CDB003 – USED ON CHILDHOOD DISABILITY BENEFIT (CDB) AWARDS TO EXPLAIN TRIAL WORK PERIOD

If (1) (2) while (3) (4) still disabled, (5) may qualify for a trial work period to test (6) ability to work. During this period, (7) may work 9 months, sometimes more, and not lose Social Security disability payments because of the work, no matter how much (8).

To end the trial work period, the 9 months of work must take place in a 60-month period. The months do not have to be in a row. After the trial work period has ended, we will look at the work (9) did and decide if (10) (11) still disabled. The pamphlet described below has more information about the trial work period and other rules that may help (12) return to work.

CDR001 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD - MEDICAL EXAM IN 3 YEARS

Doctors and other trained staff decided that (1) (2) disabled under our rules.

But, this decision must be reviewed at least once every 3 years. We will send you a letter before we start the review. Based on that review, (3) benefits will continue if (4) still disabled, but will end if (5) no longer disabled.

CDR002 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD - MEDICAL EXAM IN 5–7 YEARS

Doctors and other trained staff decided that (1) (2) disabled under our rules.

However, we must review all disability cases. Therefore, we will review (3) case in 5 to 7 years. We will send you a letter before we start the review.

Based on that review, (4) benefits will continue if (5) still disabled, but will end if (6) no longer disabled.

CDR004 – CHILDHOOD DISABILITY BENEFIT (CDB) AWARD – DISABILITY NOT PERMANENT

The doctors and other trained personnel who decided that (1) (2) disabled expect (3) health to improve. Therefore, we will review (4) case in the future.

We will send you a letter before we start the review. Based on that review, (5) benefits will continue if (6) (7) still disabled, but will end if (8) (9) no longer disabled.

CDR063 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) SUSPENDED - FAILURE TO COOPERATE

We cannot pay (1) benefits because our records show that (2) did not return information we asked for concerning (3) disability.

CDR065 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) SUSPENDED - FAILURE TO COOPERATE

If we stop (1) Social Security disability benefits and you do not give us the information we asked for before (2), (3) will have to file a new application to get Social Security disability benefits again. If we do not hear from you by this date, we will send you another letter which will give you the information about (4) appeal rights.

CDR066 – NUMBER HOLDER (NH) OR CHILDHOOD DISABILITY BENEFITS (CDB) OR DISABLED WIDOW(ER) BENEFITS (DWB) TERMINATED FOR FAILURE TO COOPERATE

(1) no longer (2) for Social Security disability benefits beginning (3) because our records show that (4) did not return information we asked for during (5) continuing disability review.

CDR067 – BENEFITS ARE TERMINATED DUE TO THE NUMBER HOLDER'S FAILURE TO COOPERATE OR DISABILITY CESSATION

We can no longer pay (1) benefits because (2) no longer qualifies for Social Security disability benefits beginning (3).

CDR083 – REQUEST FOR MEDICARE ONLY STATUTORY BENEFIT CONTINUATION FOR A BENEFICIARY WITH A FUTURE DATED DISABILITY CESSATION DATE (DBC)

In an earlier letter, we told (1) that (2) disability benefits would end. (3) no longer entitled to benefits as of (4). However, during the appeals process (5) requested to have Medicare coverage continued.

CDR084 – FAVORABLE REVERSAL OF THE MEDICAL CESSATION DECISION FOR A BENEFICIAIRY WITHOUT STATUTORY BENEFIT PAYMENT CONTINUATION

In an earlier letter, we told (1) that (2) disability benefits would end. Now, we decided that (3) still disabled and our previous notice should be disregarded.

CDR701 – PAYMENTS WILL CONTINUE AT THE SAME RATE AFTER A FAVORABLE REVERSAL OF THE MEDICAL CESSATION DECISION

We previously advised (1) that (2) disability benefits would terminate because (3) no longer entitled to benefits. However, during the appeals process (4) monthly benefit check(s) continued. It has been determined that (5) still disabled and our previous notice should be disregarded.

CFDC02 – CAPTION

If You Saved Any Money

CFD003 – CONSERVED FUNDS REQUESTED FROM FORMER PAYEE

While you were (1) payee, you may have saved some money for (2). If you have, you should return it to us unless you have already made other plans with us for handling it. The money you will need to return includes:

• •

  Saved and invested benefits.

• •

  Interest earned from these savings and investments.

• •

  Money you have left over from any checks we sent you.

• •

  Any checks you might receive after the date of this letter.

CFD004 – TELLS FORMER PAYEE HOW TO RETURN CONSERVED FUNDS

To do this, you can write us a check or money order. Make it out to the Social Security Administration. Be sure to write “Conserved Funds for (1)", and include (2) Social Security claim number on that check or money order. Please mail it in the enclosed envelope.

CHKC05 – CAPTION

When We Begin Your Payments Again

CHKC09 – CAPTION

Your Benefits

CHKC10 – CAPTION

Information About Your Checks

CIC006 – AGED SPOUSE MONTHLY BENEFIT AMOUNT IS CHANGING BECAUSE A CHILD HAS LEFT THE SPOUSE’S CARE

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.

CIC007 – AGED SPOUSE BENEFIT AMOUNT CHANGED DUE TO HAVING A CHILD IN CARE

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.

CIC008 – AGED SPOUSE BENEFIT AMOUNT CHANGE DUE TO NOT HAVING A CHILD IN CARE BECAUSE THE CHILD IS NO LONGER ENTITLED

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.

CIC012 – TELLS PARENT THAT CHILDHOOD DISABILITY BENEFITS (CDB) REVIEW IS EVERY 3 YEARS

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.

CIC013 – TELLS PARENT THAT CHILDHOOD DISABILITY BENEFITS (CDB) REVIEW IS EVERY 5 TO 7 YEARS

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.

CIC014 – CHILDHOOD DISABILITY BENEFITS (CDB) DISABILITY NOT PERMANENT

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.

CLOC01 – CAPTION

Other Social Security Benefits

CLO002 – EXPLAINS THE LIMITATION OF 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.

CLO029 – BENEFICIARY IDENTIFICATION CODE (BIC) B ENTITLEMENT CONVERSION TO BIC D OR E

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.

COA004 – TAX TREATY WITH SWITZERLAND

We will deduct a 15 percent Federal income tax from (1) monthly benefits. This is because of a treaty with Switzerland which says we will tax Social Security benefits paid to residents of Switzerland at this rate.

Please let us know if (2) (3) address again.

COA005 – TAX TREATY - CHANGE TAX STATUS

We are no longer deducting Federal income tax from (1) benefits. We do not deduct this, if (2) a U.S. citizen, or if (3) in the United States, Canada, Egypt, Germany, Ireland, Israel, Italy, Japan, Romania or the United Kingdom.

Also, if an individual is a citizen and resident of India, all or part of that person's benefits can be exempt from this Federal income tax if those benefits are based on Federal, State, or local government employment.

Please let us know if (4) (5) address again.

COA011 – CHANGE OF ADDRESS (COA) - DOMESTIC TO FOREIGN ADDRESS

We have changed (1) address as you asked. However, we will continue to send (2) payments to (3) financial institution. Please check the mailing address we used for (4). If it is not complete or if you move again, please let us know.

COP001 – TELLS THE BENEFICIARY A COPY OF THE NOTICE IS BEING SENT TO HIS OR HER REPRESENTATIVE

We are sending a copy of this notice to (1) (2) (3) (4) (5).

COP002 – TELLS THE AUTHORIZED REPRESENTATIVE THAT A COPY OF THE NOTICE WE SENT TO THE BENEFICIARY THEY REPRESENT IS ENCLOSED

Enclosed is a copy of a letter we sent to (1).

CPS001 – CRITICAL PAYMENT SYSTEM (CPS) PAID AND DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

Based on the information we have, (1) (2) previously paid benefits on this record. The amount deducted for these benefits paid will be shown under the heading What We Will Pay and When.

CPS002 – CRITICAL PAYMENT SYSTEM (CPS) PAID AND DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

• •

  We deducted (1) for money (2) (3) already paid from the check (4) will receive on or about (5).