Effective Dates: 05/20/2011 - Present Previous | Next

Basic (05-11)

NL 00720.140 DTH Death

DTH009 LUMP-SUM DEATH PAYMENT INCLUDED WITH BENEFITS (B01)

(Requested)

Caption: What We Will Pay

 (1)  first check includes a lump-sum payment of  (2)  . This is a one-time payment we make because of a worker's death.

Fill-in values:
Fill-in (1) Systems Generated
Choice 1: Your
Choice 2: Beneficiary's Name possessive
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of LSDP

DTH010 LUMP SUM ONLY SURVIVOR BENEFITS SUSPENDED OR TERMINATED (B04)

(Requested)

Caption: What We Will Pay

 (1)  will soon receive a check for  (2)  . This is a one-time payment we make because of a worker's death. It is the only money  (3)  due now.

Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2) - Systems Generated
Choice 1: Amount of LSDP
Fill-in (3) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is

DTH011 COMBINED CHECK FOR MONTH OF DEATH WITHHELD FROM WIDOW(ER) RECEIVING FIRST BENEFIT PLUS LUMP-SUM (B05)

(Requested)

Caption: What We Will Pay

This check includes  (1)  , the money  (2)  due for  (3)  . It also includes a lump-sum payment of  (4)  . This is a one-time payment we make because of a worker's death.

We subtracted  (5)  from these benefits. We did this to recover money from the combined check which we sent for the month  (6)  died.

Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of past due benefits
Fill-in (2) - Systems Generated
Choice 1: you are
Choice 2: Beneficiary's Name +is
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (4) - Systems Generated
Choice 1: Amount of lump-sum
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of reduction
Fill-in (6) - Systems Generated
Choice 1: Full name of NH

DTH012 CATEGORY M PAYMENT REASON AND AMOUNT - INTRODUCTORY PARAGRAPH (G58)

(System Generated)

Caption:

We are sorry to learn of  (1)  loss. Please accept our sincere sympathy.

 (2)  entitled to a Social Security payment because of the death of  (3)  .  (4)  will receive this payment soon.

The amount of the check is  (5)  .

Fill-in values:
Fill-in (1)
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2)
Choice 1: You are
Choice 2: He is
Choice 3: She is
Fill-in (3)
Choice 1: Name of deceased person
Fill-in (4)
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (5)
Choice 1: Amount of past due benefits
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720140
NL 00720.140 - DTH Death - 05/20/2011
Batch run: 03/29/2017
Rev:05/20/2011