TN 38 (09-24)
   
   
   
   
      ENT001 STUDENT ENFORCEMENT (B22)
      
      
      (System Generated)
      
      Caption: Your Responsibility
      
      We are writing to let you know that  (1)   (2)  for child's payments as a student. Based on the information we have,  (3)  benefits will continue through  (4)  . We will send another letter when we stop  (5)  benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's Name possessive
         Fill-in (2) - Systems Generated
            
            
Choice 1: qualify
            Choice 2: qualifies
         Fill-in (3) - Systems Generated
            
            
Choice 1: your
            Choice 2: her
            Choice 3: his
         Fill-in (4) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (5) - Systems Generated
            
            
Choice 1: your
            Choice 2: her
            Choice 3: his
          
    
   
      ENT015 RIB ALLOWANCE SUBSEQUENT DIB DENIAL (J17)
      
      
      (Requested)
      
      Caption: Other Social Security Benefits
      
      Although  (1)  cannot receive disability benefits,  (2)  still entitled to retirement benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Beneficiary's Last Name
            Choice 2: you
         Fill-in (2) - Systems Generated
            
            
Choice 1: she is
            Choice 2: he is
            Choice 3: you are
          
    
   
      ENT027 DUAL ENTITLEMENT AWARD — PRIMARY AND AUXILIARY/SURVIVOR BENEFITS AWARDED SIMULTANEOUSLY
         — ONE NOTICE SENT (A38)
      
      
      (Requested)
      
      Caption: None
      
       (1)  entitled to monthly  (2)  benefits beginning  (3)  .  (4)  also entitled to  (5)  benefits on the record of  (6)  beginning  (7)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: You are
            Choice 2: He is
            Choice 3: She is
         Fill-in (2) - Systems Generated
            
            
Choice 1: disability
            Choice 2: retirement
         Fill-in (3) - Systems Generated
            
            
Choice 1: MM/CCYY
         Fill-in (4) - Systems Generated
            
            
Choice 1: You are
            Choice 2: He is
            Choice 3: She is
         Fill-in (5) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) wife's
            Choice 2: (B) husband's
            Choice 3: (C) widow's
            Choice 4: (D) widower's
            Choice 5: (E) mother's
            Choice 6: (F) father's
            Choice 7: (G) disabled widow's
            Choice 8: (H) disabled widower's
            Choice 9: (I) disabled divorced widow's
            Choice 10: (J) disabled divorced widower's
            Choice 11: (K) Child's
         Fill-in (6) - Requested
            
            
Choice 1: Number holder's name on the other record
         Fill-in (7) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
          
    
   
      ENT028 DUAL ENTITLEMENT - PRIMARY AWARD - SIMULTANEOUS ENTITLEMENT TO AUXILIARY/SURVIVOR
         BENEFITS - SEPARATE PAYMENTS (A40)
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  also entitled to  (2)  benefits on the record of  (3)  beginning  (4)  . We are sending  (5)  another letter about these benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: You are
            Choice 2: He is
            Choice 3: She is
         Fill-in (2) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) wife's
            Choice 2: (B) husband's
            Choice 3: (C) widow's
            Choice 4: (D) widower's
            Choice 5: (E) mother's
            Choice 6: (F) father's
            Choice 7: (G) disabled widow's
            Choice 8: (H) disabled widower's
            Choice 9: (I) disabled divorce widow's
            Choice 10: (J) disabled divorced widower's
            Choice 11: (K) Child's
         Fill-in (3) - Requested
            
            
Choice 1: Number holder on the other record
         Fill-in (4) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (5) - Systems Generated
            
            
Choice 1: you
            Choice 2: her
            Choice 3: him
          
    
   
      ENT029 DUAL ENTITLEMENT AUXILIARY/SURVIVOR AWARD - SIMULTANEOUS ENTITLEMENT ON PRIMARY RECORD
         - SEPARATE PAYMENTS (A41)
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  also entitled to benefits on  (2)  own earnings record beginning  (3)  . We are sending  (4)  another letter about these benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: You are
            Choice 2: He is
            Choice 3: She is
         Fill-in (2) - Systems Generated
            
            
Choice 1: your
            Choice 2: her
            Choice 3: his
         Fill-in (3) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (4) - Systems Generated
            
            
Choice 1: you
            Choice 2: her
            Choice 3: him
          
    
   
      ENT038 BENEFITS REDUCED TO ZERO UNDER DIB FAMILY MAXIMUM PROVISIONS (J74)
      
      
      (Requested/Generated)
      
      Caption: Your Benefits
      
      We have approved  (1)  application for  (2)  benefits.  (3)  entitlement date is  (4)  . However, we cannot pay  (5)  any benefits because all of the money we can pay on this record is already being
         paid to  (6)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Your
            Choice 2: Full name possessive
         Fill-in (2) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) spouse's
            Choice 2: (B) child's
            Choice 3: (C) parent's
         Fill-in (3) - Systems Generated
            
            
Choice 1: His
            Choice 2: Her
            Choice 3: Your
         Fill-in (4) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY (DOEC)
         Fill-in (5) - Systems Generated
            
            
Choice 1: you
            Choice 2: her
            Choice 3: him
         Fill-in (6) - Requested As A Language
            
            
Choice 1: Number holders full name
          
    
   
      ENT048 ACCRUED BENEFITS TEMPORARILY WITHHELD PENDING FINAL RECOMMENDATION (B23)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We are withholding payment for  (1)  until we decide the best way
      
      
      to make payments.
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/YYYY
            Choice 2: MM/YYYY and MM/YYYY
            Choice 3: MM/YYYY through MM/YYYY
          
    
   
      ENT051 HI DATE OF ENTITLEMENT (H10)
      
      
      (Requested/Generated)
      
      Caption: Information About Medicare
      
      You are entitled to hospital insurance under Medicare beginning  (1)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
          
    
   
      ENT052 SMI DATE OF ENTITLEMENT (H12)
      
      
      (Requested/Generated))
      
      Caption: Information About Medicare
      
      You are entitled to medical insurance under Medicare beginning  (1)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
          
    
   
      ENT056 NO PAYMENT AWARD ENTITLED TO AN EQUAL OR LARGER BENEFIT ON ANOTHER RECORD (B41)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We approved  (1)  claim for  (2)  benefits. However, we cannot pay  (3)  on  (4)  record because  (5)  entitled to an equal or larger benefit on another Social Security record.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: his
            Choice 2: her
            Choice 3: your
         Fill-in (2) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) wife's
            Choice 2: (B) husband's
            Choice 3: (C) widow's
            Choice 4: (D) widower's
            Choice 5: (E) mother's
            Choice 6: (F) father's
            Choice 7: (G) disabled widow's
            Choice 8: (H) disabled widower's
            Choice 9: (I) disabled divorced widow's
            Choice 10: (J) disabled divorced widower's
            Choice 11: (K) child's
         Fill-in (3) - Systems Generated
            
            
Choice 1: him
            Choice 2: you
            Choice 3: her
         Fill-in (4) - Requested As A Language
            
            
Choice 1: Number holder's name possessive
         Fill-in (5) - Systems Generated
            
            
Choice 1: you are
            Choice 2: he is
            Choice 3: she is
          
    
   
      ENT062 MONTH OF ENTITLEMENT CONFIRMED (A52)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We reviewed  (1)  record. When  (2)  applied,  (3)  asked us to start  (4)  benefits in  (5)  . We found that  (6)  is still the month when benefits should start.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Beneficiary Name possessive
            Choice 2: your
         Fill-in (2) - Systems Generated
            
            
Choice 1: he
            Choice 2: she
            Choice 3: you
         Fill-in (3) - Systems Generated
            
            
Choice 1: he
            Choice 2: she
            Choice 3: you
         Fill-in (4) - Systems Generated
            
            
Choice 1: his
            Choice 2: her
            Choice 3: your
         Fill-in (5) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (6) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
          
    
   
      ENT063 BENEFICIARY ENTITLED ON TWO ACCOUNTS A BENEFITS (PREVIOUSLY AWARDED) TO BE COMBINED
         WITH WIDOW(ER)'S BENEFITS AND PAYMENT OF LUMP-SUM (B07)
      
      
      (Requested)
      
      Caption: What We Will Pay
      
      The check, which includes the money  (1)  due through  (2)  , will also include a lump-sum payment of  (3)  . This is a one-time payment we make because of a worker's death.
      
      
      After that, we will send  (4)  benefits in one check each month. The check will include  (5)  which  (6)  due on  (7)  own Social Security record and  (8)  which  (9)  due on the other record.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: you are
            Choice 2: Beneficiary Name is
         Fill-in (2) - Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
         Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount of lump-sum
         Fill-in (4) - Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount MBP
         Fill-in (6) - Systems Generated
            
            
Choice 1: you are
            Choice 2: he is
            Choice 3: she is
         Fill-in (7) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (8) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount MBP
         Fill-in (9) - Systems Generated
            
            
Choice 1: you are
            Choice 2: he is
            Choice 3: she is
          
    
   
      ENT064 UNDERPAYMENT PAID TO OTHER BENEFICIARY (B08)
      
      
      (Requested)
      
      Caption: What We Will Pay
      
      Your  (1)  check includes  (2)  which we owed  (3)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) next
            Choice 2: (B) first
         Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount of underpayment
         Fill-in (3) - Requested As A One Position Alpha Character or language
            
            
Choice 1: (A) your wife
            Choice 2: (B) your husband
            Choice 3: (C) your father
            Choice 4: (D) your mother
            Choice 5: name of beneficiary
          
    
   
      ENT065 SIMULTANEOUS A AND AB AWARDS (B17)
      
      
      (Requested)
      
      Caption: Other Social Security Benefits
      
      We are still working on  (1)   (2)  claim for spouse's benefits. When we decide whether or not  (3)  is entitled to benefits, we will send  (4)  a letter.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary name possessive
         Fill-in (2) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) wife's
            Choice 2: (B) husband's
         Fill-in (3) - Systems Generated
            
            
Choice 1: he
            Choice 2: she
         Fill-in (4) - Systems Generated
            
            
Choice 1: him
            Choice 2: her
          
    
   
      ENT066 AUXILIARY CLAIM PENDING (C07)
      
      
      (Requested)
      
      Caption: Things To Remember
      
      We are still working on  (1)  claim. When we decide whether or not  (2)  entitled to benefits, we will send another letter to give our decision.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Beneficiary's Name possessive
            Choice 2: your
         Fill-in (2) - Systems Generated
            
            
Choice 1: he is
            Choice 2: she is
            Choice 3: you are
          
    
   
      ENT067 UNDERPAYMENT DUE TO DEATH OF BENEFICIARY SHARED WITH INDIVIDUAL(S) OF EQUAL ENTITLEMENT
         (C09)
      
      
      (Requested)
      
      Caption: What We Will Pay
      
      This check includes  (1)  , which is part of the money which was due  (2)  . Each person who is eligible for part of this money will get an equal share. The
         amount shown above is  (3)  share.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount
         Fill-in (2) - Requested As A Language
            
            
Choice 1: Name of deceased individual
         Fill-in (3) - Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary name possessive
          
    
   
      ENT068 RIGHTS AND RESPONSIBILITIES DOMESTIC CONVERSION FROM DIB (G14)
      
      
      (System Generated)
      
      Caption: Your Responsibilities
      
      It is important that you report changes that could affect  (1)  benefits to us right away. To explain these changes, we have enclosed a pamphlet,
         When You Get Social Security Retirement or Survivor Benefits. What You Need To Know.
         It will tell you what must be reported and how to report. Please be sure to read the
         part of the pamphlet which explains how earnings from work could change  (2)  payments.
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: your
            Choice 2: Beneficiary name possessive
         Fill-in (2)
            
            
Choice 1: your
            Choice 2: Beneficiary name possessive
          
    
   
      ENT069 RIGHTS AND RESPONSIBILITIES FOREIGN CONVERSION FROM DIB (G15)
      
      
      (System Generated)
      
      Caption: Your Responsibilities
      
      It is important that you report changes that could affect  (1)  benefits to us right away. To explain these changes, we have enclosed a pamphlet,
         Your Social Security Checks While You Are Outside the United States. It will tell
         you what must be reported and how to report. The pamphlet explains that we may not
         pay  (2)  if  (3)  more than 45 hours in a month.
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: your
            Choice 2: Beneficiary name possessive
         Fill-in (2)
            
            
Choice 1: you
            Choice 2: Beneficiary's name
         Fill-in (3)
            
            
Choice 1: you work
            Choice 2: he works
            Choice 3: she works
          
    
   
      ENT070 DATE OF BIRTH ESTABLISHED DIFFERENT FROM THAT ALLEGED OR DATE ESTABLISHED BEFORE ATTAINMENT
         OF RETIREMENT AGE (C08)
      
      
      (Requested/Generated)
      
      Caption: The Basis For Our Decision
      
      Based on the information given to us,  (1)  born on  (2)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Beneficiary's name + was
            Choice 2: you were
         Fill-in (2) - Requested As A Date In Format Shown Below
            
            
MM/DD/CCYY
          
    
   
      ENT075 NEW BENEFICIARY ENTITLED TO BENEFITS (J79)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      Since  (1)  now entitled to benefits, we changed the amount we can pay  (2)  beginning  (3)  . We will continue to pay this new monthly amount as long as  (4)   (5)  payments.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) name of terminated beneficiary is
            Choice 2: (B) names of terminated beneficiaries are
            Choice 3: (C) you are
         Fill-in (2) - Systems Generated
            
            
Name (or names) of previously entitled beneficiary (or
               beneficiaries)
            
         Fill-in (3) - Requested As A Date In Format Shown Below
            
            
MM/CCYY (date of adjustment)
         Fill-in (4) - Systems Generated
            
            
Choice 1: Beneficiary's Name + receives
            Choice 2: you receive
         Fill-in (5) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) workers' compensation
            Choice 2: (B) public disability
            Choice 3: (C) workers' compensation and public disability
          
    
   
      ENT082 SMI-PBID DATE OF ENTITLEMENT
      
      
      (Systems Generated)
      
      Caption: Information about Medicare
      
       (1)  Medicare Part B Immunosuppressive Drug coverage starts  (2)  .
      
      
      
      Fill-in Values:
         
         Fill-in (1) - Systems Generated
            
            
Choice 1: Beneficiary's Name (possessive)
            Choice 2: Your
         Fill-in (2) - Systems Generated
            
            
Choice 1: MM/CCYY