREVIOUSLY POSTED FOR A SINGLE YEAR ARE LESS THAN THE EARNINGS ON THE MASTER EARNINGS RECORD AND NO BENEFITS WERE WITHHELD FOR THIS YEAR, THERE IS AN OVERPAYMENT FOR JUST ONE YEAR

Our records show that (1) had earnings in (2) of (3) that we did not consider when we paid (4). If our records are correct, we paid (5) (6) too much.

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)

Year of Earnings Report (YOER) in the format CCYY

Fill-in (3)

Amount of reported earnings (AORE)

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)

Overpayment amount

OPT085 – TELLS THE BENEFICIARY THE OVERPAYMENT AMOUNT

(1), (2) us (3).

Fill-in values:

 

Fill-in (1)

 

Choice 1

After all the changes (use when earnings caused more than 1 adjustment)

Choice 2

As a result (use when earnings caused a single adjustment)

Fill-in (2)

 

Choice 1

you owe

Choice 2

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “owes”

Fill-in (3)

Total overpayment amount

OPT086 – EARNINGS PREVIOUSLY POSTED FOR MULTIPLE YEARS ARE LESS THAN THE EARNINGS ON THE MASTER RECORD AND NO BENEFITS WERE WITHHELD, THEREFORE, THERE ARE OVERPAYMENTS FOR EACH YEAR

Our records show that (1) had earnings for the years shown below that we did not consider when we paid (2). If our records are correct, we paid (3) (4) too much.

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

him

Choice 2

her

Choice 3

you

Fill-in (3)

 

Choice 1

him

Choice 2

her

Choice 3

you

Fill-in (4)

Total overpayment amount

OPT087 – CHART HEADING UTI THAT PROVIDES THE WORKING BENEFICIARY THE EARNINGS POSTED WITH NO BENEFITS PREVIOUSLY WITHHELD FOR THAT YEAR EARNINGS

Earnings On

Year Our Records

OPT088 – EXPLAINS TO A WORKING BENEFICIARY IN A CHART THE EARNINGS POSTED WHEN NO BENEFITS WERE PREVIOUSLY WITHHELD FOR THESE EARNINGS

(1) (2)

Fill-in values:

 

Fill-in (1)

Year of Earnings Report (YOER) in format CCYY

Fill-in (2)

Amount of reported earnings (AORE)

OPT096 – PRIOR OVERPAYMENT WITH A PROTEST AND PROTEST DECISION STILL PENDING

We already told you that we paid (1) (2) too much for a past period. We will send you another letter to let you know what we will do about the recovery of that money.

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

Due process overpayment amount in the format $$$$$.¢¢

Choice 2

Null

OPT097 – RECOVERY OF AN INCORRECT PAYMENT

Once we get back the money (1) not due for this year, we will start to withhold (2) benefits to get back the other money (3).

Fill-in values

 

Fill-in (1)

 

Choice 1

you were

Choice 2

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “was”

Fill-in (2)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (3)

 

Choice 1

you owe

Choice 2

he owes

Choice 3

she owes

OPT107 – FULL OR PARTIAL WITHHOLDING FOR ONE MONTH

We will withhold (1) (2) (3) (4) payment to recover the money we (5) (6). This is the payment you would normally receive about (7).

Fill-in values:

 

Fill-in (1)

 

Choice 1

Overpayment amount

Choice 2

Null

Fill-in (2)

 

Choice 1

from

Choice 2

Null

Fill-in (3)

 

Choice 1

your

Choice 4

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

Fill-in (4)

Recovery of the overpayment date in the format Month CCYY

Fill-in (5)

 

Choice 1

overpaid

Choice 2

incorrectly paid

Fill-in (6)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (7)

Date the overpayment will be deducted in the format Month DD, CCYY

OPT122 – NEW OVERPAYMENT DUE TO RETROACTIVE TERMINATION

Since we did not stop (1) payments until (2), (3) paid (4) too much in 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)

Current Operating Month (COM) in format Month CCYY

Fill-in (3)

 

Choice 1

he was

Choice 2

she was

Choice 3

you were

Fill-in (4)

New overpayment amount in $$$$$.¢¢

OPT123 – TOTAL OVERPAYMENT INCLUDES PRIOR OVERPAYMENT

(1) total overpayment of (2) includes (3) prior overpayment.

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)

Due Process Overpayment (DPO) on the post-MBR in format $$$$$.¢¢

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

OPT125 – BENEFICIARY'S OVERPAYMENT BEING RECOVERED FROM ANOTHER AUXILIARY

We paid other person(s) on this record (1) more in benefits than we should have. Under Social Security law, you are responsible for this overpayment.

Fill-in values:

 

Fill-in (1)

Other beneficiary's overpayment amount in format $$$$$.¢¢

OPT127 – ADVISES OF OVERPAYMENT RECOVERY AMOUNT (OPRA) ON POST-MBR

We used (1) of (2) benefits to recover (3) of an overpayment on this record.

Fill-in values:

 

Fill-in (1)

Overpayment Recovery Amount (OPRA) on post-MBR in format $$$$$$.¢¢

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

all

Choice 2

part

OPT128 – BENEFICIARY’S NEW OVERPAYMENT, BENEFICIARY’S PRIOR OVERPAYMENT AND ANOTHER BENEFICIARY’S OVERPAYMENT

(1) total overpayment of (2) includes (3) prior overpayment and another beneficiary's overpayment that (4) (5) liable for under Social Security law.

Fill-in values:

 

Fill-in (1)

 

Choice 1

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

Fill-in (2)

Due Process Overpayment (DPO) amount on the post-MBR in format $$$$$.¢¢

Fill-in (3)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

Fill-in (5)

 

Choice 1

is

Choice 2

are

OPT131 – REMAINING BALANCE ON PRIOR OVERPAYMENT

(1) (2) an outstanding balance remaining on a prior overpayment. That remaining balance is (3).

Fill-in (3)

Remaining overpayment amount or the old overpayment amount in format $$$$$.¢¢

OPT132 – PIC A (H) DIES OR PIC B DIES AND HAVE JOINT BANK DATA ON MBR AND THERE IS AN OVERPAYMENT

We paid (1) more in benefits than we should have. We deposited (2) benefits for (3) into a bank account which (4) also owned. We can't pay benefits for the month of death, (5), or later. Because (6) a joint owner of the bank account, (7) overpaid (8).

Fill-in values:

 

Fill-in (1)

 

Choice 1

New overpayment amount

Fill-in (2)

 

Choice 1

NH-FULL name (possessive) when PIC A died and PIC B is responsible for the overpayment

Choice 2

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) when PIC B died and PIC A is responsible for the overpayment

Fill-in (3)

 

Choice 1

Beneficiary's date of death when Beneficiary Date of Death (BDOD) = Current Operating Month (COM) minus 1 month

Choice 2

Beneficiary's date of death plus “and” plus the Current Operating Month (COM) minus 1 month when the Beneficiary Date of Death (BDOD) = Current Operating Month (COM) minus 2 months

Choice 3

Beneficiary's date of death plus “through” plus Current Operating Month (COM) minus 1 month when the Beneficiary Date of Death (BDOD) > Current Operating Month (COM) minus 2 months

Fill-in (4)

Choice 1

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

Choice 2

you

Fill-in (5)

 

Choice 1

Beneficiary Date of Death (BDOD) for PIC A in the format Month CCYY

Choice 2

Beneficiary Date of Death (BDOD) for PIC B in the format Month CCYY

Fill-in (6)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is”

Choice 2

you are

Fill-in (7)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is”

Choice 2

you are

Fill-in (8)

 

Choice 1

Trigger Record New Overpayment Amount (WS-TR-NEW-OPA) in the format $$$$$.¢¢

Choice 2

Trigger Record Other Beneficiary Overpayment Amount (WS-TR-OTH-BENE-OPA) for WS-TR-OTH-OPA-BIC = A or WS-TR-OTH-BENE-OPA-BIC = B in the format $$$$$.¢¢

OPT133 – BENEFICIARY(S) DIE AND OVERPAYMENT RECOVERED FROM ANOTHER ENTITLED BENEFICIARY

We paid you (1) more in benefits than we should have. The overpayment occurred because we did not stop (2) benefits for (3). We can't pay benefits for the month of death, (4), or later.

Fill-in values:

 

Fill-in (1)

 

Choice 1

New overpayment amount

Choice 2

If more than one dead beneficiary is overpaid and overpayments are being recovered from another entitled beneficiary, then show the total amount of all overpaid beneficiaries

Fill-in (2)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) for one overpaid beneficiary

Choice 2

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) plus “and” for two overpaid beneficiaries followed by the Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) for the second overpaid beneficiary

Choice 3

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) followed by a comma followed by Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) for the second overpaid beneficiary plus “and” followed by Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive) for the third overpaid beneficiary

NOTE: If more than three dead beneficiaries with the same BDOD and overpaid, then an Incomplete notice will be generate (see Incomplete Notices under the Completion Code section for the CODE and more information)

Fill-in (3)

 

Choice 1

Beneficiary's date of death when Beneficiary Date of Death (BDOD) = Current Operating Month (COM) minus 1 month

Choice 2

Beneficiary's date of death plus “and” plus the Current Operating Month (COM) minus 1 month when the BDOD = COM minus 2 months

Choice 3

Beneficiary's date of death plus “through” plus COM minus 1 month when the Beneficiary Date of Death (BDOD) > Current Operating Month (COM) minus 2 months

Fill-in (4)

Beneficiary Date of Death (BDOD)

OPT147 – DUE PROCESS TITLE II OVERPAYMENT RECOVERY LESS THAN FULL MONTHLY BENEFIT AMOUNT

We plan to recover this overpayment (1) the payment (2) would normally receive about (3).

Fill-in values:

 

Fill-in (1)

 

Choice 1

from

Choice 2

by withholding

Fill-in (2)

 

Choice 1

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

Choice 2

you

Fill-in (3)

Use the Due Process Recovery Date (DPRD) plus 1 month to determine the month and year; then using the Payment Cycle Indicator (PCI) on the post-MBR call the PCI utility to get the correct day that corresponds to the determined month and year and show this date as the Fill-in value in the format Month DD, CCYY

OPT148 – TITLE XVI (SSI) UNDERPAYMENT USED TO REDUCE OR RECOVERY A TITLE II OVERPAYMENT (CROSS PROGRAM RECOVERY PHASE 3)

We used (1) of (2) SSI benefits to recover some or all of an overpayment on this record.

Fill-in values:

 

Fill-in (1)

Deductions Additions History Amount (DAH-AMOUNT) that corresponds to the Deductions Additions History Type of Payment Code (DAH-TOP) = P and Deductions Additions History Item Code (DAH-ITEM) = 382 in the format $$$$$$.¢¢

Fill-in (2)

 

Choice 1

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

Choice 2

your

OPT149 – TITLE XVI (SSI) UNDERPAYMENT NOT USED TO REDUCE OR RECOVERY A TITLE II OVERPAYMENT (CROSS PROGRAM RECOVERY PHASE 3)

We did not use any of (1) SSI benefits to recover an overpayment on this record.

Fill-in values:

Fill-in (1)

Choice 1

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

Choice 2

your

OPT216 – OVERPAYMENT CAUSED BY SUBSTANTIAL GAINFUL WORK ACTIVITY (SGA) DURING THE EXTENDED PERIOD OF ELIGIBILITY (EPE) OR DISABILITY CESSATION DUE TO SGA

(1) received (2) too much in benefits because of (3) work activity. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

Choice 1

your

Choice 2

his

Choice 3

her

Choice 4

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

Fill-in (4)

Choice 1

your

Choice 2

his

Choice 3

her

OPT217 – OVERPAYMENT ESTABLISHED VIA CROSS PROGRAM RECOVERY (CPR) TO RECOVER A TITLE VIII SPECIAL VETERANS BENEFITS (SVB) PAID IN EXCESS

(1) received (2) too much in benefits because (3) received Special Veterans Benefit (SVB) payments. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

Choice 1

your

Choice 2

his

Choice 3

her

OPT218 – OVERPAYMENT CAUSED DUE TO INCORRECT PAYMENTS FOR MEDICARE SERVICES

(1) received (2) too much in benefits because of incorrect payments for Medicare services. Please read the rest of this letter carefully. In it, we explain the changes we made to (3) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT219 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFCIARY WAS CONVICTED OF A CRIME OR IMPRISONED FOR MORE THAN 30 DAYS DUE TO FELONIOUS HOMICIDE

(1) received (2) too much in benefits because (3) criminal conviction and imprisonment for more than 30 days. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

Choice 1

your

Choice 2

his

Choice 3

her

OPT220 – OVERPAYMENT CAUSED BY WINDFALL OFFSET

(1) received (2) too much in benefits because (3) received Supplemental Security Income (SSI) payments (4) (5). Please read the rest of this letter carefully. In it, we explain the changes we made to (6) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

 

 

 

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

Choice 1

from

Choice 2

in

Fill-in (5)

Choice 1

Month CCYY through Month CCYY

Choice 2

Month CCYY

Fill-in (5)

Choice 1

your

Choice 2

his

Choice 3

her

OPT221 – OVERPAYMENT ESTABLISHED BECAUSE MORE THAN ONE PAYMENT WAS CASHED FOR THE SAME MONTH

(1) received (2) too much in benefits because we should not have paid two payments for the same month(s). Please read the rest of this letter carefully. In it, we explain the changes we made to (3) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT222 – OVERPAYMENT ESTABLISHED DUE TO INVALID FAMILY RELATIONSHIPS

(1) received (2) too much in benefits because (3) did not meet the relationship requirements to receive benefits. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT223 – OVERPAYMENT ESTABLISHED BECAUSE OF INVALID ENTITLEMENT

(1) received (2) too much in benefits because (3) did not qualify for benefits. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT224 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WAS DEPORTED

(1) received (2) too much in benefits because (3) deported from the United States. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you were

Choice 2

he was

Choice 3

she was

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT225 – OVERPAYMENT ESTABLISHED DUE TO INCORRECT COMPUTATION, A LEGALLY DEFINED OVERPAYMENT OR TO RECOVER A SKELETON DUE PROCESS OVERPAYMENT

(1) received (2) too much in benefits because the payment amount was incorrect. We corrected (3) record, which caused (4) benefit amount to decrease. Please read the rest of this letter carefully. In it, we explain the changes we made to (5) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT226 – OVERPAYMENT ESTABLISHED DUE TO SUBVERSIVE ACTIVITY

(1) received (2) too much in benefits because (3) convicted of crimes against the United States. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you were

Choice 2

he was

Choice 3

she was

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT227 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY DID NOT HAVE A CHILD IN THEIR CARE

(1) received (2) too much in benefits because (3) a child in (4) care who receives benefits from us. Please read the rest of this letter carefully. In it, we explain the changes we made to (5) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you no longer have

Choice 2

he no longer has

Choice 3

she no longer has

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT229 – OVERPAYMENT ESTABLISHED BECAUSE A WARRANT FOR THE BENEFICIARY’S ARREST EXISTS

(1) received (2) too much in benefits. We should not have paid (3) because of a warrant for (4) arrest. Please read the rest of this letter carefully. In it, we explain the changes we made to (5) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT230 – OVERPAYMENT ESTABLISHED BECAUSE OF STATE OR FEDERAL ASSISTANCE

(1) received (2) too much in benefits because (3) received State or Federal assistance. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT231 – OVERPAYMENT CAUSED BY REPRESENTATIVE PAYEE MISUSE OF BENEFITS

(1) received (2) too much in benefits because (3) misused funds while acting as a representative payee. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT232 – OVERPAYMENT CAUSED BY DISABILITY CESSATION

(1) received (2) too much in benefits because we cannot pay benefits after (3) disability ends. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Choice 4

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

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT234 – OVERPAYMENT ESTABLISHED DUE TO RECEIPT OF PROVISIONAL BENEFITS ON A CLAIM THAT WAS LATER DENIED

(1) received (2) too much in benefits because (3) you received temporary benefits while we were making a decision on (4) claim that we later denied. Please read the rest of this letter carefully. In it, we explain the changes we made to (5) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT235 – OVERPAYMENT ESTABLISHED DUE TO CROSS-BENEFIT ADJUSTMENT

We moved (1) overpayment of (2) to (3) for collection. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

Fill-in values:

 

Fill-in (1)

 

Choice 1

another person's

Choice 2

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

Fill-in (2)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

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

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT236 – OVERPAYMENT ESTABLISHED DUE TO CHANGE IN THE AMOUNT OR COMMENCEMENT OF THE GOVERNMENT PENSION OFFSET

(1) received (2) too much in benefits because we must offset (3) benefit payments due to (4) receipt of a government pension. Please read the rest of this letter carefully. In it, we explain the changes we made to (5) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT237 – OVERPAYMENT ESTABLISHED DUE TO RECEIPT OF A PENSION BASED ON WORK NOT COVERED BY SOCIAL SECURITY TAXES

(1) received (2) too much in benefits because (3) received a pension based on work not covered by Social Security taxes. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Choice 4

Wage Earner’s Name

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT238 – OVERPAYMENT ESTABLISHED DUE TO RECEIPT OF PAYMENTS AFTER CONFINEMENT TO A MENTAL INSTITUTION BECAUSE OF A COURT ORDER

(1) received (2) too much in benefits because (3) received payments after being confined to an institution because of a court order. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT239 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WAS AN ALIEN LIVING OUTSIDE THE UNITED STATES WHILE RECEIVING BENEFITS

(1) received (2) too much in benefits because (3) not a United States citizen and (4) outside the country for six months in a row. Please read the rest of this letter carefully. In it, we explain the changes we made to (5) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you are

Choice 2

he is

Choice 3

she is

Fill-in (3)

 

Choice 1

you were

Choice 2

he was

Choice 3

she was

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT240 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WORKED OUTSIDE THE US IN A JOB NOT COVERED UNDER SOCIAL SECURITY TAXES

(1) received (2) too much in benefits because (3) you worked outside the United States in a job not covered by United States Social Security taxes. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT241 – OVERPAYMENT ESTABLISHED DUE TO PRISONER SUSPENSION

(1) received (2) too much in benefits because of (3) criminal conviction and confinement in a correctional institution for more than 30 days. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT242 – OVERPAYMENT ESTABLISHED DUE TO DEATH RECLAMATION, REPRESENTATIVE PAYEE ELECTRONIC FUNDS TRANSFER (EFT) AFTER DEATH OR REPRESENTATIVE PAYEE DEATH

(1) received (2) too much in benefits because we cannot pay benefits for the month of death or later. Please read the rest of this letter carefully. In it, we explain the changes we made to (3) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT243 – OVERPAYMENT ESTABLISHED DUE TO PERMANENT DEDUCTIONS RESULTING FROM THE ANNUAL EARNINGS TEST

(1) received (2) too much in benefits because of (3) work and earnings. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT244 – OVERPAYMENT ESTABLISHED DUE TO DEATH SUPER-ENDORSEMENT

(1) received (2) too much in benefits because (3) signed and cashed a check for the month of death or later . Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT245 – OVERPAYMENT ESTABLISHED DUE TO A CHANGE IN MARITAL STATUS

(1) received (2) too much in benefits because of a change in (3) marital status. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT246 – OVERPAYMENT ESTABLISHED DUE TO ENTITLEMENT TO WORKERS’ COMPENSATION, PUBLIC DISABILITY OR BOTH

(1) received (2) too much in benefits because of (3) receipt of workers’ compensation, pubic disability payments or both of these payments. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT247 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY CONTINUED TO RECEIVE BENEFITS AFTER THE AGE OF 18

(1) received (2) too much in benefits because we do not pay benefits once a student reaches age 18, unless he or she is a full time student elementary or high school student. Please read the rest of this letter carefully. In it, we explain the changes we made to (3) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT248 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY CONTINUED TO RECEIVE BENEFITS AFTER AGE 19 OR 22

(1) received (2) too much in benefits because we do not pay benefits once a full-time student reaches age 19, unless (3) disabled or meet(s) an exception which allows benefits to continue:

  • for 2 months after a student turns 19, or;

  • until the end of the school term, whichever comes first.

Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

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

OPT249 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY IS NO LONGER IN FULL-TIME SCHOOL ATTENDANCE

(1) received (2) too much in benefits because we do not pay benefits once a student stops going to school full-time. Please read the rest of this letter carefully. In it, we explain the changes we made to (3) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT250 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY REFUSED TO ACCEPT VOCATIONAL REHABILITATION

(1) received (2) too much in benefits because we should not have paid benefits when (3) refused vocational rehabilitation services. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT252 – OVERPAYMENT ESTABLISHED DUE TO UNPAID ATTORNEY FEES

(1) received (2) too much in benefits because of unpaid attorney’s fees. Please read the rest of this letter carefully. In it, we explain the changes we made to (3) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT253 – OVERPAYMENT ESTABLISHED RAILROAD RETIREMENT BOARD EARNINGS WERE INCORRECTLY USED TO ESTABLISH THE BENEFICARY’S ENTITLEMENT

(1) received (2) too much in benefits because (3) received incorrect payments from the Railroad Retirement Board. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT254 – OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICARY WAS NOT A UNITED STATES (U.S.) CITIZEN OR LAWFULLY PRESENT IN THE U.S.

(1) received (2) too much in benefits because (3) received payments even though (4) not a United States citizen or lawfully present in the U.S. Please read the rest of this letter carefully. In it, we explain the changes we made to (5) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

you were

Choice 2

he was

Choice 3

she was

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT255 – OVERPAYMENT ESTABLISHED BECAUSE THE MONTH OF ENTITLEMENT WAS INCORRECT

(1) received (2) too much in benefits because of a change in the month (3) benefits started. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT257 – OVERPAYMENT ESTABLISHED DUE TO MULTIPLE ENTITLEMENTS

(1) received (2) too much in benefits because (3) received payments on two or more records for the same month(s). Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT258 – OVERPAYMENT ESTABLISHED BECAUSE INSURED STATUS WAS NOT MET

(1) received (2) too much in benefits because (3) worked long enough under Social Security to receive monthly benefits. Please read the rest of this letter carefully. In it, we explain the changes we made to (4) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you have not

Choice 2

he has not

Choice 3

she has not

Fill-in (4)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT259 – OVERPAYMENT ESTABLISHED BECAUSE THE BENFICIARY MISUSED FUNDS WHILE SERVING AS A REPRESENTATIVE PAYEE

(1) received (2) too much in benefits because (3) misused benefits that (4) received as the representative payee for another person. Please read the rest of this letter carefully. In it, we explain the changes we made to (5) benefits.

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)

Overpayment amount in the format $$$$$.¢¢

Fill-in (3)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (4)

 

Choice 1

you

Choice 2

he

Choice 3

she

Fill-in (5)

 

Choice 1

your

Choice 2

his

Choice 3

her

OPT302 – OVERPAYMENT TRANSFERRED FROM ANOTHER RECORD FOR A DUALLY ENTITLED BENEFICIARY

We have determined that (1) (2) overpaid (3) on another record. We will recover this overpayment on this 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

is

Choice 2

are

Fill-in (3)

Overpayment amount in the format $$$$$.¢¢

NL 00730.138 “S” Paragraphs and Captions

List of “S” Paragraphs and Captions

A. “SNO” Universal Text Identifiers – Special Notice Option

SNO002 – SPECIAL NOTICE OPTION – USED FOR BRAILLE (3), DATA CD (4), AUDIO CD (6) AND LARGE PRINT (7)

We are sending you this letter in both a standard print version and (1). You will receive them in separate envelopes.

Fill-in values:

 

Fill-in (1)

 

Choice 1

in a Braille version

Choice 2

on a compact disc in Microsoft Word format

Choice 3

on an audio compact disc

Choice 4

a large print version

SNO004 – SPECIAL NOTICE OPTION – USED FOR TELEPHONE CONTACT (2)

As you requested, we will call you within 5 business days of the date of this letter to read it to you.

B. “SSA” Universal Text Identifiers – Headings and Signatures

SSAH16 – BNC NUMBER HEADER ON SUBSEQUENT PAGES

(1)

Fill-in values:

 

Fill-in (1)

Show BNC# derived from the BNC utility plus BIC code

SSAH30 – NAME AND ADDRESS

(1)

(2)

(3)

(4)

(5)

(6)

Fill-in values:

 

Fill-in (1)

Payee Name

Fill-in (2)

Payee Address Line 1

Fill-in (3)

Payee Address Line 2

Fill-in (4)

Payee Address Line 3

Fill-in (5)

Payee Address Line 4

Fill-in (6)

Payee Address Line 5

SSAH32 – APPOINTED REPRESENTATIVE'S NAME AND ADDRESS

(1)

(2)

(3)

(4)

(5)

(6)

Fill-in values:

 

Fill-in (1)

Appointed Representative Name

Fill-in (2)

Appointed Representative Address Line 1

Fill-in (3)

Appointed Representative Address Line 2

Fill-in (4)

Appointed Representative Address Line 3

Fill-in (5)

Appointed Representative Address Line 4

Fill-in (6)

Appointed Representative Address Line 5

C. “SUS” Universal Text Identifiers - Suspension

SUSC02 – CAPTION

We May Be Able To Pay (1) Again

Fill-in values:

 

Fill-in (1)

 

Choice 1

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

Choice 2

You

SUS013 – SUSPENSION HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF WAIVER OF BENEFIT PAYMENTS (WAIVER)

If (1) to receive (2) benefits, we will pay benefits beginning with the month we receive a signed statement from you (3) asking for the benefits.

Fill-in values:

 

Fill-in (1)

 

Choice 1

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “decides”

Choice 2

you decide

Fill-in (2)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (3)

 

Choice 1

“or” plus Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

Choice 2

Null

SUS014 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF NO CHILD IN CARE (NOCICS)

We cannot pay (1) because (2) not taking care of a child who (3) entitled to Social Security benefits.

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

Choice 4

he was

Choice 5

she was

Choice 6

you were

Fill-in (3)

 

Choice 1

is

Choice 2

are

SUS025 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF PAYEE DEVELOPMENT (DEVPYE) OR DEATH OF PAYEE (DTHPYE) - NO DAA BENEFICIARY OR SUSPENSION HRFST OF PAYEE IS A FUGITIVE FELON (RPFUGF)

The person who received your payments will no longer be your representative payee. We are looking for another qualified person to receive your payments and use them for your needs.

SUS026 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF PAYEE DEVELOPMENT (DEVPYE) - NO DAA BENEFICIARY

We have determined that you need help managing your payments. We will be selecting a qualified person to receive your payments. We call this person a representative payee. It will be your payee's duty to manage your (1) payments for you and use them for your needs.

Fill-in values:

 

Fill-in (1)

Social Security

SUS027 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF PAYEE DEVELOPMENT (DEVPYE) OR DEATH OF PAYEE (DTHPYE)

When we begin your (1) payments again, you will be paid all the money that is due you. When we make a decision about your payee, we will send you another letter. This letter will explain what you can do if you disagree with our payee decision.

Fill-in values:

 

Fill-in (1)

Social Security

SUS035 – AUXILIARY SUSPENDED - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF SUSPENSION FOR CDR (DEVDIB) DUE TO NUMBER HOLDER OR AUXILIARY SUSPENDED HRFST OF CDRFTC DUE TO NUMBER HOLDER'S FAILURE TO COOPERATE OR PIC B/E SUSPENDED HRFST OF CDRFTC DUE TO PIC C (CDB) FAILURE TO COOPERATE

We cannot pay further benefits until we can study the facts and decide whether (1) still meets the requirements to receive disability benefits. We will let you know when we make this decision and will tell you whether we can start (2) benefits again.

Fill-in values:

 

Fill-in (1)

 

Choice 1

NH-NAME

Choice 2

Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) for PIC C with the BCLM-CEC = B (disabled)

Fill-in (2)

 

Choice 1

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

Choice 2

your

SUS040 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF TREASURY BARRED (BARRED)

We cannot pay (1) benefits because the rules of the United States Treasury Department do not allow payment while (2) (3) in (4). We will let you know if the tax rules change.

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

lives

Choice 2

live

Fill-in (4)

 

Choice 1

Cuba

Choice 2

North Korea

SUS041 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF FOREIGN ENFORCEMENT REPORT NOT RETURNED (FORENF)

We cannot pay (1) benefits because (2) (3) not returned the form, “Report to United States Social Security Administration.” We need the information requested on this form to decide if (4) can receive benefits again.

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

has

Choice 2

have

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

SUS045 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF ENTITLEMENT TO HIGHER BENEFITS ON ANOTHER ACCOUNT (T5NENT) OR TECHNICAL ENTITLEMENT (TECENT)

We cannot pay benefits because (1) (2) eligible for a higher benefit on another 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

is

Choice 2

are

SUS047 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF GOVERNMENT PENSION OFFSET (GPOOFF)

We cannot pay benefits because (1) (2) eligible for a government pension that is equal to or greater than the monthly Social Security benefit.

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

SUS052 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF DOMESTIC WORK (DOMWRK) OR FOREIGN WORK (FORWRK)

We cannot pay benefits because of (1) work.

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

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

SUS054 – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF NON-RESPONDER TO RECONTACT FORM (RECONT) OR TERMINATION BASED ON NON-RESPONSE TO RECONTACT NOTICE (RECONM) FOR PIC E OR PIC C AND NO PAYEE INVOLVED

We cannot pay (1) benefits because (2) (3) not returned the form, SSA-1588 “Beneficiary Recontact Report”. We need the information requested on this form to decide if (4) can receive benefits again.

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

has

Choice 2

have

Fill-in (4)

 

Choice 1

he

Choice 2

she

Choice 3

you

SUS055 – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF NON-RESPONDER TO RECONTACT FORM (RECONT) OR TERMINATION BASED ON NON-RESPONSE TO RECONTACT NOTICE (RECONM) FOR PIC C AND PAYEE INVOLVED

We cannot pay (1) benefits because (2) (3) not returned the Form SSA-1587 “Beneficiary Recontact Report.” We need the information requested on this form to decide if (4) can receive benefits again.

Fill-in values:

 

Fill-in (1)

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

Fill-in (2)

 

Choice 1

he

Choice 2

she

Fill-in (3)

 

Choice 1

has

Choice 2

have

Fill-in (4)

 

Choice 1

he

Choice 2

she

SUS068 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF NO CHILD IN CARE (NOCICS)

Please let us know if you are taking care of a child again who is entitled to benefits and under 16 or disabled. We may be able to pay you again.

SUS069 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF SUSPENSION FOR CDR (DEVDIB) (HA, CDB, WIDOW'S DIB) NO DAA

We cannot pay (1) benefits because our records show that (2):

  • did not return information we asked for; or

  • (3) returned to work; or

  • (4) health improved; or

  • (5) could not be located.

We cannot pay benefits because we must study the facts and decide whether (6) still (7) the requirements to receive disability benefits.

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

he

Choice 2

she

Choice 3

you

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

he

Choice 2

she

Choice 3

you

Fill-in (7)

 

Choice 1

meets

Choice 2

meet

SUS070 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF WHEREABOUTS UNKNOWN (WHEREU), ADDRESS DEVELOPMENT (DEVADD), AGE DEVELOPMENT (DEVAGE), PENDING DISABILITY DETERMINATION (DISDET), DUAL ENTITLEMENT POTENTIAL WIDOW (CERTEL)

We cannot pay (1) starting (2). We need more information before we can start (3) payments again.

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)

Date of Suspension

Fill-in (3)

his

Choice 1

your

Choice 2

his

Choice 3

her

SUS071 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF BARRED (SSA)

We cannot pay benefits because Social Security rules do not allow payment while a beneficiary lives or lived in a barred country.

SUS072 – SUSPENSION LEAD - FOLLOW BY SPECIFIC UTI

Based on the information we have, we cannot pay benefits (1) (2) (3) (4).

Fill-in values:

 

Fill-in (1)

 

Choice 1

beginning

Choice 2

for

Fill-in (2)

 

Choice 1

Date of Suspension or Termination (DOST) that corresponds to the ongoing suspension in the format Month CCYY

Choice 2

NA-HIST-START date in the format Month CCYY

Fill-in (3)

 

Choice 1

and

Choice 2

through

Choice 3

Null

Fill-in (4)

 

Choice 1

NA-HIST-STOP date in the format Month CCYY

Choice 2

Null

SUS073 – RESUMPTION OR REINSTATEMENT OF BENEFITS

Based on the information we have, we can pay benefits (1) (2) (3) (4).

Fill-in values:

 

Fill-in (1)

 

Choice 1

beginning

Choice 2

for

Fill-in (2)

 

Choice 1

First Effective Date (EFD) in History data that corresponds to the reinstatement period

Choice 2

NH-HIST-START date in the format Month CCYY for the embedded reinstatement period

Fill-in (3)

 

Choice 1

and

Choice 2

through

Choice 3

Null

Fill-in (4)

 

Choice 1

NA-HIST-STOP date for the embedded reinstatement period in the format Month CCYY

Choice 2

Null

SUS074 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF NOT LAWFULLY PRESENT (NOTLAW)

We cannot pay (1) benefits because (2) not lawfully present in the U.S.

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

SUS075 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF NOT A U.S. CITIZEN (NOUSCP)

We cannot pay (1) benefits because (2) not a U.S. citizen.

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

SUS076 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF LEF U.S. ALIEN SUSPENSION (ALNSUS)

We cannot pay (1) benefits because (2) not a United States citizen and (3) been outside the United States for more than 6 months.

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

has

Choice 2

have

 

SUS077 – ONGOING VOLUNTARY SUSPENSION TO EARN DELAYED RETIREMENT CREDITS (VOLDRC or LEGIS1)

We received (1) request to suspend (2) retirement benefits to earn delayed retirement credits. Suspending these benefits will also stop payments to (3) on any other record on which (4) entitled. We will restart (5) benefits at the earlier of:

  • The month (6) age 70, or

  • The month after (7) for payments to restart.

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

Fill-in (3)

 

Choice 1

you

Choice 2

him

Choice 3

her

Fill-in (4)

 

Choice 1

you are

Choice 2

he is

Choice 3

she is

Fill-in (5)

 

Choice 1

your

Choice 2

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

Fill-in (6)

 

Choice 1

you reach

Choice 2

he reaches

Choice 3

she reaches

Fill-in (7)

 

Choice 1

you ask

Choice 2

he asks

Choice 3

she asks

SUS078 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF MONTHLY BENEFIT AMOUNT (MBA) < $1.00 (LESSDO) AND HIB225 OR HIB226 NOT USED

We cannot pay (1) beginning (2) because (3) monthly payment is less than a dollar. At the end of the year, we will adjust (4) record and pay all money (5) due.

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)

Effective Date (EFD) in History (HIST) Data on the post-MBR that corresponds to the HRFST LESSDO in format Month CCYY

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

SUS079 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF WAIVER

We are withholding (1) benefits because (2) requested us to do so.

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 has

Choice 2

she has

Choice 3

you have

SUS080 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF PREDATOR (PREDTR)

We cannot pay (1) because:

  • (2) convicted of a crime and confined in a jail or prison;

  • The crime included sexual activity, and

  • When (3) completed (4) sentence, (5) immediately sent by court order to an institution at public expense.

  • The court decided (6) a sexually dangerous person.

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

Choice 2

she

Choice 3

you

Fill-in (4)

 

Choice 1

his

Choice 2

her

Choice 3

your

Fill-in (5)

 

Choice 1

he was

Choice 2

she was

Choice 3

you were

Fill-in (6)

 

Choice 1

he is

Choice 2

she is

Choice 3

you are

SUS084 – HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF VOLUNTARY SUSPENSION TO EARN DELAYED RETIREMENT CREDIT (VOLDRC or LEGIS1) FOR AN EMBEDDED PERIOD OF SUSPENSION

We received (1) request to suspend (2) retirement benefits for (3) to earn delayed retirement credits. Suspending these benefits will also stop payments to (4) on any other record on which (5) entitled. We will restart (6) benefits for (7) in (8), unless (9) us to restart (10) benefits earlier.

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

Fill-in (3)

 

Choice 1

If one month of suspension, show the Effective Date (EFD) in History Data that corresponds to the embedded month of VOLDRC or LEGIS1 suspension in Month CCYY format

Choice 2

If two or more months of suspension, show the first Effective Date (EFD) in History Data that corresponds to the embedded period of VOLDRC or LEGIS1 suspension in Month CCYY format plus the word “through” and ending with the last Effective Date (EFD) in History Data that corresponds to the embedded period of VOLDRC or LEGIS1 in Month CCYY format

Fill-in (4)

 

Choice 1

you

Choice 2

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

Fill-in (5)

 

Choice 1

you are

Choice 2

he is

Choice 3

she is

Fill-in (6)

 

Choice 1

your

Choice 2

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

Fill-in (7)

Show the first Effective Date (EFD) in History Data after the embedded period where VOLDRC or LEGIS1 suspension is not present in Month CCYY format

Fill-in (8)

Show the first Effective Date (EFD) in History Data after the embedded period where VOLDRC or LEGIS1 suspension is not present plus one month in Month CCYY format

Fill-in (9)

 

Choice 1

you ask

Choice 2

he asks

Choice 3

she asks

Fill-in (10)

 

Choice 1

your

Choice 2

his

Choice 3

her

SUS087 – PIC A SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF DEPORTATION (DEPORT) – ONGOING OR EMBEDDED PERIOD OF SUSPENSION

We cannot pay (1) benefits because (2) deported or removed from the United States under one of the following sections of the Immigration and Nationality Act (INA):

  • Section 241(a) of the INA in effect prior to April 1, 1997;

  • Section 237(a);

  • Section 212(a)(6)(A).

This is based on information from the U.S. Department of Homeland Security. Please get in touch with us if in the future (3) permitted to return to the United States as a lawful permanent resident. Benefits may again be payable at that time.

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 is

Choice 2

she is

Choice 3

you are

SUS088 – AUXILIARY SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF DEPORTATION (DEPORT) – ONGOING OR EMBEDDED PERIOD OF SUSPENSION

No benefits are payable to (1) because (2) was deported or removed from the United States. Please get in touch with us if (3) a U.S. citizen or (4) in the United States for a full calendar month or more without leaving for any period, no matter how short. Benefits may again be payable at that time.

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)

 

Choice 1

BGN plus “becomes”

Choice 2

you become

Fill-in (4)

 

Choice 1

he stays

Choice 2

she stays

Choice 3

you stay

SUS099 –SUSPENSION – DIRECT DEPOSIT FRAUD

We stopped (1) Social Security benefits because of possible fraud on (2) record. Please contact us right away. We need to verify your direct deposit information before we can resume (3) benefits.

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

Fill-in (3)

 

Choice 1

your

Choice 2

his

Choice 3

her

SUS100 –SUSPENSION OF AUXILIARY’S BENEFITS - NUMBER HOLDER (NH) REQUESTS VOLUNTARY SUSPENSION TO EARN DELAYED RETIREMENT CREDITS (LEGIS1)

We received (1) request to suspend (2) benefits to earn delayed retirement credits. As a result, we must suspend the benefits (3) on (4) record. We will restart (5) benefits with the earlier of:

  • The month (6) reaches age 70, or

  • The month after (7) asks for payments to restart.

Fill-in values:

 

Fill-in (1)

 

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

Fill-in (2)

 

Choice 1

his

Choice 2

her

Choice 3

Null

Fill-in (3)

 

Choice 1

you receive

Choice 2

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

Fill-in (4)

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

Fill-in (5)

 

Choice 1

your

Choice 2

 

 

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

Fill-in (6)

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

Fill-in (7)

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


NL 00730 TN 29 - Title II Redesign (T2R) Notices Title II Postentitlement (PE) Actions - 11/27/2018