TN 1 (07-11)
   
   
   
   
      AWD010 PIC “D” AWARD BETWEEN AGE 62 AND FULL RETIREMENT AGE (G05)
      
      
      (Generated)
      
      Caption: Other Social Security Benefits
      
      Please get in touch with us 3 months before  (1)   (2)   (3)  to find out whether  (4)  for retirement benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: you reach
            Choice 2: beneficiary name reaches
         Fill-in (2)
            
            
Choice 1: age 65
            Choice 2: full retirement age
         Fill-in (3)
            
            
Choice 1: NULL
            Choice 2: real retirement age from FRA utility in below format:
            (i.e., 66 and 2 months)
         Fill-in (4)
            
            
Choice 1: you qualify
            Choice 2: he qualifies
            Choice 3: she qualifies
          
    
   
      AWD011 OPENING PARAGRAPH FOR OTHER THAN “PIC-O” AWARDS IN “LAF-S” (OTHER THAN SD) (G09)
      
      
      (System Generated)
      
      Caption: None
      
      We are writing to let you know that we have approved  (1)  application for  (2)  benefits. The rate is  (3)  beginning  (4)  , but  (5)  will not receive regular monthly checks at this time.
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: your
            Choice 2: Beneficiary's Name possessive
         Fill-in (2)
            
            
Choice 1: disability
            Choice 2: retirement
            Choice 3: wife’s
            Choice 4: husband’s
            Choice 5: child’s
            Choice 6: widow’s
            Choice 7: widower’s
            Choice 8: mother’s
            Choice 9: father’s
            Choice 10: disabled widow’s
            Choice 11: disabled widower’s
            Choice 12: disabled divorced widow’s
            Choice 13: disabled divorced widower’s
            Choice 14: NULL
         Fill-in (5)
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
          
    
   
      AWD012 INTRODUCTORY STATEMENT CHANGE OF PAYEE AWARD BENEFICIARY OWN PAYEE (G48)
      
      
      (System Generated)
      
      Caption: None
      
      We are writing to tell  (1)  that beginning  (2)  we will begin to send  (3)  checks directly. The rest of this letter will give  (4)  more information about this change.
      
      
      
      Fill-in values:
         
         
            
            Fill-in (1
            Choice 1: you
            Choice 2: Beneficiary's Name
          
         
         Fill-in (3)
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (4)
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
          
    
   
      AWD013 INTRODUCTORY STATEMENT AWARDS (EXCEPT “PIC-O” OR “LAF-S") (G49)
      
      
      (System Generated)
      
      Caption: None
      
      We are writing to let you know that  (1)  entitled to monthly  (2)  benefits from Social Security beginning  (3)  .
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: you are
            Choice 2: Beneficiary's name is
         Fill-in (2)
            
            
Choice 1: disability
            Choice 2: retirement
            Choice 3: wife's
            Choice 4: husband's
            Choice 5: child's
            Choice 6: widow's
            Choice 7: widower's
            Choice 8: mother's
            Choice 9: father's
            Choice 10: disabled widow's
            Choice 11: disabled widower's
            Choice 12: disabled divorced widow's
            Choice 13: disabled divorced widower's
            Choice 14: null
          
    
   
      AWD014 MBA Paragraph (B30)
      
      
      (Requested/Generated)
      
      Caption: Your Benefits
      
      The following chart shows  (1)  benefit amount(s) before any deductions or rounding. The amount  (2)  may differ from  (3)  full benefit amount. When we figure how much to pay  (4)  , we must deduct certain amounts, such as Medicare premiums and worker's compensation
         offset. We must also round down to the nearest dollar.
      
      
      Beginning Benefit
      
      Date Amount Reason
      
       (5)   (6)   (7) 
      
      NOTE:  This UTI is flexible, to allow multiple repetitions of the three fill-ins. This allows
         it to be used once, and provide as many benefit amount, dates and reasons as are needed
         to explain the action, or more than once with the benefit amount, date and reason.
         An example of how to input this in the ENB is:
      
      
      C*AWD014,12/2012,848.70,a,01/2013,871.90,a,12/2013,885.00,a. OR
 C*AWD014,07/2013,910.40,a*AWD017,12/2013,924.10,a*AWD014,01/2014,925.10,a.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary's name, possessive
         Fill-in (2) - Systems Generated
            
            
Choice 1: you actually receive
            Choice 2: he actually receives
            Choice 3: she actually receives
         Fill-in (3) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (5) - Requested As A Date In Format MM/CCYY
            
            
Date displayed in format “September 2010”
         Fill-in (6) - Requested As A Money Amount In Format Shown Below
            
            
Money amount displayed in format “$$$$$.¢¢”
         Fill-in (7) - Requested As A One Position Alpha Character
            
            
Choice 1 (A): Entitlement began
            Choice 2 (B): Cost of living adjustment
            Choice 3 (C): Credit for additional earnings
            Choice 4 (D): Benefits to another person began or ended
            Choice 5 (E): Your own benefit increased
            Choice 6 (F): His own benefit increased
            Choice 7 (G): Her own benefit increased
            Choice 8 (H): You became entitled to your own benefit
            Choice 9 (I): He became entitled to his own benefit
            Choice 10 (J): She became entitled to her own benefit
          
    
   
      AWD015 (B30 and B33 Detail Line)
      
      
      (System Generated)
      
      Caption: Your Benefits
      
      (1) (2) (3)
      
      
         - 
            
         
      Fill-in values:
         
         Fill-in (1) - Requested As A Date In Format MM/CCYY
            
            
Date displayed in format “September 2010”
         Fill-in (2) - Requested As A Money Amount In Format Shown Below
            
            
Money amount displayed in format “$$$$$.¢¢”
         Fill-in (3) - Requested As A One Position Alpha Character
            
            
Choice 1 (A): Entitlement began
            Choice 2 (B): Cost of living adjustment
            Choice 3 (C): Credit for additional earnings
            Choice 4 (D): Benefits to another person began or ended
            Choice 5 (E): Your own benefit increased
            Choice 6 (F): His own benefit increased
            Choice 7 (G): Her own benefit increased
            Choice 8 (H): You became entitled to your own benefit
            Choice 9 (I): He became entitled to his own benefit
            Choice 10 (J): She became entitled to her own benefit
          
    
   
      AWD016 MBA Paragraph (B33)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      The following charts show  (1)  disability benefit amount(s) before any deductions or rounding. The first chart shows
         the amount(s) on  (2)  own record and the second chart shows  (3)  benefit amount(s) as a childhood disability beneficiary. The amount  (4)  may differ from  (5)  full benefit amount. When we figure how much to pay  (6)  , we must deduct certain amounts, such as Medicare premiums and worker's compensation
         offset. We must also round down to the nearest dollar.
      
      
      Beginning Benefit
      
      Date Amount Reason
      
       (7)   (8)   (9) 
      
      NOTE: This UTI is flexible, to allow multiple repetitions of the three fill-ins. This allows
         it to be used once, and provide as many benefit amount, dates and reasons as are needed
         to explain the action, or more than once with the benefit amount, date and reason.
         An example of how to input this in the ENB is:
      
      
      C*AWD016,12/2012,848.70,a,01/2013,871.90,a,12/2013,885.00,a. OR
 C*AWD016,07/2013,910.40,a*AWD016,12/2013,924.10,a*AWD0167,01/2014,925.10,a.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary's name, possessive
         Fill-in (2) – Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (3) – Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (4) – Systems Generated
            
            
Choice 1: you actually receive
            Choice 2: he actually receives
            Choice 3: she actually receives
         Fill-in (5) – Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (6) – Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (7) - Requested As A Date In Format MM/CCYY
            
            
Date displayed in format “September 2010”
         Fill-in (8) - Requested As A Money Amount In Format Shown Below
            
            
Money amount displayed in format “$$$$$.¢¢”
         Fill-in (9) - Requested As A One Position Alpha Character
            
            
Choice 1 (A): Entitlement began
            Choice 2 (B): Cost of living adjustment
            Choice 3 (C): Credit for additional earnings
            Choice 4 (D): Benefits to another person began or ended
            Choice 5 (E): Your own benefit increased
            Choice 6 (F): His own benefit increased
            Choice 7 (G): Her own benefit increased
            Choice 8 (H): You became entitled to your own benefit
            Choice 9 (I): He became entitled to his own benefit
            Choice 10 (J): She became entitled to her own benefit
          
    
   
      AWD017 NEW RATE(S) AND EFFECTIVE DATE(S) DISPLAY DUAL ENTITLEMENT (B64)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      The following are  (1)  new benefit rates:
      
      
      Beginning Rate On Rate On
      
      Date This Record The Other Record
      
       (2)   (3)   (4) 
      
      NOTE: This UTI is flexible, to allow multiple repetitions of the three fill-ins. This allows
         it to be used once, and provide as many benefit amount, dates and reasons as are needed
         to explain the action, or more than once with the benefit amount, date and reason.
         An example of how to input this in the ENB is:
      
      
      C*AWD017,12/2012,848.00,164.00,01/2013,871.00,138.00,12/2013,885.00,140.00. OR
 C*AWD017,07/2013,910.00,42.00*AWD017,12/2013,924.00,43.20*AWD017,01/2014,925.00,42.00.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary's name, possessive
         Fill-in (2) - Requested As A Date In Format MM/CCYY
            
            
Date displayed in format “September 2010”
         Fill-in (3) - Requested As A Money Amount In Format Shown Below
            
            
Money amount displayed in format “$$$$$.¢¢”
         Fill-in (4) - Requested As A Money Amount In Format Shown Below
            
            
Money amount displayed in format “$$$$$.¢¢”