Basic (05-11)
   
   
   
   
      PEN001 PENALTY DEDUCTED FROM BENEFITS DOMESTIC CASES (W23)
      
      
      (Requested)
      
      Caption: A Penalty Will Be Deducted From Payments
      
      We are writing to you about a  (1)  penalty that will be held back from  (2)  benefits. We told you earlier that this penalty would be held back because you did
         not report  (3)   (4)  earnings to us before April 15,  (5)  and did not give us a good reason for being late.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Systems Generated
            
            
Amount
         Fill-in (2) - Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary's Name
         Fill-in (3) - Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
            Choice 4: Beneficiary's Name possessive
         Fill-in (4) - Systems Generated
            
            
CCYY
         Fill-in (5) - Systems Generated
            
            
CCYY
          
    
   
      PEN016 HEALTH PLAN PREMIUM AMOUNT INCLUDES A PENALTY (H28)
      
      
      (System Generated)
      
      Caption: Information About Health Plan Premiums
      
      This amount includes a penalty for  (1)  Medicare Prescription Drug Plan Premium.
      
      
      
      Fill-in values:
         
         
            
            Choice 1: your
            Choice 2: his
            Choice 3: her
          
       
    
   
      PEN024 PENALTY DEDUCTED FROM BENEFITS FOREIGN CASES (W24)
      
      
      (Requested)
      
      Caption: A Penalty Will Be Deducted From Payments
      
      We are withholding  (1)  from  (2)  monthly benefits. This is a penalty because  (3)  did not give us  (4)  report of work on time.
      
      
      
      Fill-in values:
         
         Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of penalty
         Fill-in (2) Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary's name possessive
         Fill-in (3) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (4) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
          
    
   
      PEN025 PENALTY PROPOSED/GOOD REASON REQUESTED DOMESTIC CASES (W25)
      
      
      (Requested)
      
      Caption: A Penalty Will Be Deducted From Payments
      
       (1)  to let us know how much money  (2)  each year. To do this,  (3)  must give us a report of each year's earnings within 3 ½ months after the end of
         the taxable year. Since  (4)  did not do this for  (5) , we will withhold  (6)  more from  (7)  benefits as a penalty. We will do this unless  (8)  can show that  (9)  had a good reason for not giving us the report on time.
      
      
      If  (10)   (11)  had a good reason for not reporting your earnings before  (12) , please let us know within 30 days of the date of this letter. If  (13)  had a good reason for not reporting, we will not withhold the additional money. Otherwise,
         we will send  (14)  another letter to tell  (15)  when we will start withholding the money.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You need
            Choice 2: Beneficiary's name needs
         Fill-in (2) Systems Generated
            
            
Choice 1: you earn
            Choice 2: he earns
            Choice 3: she earns
         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
         Fill-in (5) Requested as a date shown below
            
            
Year CCYY
         Fill-in (6) Requested as Money amount in format $$$$$.¢¢
            
            
Amount
         Fill-in (7) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (8) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (9) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (10) Systems Generated
            
            
Choice 1: you think
            Choice 2: Beneficiary's name thinks
         Fill-in (11) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (13) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (14) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (15) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
          
    
   
      PEN026 PENALTY PROPOSED/GOOD REASON REQUESTED FOREIGN CASES (W26)
      
      
      (Requested)
      
      Caption: A Penalty Will Be Deducted From Payments
      
       (1)  to let us know when  (2)  more than 45 hours in a month.  (3)  must let us know about this work before  (4)   (5)  third Social Security check after returning to work. Since  (6)  did not do this, we will withhold  (7)  more from  (8)  benefits as a penalty. We will do this unless  (9)  can show that  (10)  had a good reason for not giving us the report on time.
      
      
      If  (11)   (12)  had a good reason for not reporting  (13)  work on time, please let us know within 30 days of the date of this letter. If  (14)  had a good reason for not reporting, we will not withhold the additional money. Otherwise,
         we will send  (15)  another letter to tell  (16)  when we will start withholding the money.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You need
            Choice 2: Beneficiary's name needs
         Fill-in (2) Systems Generated
            
            
Choice 1: you work
            Choice 2: he works
            Choice 3: she works
         Fill-in (3) Systems Generated
            
            
Choice 1: You
            Choice 2: He
            Choice 3: She
         Fill-in (4) Systems Generated
            
            
Choice 1: you receive
            Choice 2: he receives
            Choice 3: she 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: he
            Choice 3: she
         Fill-in (7) Requested as Money amount in format $$$$$.¢¢
            
            
Amount of penalty
         Fill-in (8) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (9) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (10) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (11) Systems Generated
            
            
Choice 1: you think
            Choice 2: Beneficiary's name thinks
         Fill-in (12) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (13) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (14) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (15) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (16) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
          
    
   
      PEN027 PENALTY TO BE DEDUCTED FROM FUTURE BENEFITS DOMESTIC CASES (W27)
      
      
      (Requested)
      
      Caption: A Penalty Will Be Deducted From Payments
      
      When we start to pay  (1)  again, we will withhold  (2)  more from  (3)  benefits as a penalty because  (4)  did not let us know how much  (5)  earned in  (6)  within 3 ½ months after the end of the taxable year.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's name
         Fill-in (2) Requested as Money amount in format $$$$$.¢¢
            
            
Amount of penalty
         Fill-in (3) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (5) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (6) Request As A Date in Format Shown Below
            
            
CCYY format
          
    
   
      PEN028 PENALTY TO BE DEDUCTED FROM FUTURE BENEFITS FOREIGN CASES (W28)
      
      
      (Requested)
      
      Caption: A Penalty Will Be Deducted From Payments
      
      When we start to pay  (1)  again, we will withhold  (2)  more from  (3)  benefits as a penalty. This is because  (4)  did not let us know that  (5)  started working before  (6)  received  (7)  third Social Security check after beginning to work.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's name
         Fill-in (2) Requested as Money amount in format $$$$$.¢¢
            
            
Amount of penalty
         Fill-in (3) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         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
         Fill-in (7) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
          
    
   
      PEN029 REASON FOR NOT REPORTING ACCEPTED DOMESTIC CASES (SEE W34 FOR FOREIGN) (W30)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We will not withhold a penalty from  (1)  benefits because  (2)  had a good reason for not telling us on time how much  (3)  earned in  (4) .
      
      
      
      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
            Choice 2: he
            Choice 3: she
         Fill-in (3) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (4) Requested As A Date in Format Shown Below
            
            
CCYY
          
    
   
      PEN030 REASON FOR NOT REPORTING ACCEPTED FOREIGN CASES (SEE W30 FOR DOMESTIC CASES) (W34)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We will not withhold a penalty from  (1)  benefits because  (2)  had a good reason for not telling us on time that  (3)  began working.
      
      
      
      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
            Choice 2: he
            Choice 3: she
         Fill-in (3) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she