TN 4 (08-12)
   
   
   
   
      CIC002 NO CHILD-IN-CARE (A10)
      
      
      (Requested)
      
      Caption: If You Disagree With The Decision
      
      We cannot pay  (1)  benefits for the months of  (2)  because  (3)  not taking care of  (4)  child in those months.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: you
            Choice 2: beneficiary name
         Fill-in (2) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY through MM/CCYY
         Fill-in (3) - Systems Generated
            
            
Choice 1: you were
            Choice 2: he was
            Choice 3: she was
         Fill-in (4) - Systems Generated
            
            
Choice 1: Beneficiary's Name possessive
          
    
   
      CIC003 MEDICAL IMPROVEMENT NOT EXPECTED MOTHER'S/FATHER'S BENEFITS (J60)
      
      
      (Requested)
      
      Caption: Things To Remember
      
       (1)  for benefits because doctors and other trained staff decided that  (2)  a disabled child in  (3)  care. However, we must review all disability cases. Therefore, we will review  (4)  child's case in 5 to 7 years. We will send  (5)  a letter before we start the review. Based on that review,  (6)  benefits will continue if  (7)  child is still disabled, but will end if  (8)  child is no longer disabled.
      
      
      The decisions we made on  (9)  claim are based on information  (10)  gave us. If this information changes, it could affect  (11)  benefits. For this reason, it is important that  (12)  changes right away. We have enclosed a pamphlet, "When You Get Social Security Disability
         Benefits... What You Need To Know." It will tell  (13)  what must be reported and how to report. Be sure to read the parts of the pamphlet
         about what to do if your child goes to work or if your child's health improves. Also,
         remember to tell us if  (14)  child is no longer in  (15)  care.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: You qualify
            Choice 2: Beneficiary Name qualifies
         Fill-in (2) - Systems Generated
            
            
Choice 1: you have
            Choice 2: he has
            Choice 3: she has
         Fill-in (3) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (4) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (5) - Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (6) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (7) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (8) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (9) - Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary Name possessive
         Fill-in (10) - Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (11) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (12) - Systems Generated
            
            
Choice 1: you report
            Choice 2: he reports
            Choice 3: she reports
         Fill-in (13) - Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (14) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (15) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
          
    
   
      CIC004 REEXAMINATION PARAGRAPH SSA-831-U5 CONTAINS A REEXAMINATION DATE (J61)
      
      
      (Requested)
      
      Caption: Things To Remember
      
       (1)  entitled to benefits because  (2)  a disabled child in  (3)  care. The doctors and other trained personnel who made the disability decision expect
          (4)  child's health to improve. Therefore we will review  (5)  child's case in  (6)  . We will send  (7)  a letter before we start the review. Based on that review,  (8)  benefits will continue if  (9)  child is still disabled. But they will end if  (10)  child is no longer disabled.
      
      
      It is important that  (11)  changes to us right away. We have enclosed a pamphlet, "When You Get Social Security
         Disability Benefits . . . What You Need To Know." It will tell  (12)  what must be reported and how to report. Be sure to read the parts of the pamphlet
         about what to do if  (13)  child goes to work or if  (14)  child's health improves. Also remember to tell us if  (15)  child is no longer in  (16)  care.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: You are
            Choice 2: Beneficiary name plus is
         Fill-in (2) - Systems Generated
            
            
Choice 1: you have
            Choice 2: he has
            Choice 3: she has
         Fill-in (3) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (4) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (5) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (6) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (7) - Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (8) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (9) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (10) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (11) - Systems Generated
            
            
Choice 1: you report
            Choice 2: he reports
            Choice 3: she reports
         Fill-in (12) - Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (13) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (14) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (15) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (16) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
          
    
   
      CIC006 NO CHILD-IN-CARE
      
      
      (Requested)
      
      Caption: None
      
      We changed  (1)  monthly benefit to  (2)  beginning  (3) . We changed  (4)  benefit because  (5)  no longer  (6)  a child who is entitled to benefits in  (7)  care.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Beneficiary's Name Possessive
            Choice 2: your
         Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount
         Fill-in (3) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (4) - Systems Generated
            
            
Choice 1: his
            Choice 2: her
            Choice 3: your
         Fill-in (5) - Systems Generated
            
            
Choice 1: he
            Choice 2: she
            Choice 3: you
         Fill-in (6) - Systems Generated
            
            
Choice 1: has
            Choice 2: have
         Fill-in (7) - Systems Generated
            
            
Choice 1: his
            Choice 2: her
            Choice 3: your
          
    
   
      CIC007 CHILD-IN-CARE
      
      
      (Requested)
      
      Caption: None
      
      We changed  (1)  monthly benefit to  (2)  beginning  (3) . We changed  (4)  benefit because  (5)  now  (6)  a child who is entitled to benefits in  (7)  care.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Beneficiary's Name Possessive
            Choice 2: your
         Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount
         Fill-in (3) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (4) - Systems Generated
            
            
Choice 1: his
            Choice 2: her
            Choice 3: your
         Fill-in (5) - Systems Generated
            
            
Choice 1: he
            Choice 2: she
            Choice 3: you
         Fill-in (6) - Systems Generated
            
            
Choice 1: has
            Choice 2: have
         Fill-in (7) - Systems Generated
            
            
Choice 1: his
            Choice 2: her
            Choice 3: your
          
    
   
      CIC008 CHILD-IN-CARE NO LONGER ENTITLED
      
      
      (Requested)
      
      Caption: None
      
      We changed  (1)  monthly benefit to  (2)  beginning  (3) . We changed  (4)  benefit because the child in  (5)  care is no longer entitled to benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Beneficiary's Name Possessive
            Choice 2: your
         Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount
         Fill-in (3) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (4) - Systems Generated
            
            
Choice 1: his
            Choice 2: her
            Choice 3: your
         Fill-in (5) - Systems Generated
            
            
Choice 1: his
            Choice 2: her
            Choice 3: your
          
    
   
      CIC010 DISABLED MINOR CHILD ONSET ESTABLISHED LATER THAN ALLEGED SPOUSE'S (MOTHER'S/FATHER'S)
         MONTH OF ENTITLEMENT AFFECTED (J63)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We found that your child became disabled  (1)  . This is different from the date given on the application. You are entitled to benefits
         because you have a disabled child in your care. Therefore, the date the child became
         disabled affects when your benefits start. You are entitled to benefits beginning
          (2)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: PIC C's DDO in the format Month DD, CCYY
         Fill-in (2) - Systems Generated
            
            
Choice 1: DOED (for the disabled child in the NOTICE-PIC's care) in the format Month
               CCYY
            
          
    
   
      CIC012 FPM CASE-MOTHER/FATHER ENTITLED-DAC IN CARE-3 YEAR REVIEW (J68)
      
      
      (System Generated)
      
      Caption: Things To Remember
      
      You are entitled to benefits because doctors and other trained staff decided that
         your child is disabled under our rules. But, this decision must be reviewed at least
         once every 3 years. We will send you or your child a letter before we start the review.
         Based on that review, your benefits will continue if your child is still disabled,
         but will end if your child is no longer disabled.
      
      
      
      Fill-in values:
         
      
    
    
   
   NONE
   
   
      CIC013 FPM CASE-MOTHER/FATHER ENTITLED-DAC IN CARE-5 OR 7 YEAR REVIEW (J69)
      
      
      (System Generated)
      
      Caption: Things To Remember
      
      You qualify for benefits because doctors and other trained staff found that you have
         a disabled child in your care. However, we must review all disability cases. Therefore,
         we will review your child's case in 5 to 7 years. We will send you a letter before
         we start the review. Based on that review, your benefits will continue if your child
         is still disabled, but will end if your child is no longer disabled.
      
      
      
      Fill-in values:
         
      
    
    
   
   NONE
   
   
      CIC014 FPM CASE-MOTHER/FATHER ENTITLED-DAC IN CARE-REVIEW BASED ON MRED (J70)
      
      
      (System Generated)
      
      Caption: Things To Remember
      
      You are entitled to benefits because you have a disabled child in your care. The doctors
         and other trained personnel who made the disability decision expect your child's health
         to improve. Therefore, we will review your child's case in  (1)  . We will send you a letter before we start the review. Based on that review, your
         benefits will continue if your child is still disabled. But they will end if your
         child is no longer disabled.
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: date of review
          
    
   
      CICR11 DISABLED MINOR CHILD GIVEN A CLOSED PERIOD OF DISABILITY SPOUSE'S (MOTHER'S/FATHER'S)
         MONTH OF ENTITLEMENT AFFECTED (J64)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      To be entitled to Social Security Benefits, you must have a child in your care who
         is also entitled to benefits. And, that child must be under age 16 or disabled.
      
      
      We have decided that your child became disabled according to our rules on  (1)  and was no longer disabled in  (2)  . Therefore, the first month for which we could pay you benefits is  (3)  . We could pay you for the month the disability ended and the following 2 months.
         This means that the last month for which you were entitled to benefits was  (4)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: DDO in the format Month DD, CCYY
         Fill-in (2) - Requested As A Date In Format Shown Below
            
            
Choice 1: EFD associated with T6 minus 3 months for BIC = C shown in Fill-in 1, in
               the format Month CCYY
            
         Fill-in (3) - Systems Generated
            
            
Choice 1: DOEC in the format Month CCYY
         Fill-in (4) - Requested As A Date In Format Shown Below
            
            
Choice 1: EFD Date associated with T6 minus 1 month for BIC = C shown in Fill-in 1,
               in the format Month CCYY
            
          
    
   
      CICR12 PERIODIC REVIEW PARAGRAPH SPOUSE'S (MOTHER'S/FATHER'S) AWARD NOTICES WHERE A REEXAM
         IS NOT INDICATED (J62)
      
      
      (Requested)
      
      Caption: Things To Remember
      
      You are entitled to benefits because doctors and other trained staff decided that
         you child is disabled under our rules. But, this decision must be reviewed at least
         once every 3 years. We will send you or your child a letter before we start the review.
         Based on that review, your benefits will continue if your child is still disabled,
         but will end if your child is no longer disabled.
      
      
      
      Fill-in values:
         
      
    
    
   
   NONE