TN 16 (12-20)
   
   
   
   
       GENERAL CLOSEOUT FOR AWARDS (G19)
      
      
      (System Generated)
      
      Caption: Other Social Security Benefits
      
       (1)   (2)  can receive from us at this time. In the future, if you think  (3)  might qualify for another benefit from us,  (4)  will need to apply again.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: This benefit is the only benefit
            Choice 2: These benefits are the only benefits
         Fill-in (2) - Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (3) - Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (4) - Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
          
    
   
       AD, B TO D, AND AB TO AD CONVERSION HIGHER BENEFITS POSSIBLE ON PRIOR SPOUSE'S RECORD
         (B35)
      
      
      (Requested)
      
      Caption: Other Social Security Benefits
      
      If  (1)  married more than once, please contact us.  (2)  may be able to get a higher benefit on the record of a prior spouse.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: you were
            Choice 2: he was
            Choice 3: she was
         Fill-in (2) - Systems Generated
            
            
Choice 1: You
            Choice 2: He
            Choice 3: She
          
    
   
       CLOSE OUT ANOTHER CLAIM PENDING (B56)
      
      
      (Requested)
      
      Caption: Other Social Security Benefits
      
      This  (1)  benefit is the only benefit we can pay  (2)  at this time. We will let you know if  (3)  eligible for  (4)  benefits.  (5)  cannot receive any other type of benefits based on the application  (6)  filed.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) retirement
            Choice 2: (B) wife's
            Choice 3: (C) husband's
            Choice 4: (D) widow's
            Choice 5: (E) widower's
            Choice 6: (F) mother's
            Choice 7: (G) father's
            Choice 8: (H) parent's
            Choice 9: (I) disabled widow's
            Choice 10: (J) disabled widower's
            Choice 11: (K) disabled divorced widow's
            Choice 12: (L) disabled divorced widower's
            Choice 13: (M) child's
            Choice 14: (N) lump sum death payment
         Fill-in (2) - Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (3) - Systems Generated
            
            
Choice 1: you are
            Choice 2: he is
            Choice 3: she is
         Fill-in (4) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) retirement
            Choice 2: (B) wife's
            Choice 3: (C) husband's
            Choice 4: (D) widow's
            Choice 5: (E) widower's
            Choice 6: (F)                     mother's
            Choice 7: (G) father's
            Choice 8: (H) parent's
            Choice 9: (I)disabled widow's
            Choice 10: (J) disabled widower's
            Choice 11: (K) disabled divorced widow's
            Choice 12: (L) disabled divorced widower's
            Choice 13: (M) child's
            Choice 14: (N) lump sum death payment
         Fill-in (5) - Systems Generated
            
            
Choice 1: You
            Choice 2: He
            Choice 3: She 
         Fill-in (6) - Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she 
          
    
   
       AWARD CLOSEOUT OTHER POTENTIAL CLAIM GIVEN 6-MONTH CLOSEOUT (B11)
      
      
      (Requested)
      
      Caption: Other Social Security Benefits
      
      The  (1)  benefit is the only kind of benefit  (2)   (3)  entitled to receive, with the possible exception of  (4)  benefits. You told us when you applied for  (5)  benefits  (6)   (7)  that you did not wish to apply for  (8)  benefits  (9)  at that time.
      
      
      If you change your mind, you need to apply for these benefits. The application date
         can make a difference in the amount we pay. If you apply within 6 months of the date
         of this letter, we may be able to use the date of your application for  (10)  benefits as the date of your application for  (11)  benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: retirement
            Choice 2: disability
         Fill-in (2) - Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary name
         Fill-in (3) - Systems Generated
            
            
Choice 1: are
            Choice 2: is
         Fill-in (4) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) retirement
            Choice 2: (B) disability
            Choice 3: (C) spouse’s
            Choice 4: (D) widow’s
            Choice 5: (E) widower’s
            Choice 6: (F) mother’s
            Choice 7: (G) father’s
            Choice 8: (H) child’s
            Choice 9: (I) parent’s
            Choice 10: (J) disabled widow’s
            Choice 11: (K) disabled widower’s
            Choice 12: (L) disabled divorced widow’s
            Choice 13: (M) disabled divorced widower’s
         Fill-in (5) - Systems Generated
            
            
Choice 1: retirement
            Choice 2: disability
         Fill-in (6) - Systems Generated
            
            
Choice 1: for
            Choice 2: null
         Fill-in (7) - Systems Generated
            
            
Choice 1: Beneficiary name
            Choice 2: null
         Fill-in (8) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) retirement
            Choice 2: (B) disability
            Choice 3: (C) spouse’s
            Choice 4: (D) widow’s
            Choice 5: (E) widower’s
            Choice 6: (F) mother’s
            Choice 7: (G) father’s
            Choice 8: (H) child’s
            Choice 9: (I) parent’s
            Choice 10: (J) disabled widow’s
            Choice 11: (K) disabled widower’s
            Choice 12: (L) disabled divorced widow’s
            Choice 13: (M) disabled divorced widower’s
         Fill-in (9) - Systems Generated
            
            
Choice 1: for him
            Choice 2: for her
            Choice 3: null
         Fill-in (10) - Systems Generated
            
            
Choice 1: retirement
            Choice 2: disability
         Fill-in (11) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) retirement
            Choice 2: (B) disability
            Choice 3: (C) spouse’s
            Choice 4: (D) widow’s
            Choice 5: (E) widower’s
            Choice 6: (F) mother’s
            Choice 7: (G) father’s
            Choice 8: (H) child’s
            Choice 9: (I) parent’s
            Choice 10: (J) disabled widow’s
            Choice 11: (K) disabled widower’s
            Choice 12: (L) disabled divorced widow’s
            Choice 13: (M) disabled divorced widower’s
          
    
   
       AWARD CLOSEOUT POTENTIAL AUXILIARY AND FAMILY CLAIM GIVEN 6-MONTH CLOSEOUT (B12)
      
      
      (Requested)
      
      Caption: Other Social Security Benefits
      
      The  (1)  benefit is the only kind of benefit  (2)   (3)  family are entitled to receive, with the possible exception of  (4)  benefits. You told us when you applied for  (5)  benefits  (6)   (7)  that  (8)  did not wish to apply for  (9)  benefits at that time.
      
      
      If  (10)  mind,  (11)  to apply for these benefits. The application date can make a difference in the amount
         we pay. If  (12)  within 6 months of the date of this letter, we may be able to use the date of the
         application for  (13)  benefits  (14)   (15)  as the date of application for  (16)  benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: retirement
            Choice 2: disability
         Fill-in (2) - Systems Generated
            
            
Choice 1: you and your family
            Choice 2: Number Holder's Fullname
         Fill-in (3) - Systems Generated
            
            
Choice 1: and his
            Choice 2: and her
            Choice 3: null
         Fill-in (4) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) wife's
            Choice 2: (B)                     husband's
            Choice 3: (C) child's
         Fill-in (5) - Systems Generated
            
            
Choice 1: retirement
            Choice 2: disability
         Fill-in (6) - Systems Generated
            
            
Choice 1: for
            Choice 2: null
         Fill-in (7) - Systems Generated
            
            
Choice 1: Number Holder's fullname
            Choice 2: null
         Fill-in (8) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) you
            Choice 2: (B) your wife
            Choice 3: (C) your husband
            Choice 4: (D) your child
         Fill-in (9) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) wife's
            Choice 2: (B)                     husband's
            Choice 3: (C) child's
         Fill-in (10) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) you change your
            Choice 2: (B) your wife changes her
            Choice 3: (C) your husband changes his
            Choice 4: (D) your child changes his
            Choice 5: (E) your child changes her
         Fill-in (11) - Systems Generated
            
            
Choice 1: you need
            Choice 2: he needs
            Choice 3: she needs
         Fill-in (12) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) you apply
            Choice 2: (B) your wife applies
            Choice 3: (C) your husband applies
         Fill-in (13) - Systems Generated
            
            
Choice 1: retirement
            Choice 2: disability
         Fill-in (14) - Systems Generated
            
            
Choice 1: for
            Choice 2: null
         Fill-in (15) - Systems Generated
            
            
Choice 1: Number Holder's Surname
         Fill-in (16) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) wife's
            Choice 2: (B)                     husband's
            Choice 3: (C) child's
          
    
   
       LUMP-SUM DEATH PAYMENT AWARD CLOSEOUT OTHER POTENTIAL CLAIM GIVEN 6-MONTH CLOSEOUT
         (B13)
      
      
      (Requested)
      
      Caption: Other Social Security Benefits
      
      The lump-sum death payment is the only kind of payment  (1)   (2)  entitled to receive, with the possible exception of  (3)  benefits. You told us when you applied for the lump-sum death payment  (4)   (5)  that you did not wish to apply for  (6)  benefits  (7)  at that time.
      
      
      If you change your mind, you need to apply for these benefits. The application date
         can make a difference in the amount we pay. If you apply within 6 months of the date
         of this letter, we may be able to use the date of the application for  (8)  benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: you
            Choice 2: Fullname
         Fill-in (2) - Systems Generated
            
            
Choice 1: are
            Choice 2: is
         Fill-in (3) - Systems Generated
            
            
Choice 1: retirement
            Choice 2: disability
         Fill-in (4) - Systems Generated
            
            
Choice 1: for
            Choice 2: null
         Fill-in (5) - Systems Generated
            
            
Choice 1: Surname
            Choice 2: null
         Fill-in (6) - Systems Generated
            
            
Choice 1: wife's
            Choice 2: husband's
            Choice 3: child's
         Fill-in (7) - Systems Generated
            
            
Choice 1: for him
            Choice 2: for her
            Choice 3: null
         Fill-in (8) - Systems Generated
            
            
Choice 1: wife's
            Choice 2:                     husband's
            Choice 3: child's
          
    
   
       AUXILIARY CLAIMANT NOT INSURED ON OWN RECORD (Q04)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      Benefits are not payable on your own record because you have not worked long enough
         under Social Security. To qualify, you need credit for  (1)  calendar quarters of work. You now have  (2)  . If you earn the additional quarters, please contact any Social Security office.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A Number
            
            
Choice 1: required QCs
         Fill-in (2) - Requested As A Number
            
            
Choice 1: acquired QCs