Effective Dates: 02/16/1995 - Present Previous | Next

TN 4 (02-95)

NL 00803.050 Chart for Completing the SSA-L8151-U2, SSA-L8155-U2 and SSA-L8166-U2 Before a COLA

A. Procedure

Use the following chart to find the captions and paragraphs appropriate for the recipient's situation when a COLA is scheduled to take effect. Instructions in NL 00802.001B apply for using this chart. Instructions in NL 00803.020 apply to COLA notices. We labeled the captions with capital letters in alphabetic order as a place-keeping device.

B. Information about your payments

(Mandatory caption)

NL Reference Paragraph Use
NL 00804.220 2801 Tells new amount due and effective date. (Mandatory for all notices when recipient is due payment.)
2803 N01 - Recipient is ineligible due to excess income. (Use on SSA-L8155-U2 only.)
2804 Recipient receives title II - SSI payment will decrease or stop. (Mandatory on all SSA-L8155-U2's.)
2805 SSI payment will increase or be reinstated. (Mandatory on all SSA-L8151-U2's.)
COLM05 Appeal pending - Record is in protected payment status. COLA results in increase or decrease in the protected payment level.
 
The following overpayment paragraphs are only used in COLA notices. Consider these paragraphs when an overpayment collection is in process: 2816, 2817, 2818, 2819 and 2820.
NL 00804.210 ​ Consider the following standard overpayment paragraphs when you plan to initiate overpayment collection or overpayment collection is in process: 1015, 1018, 1016, 2042, 1017, and 2456.

C. Your payment is based on these facts

(Use when the recipient has income or deemed income).

NL Reference Paragraph Use
NL 00804.220 2836 Lead-in paragraph for any income on the record.
2807 Use this income lead-in only on the SSA-L8151-U2 when there is an increase or reinstatement of SSI and other income on the record changes.
2814 Use when title II income will increase.
2815 Use when title II income of spouse will increase.
NL 00804.175 1232 Describes type, period and amount of countable income. (Follows paragraph 2836 and 2807 above.)
1260 Tells value of ISM.
1258 Tells value of VTR.
1248 Spouse or parent(s) has income deemed to recipient.
1234 Sponsor has income deemed to recipient.

D. Information about medicaid

(Use only if one of the paragraphs below applies.)

NL Reference Paragraph Use
NL 00804.110 1150 Mandatory for SSA-L8151-U2 if recipient is being reinstated and lives in a State where SSA makes Medicaid eligibility determinations or has moved to a State where SSA makes Medicaid eligibility determinations.
1152 or 1170
(for Texas) 		Mandatory on SSA-L8155-U2's if recipient lives in a State where SSA makes Medicaid determinations and recipient will be N01.

E. Things to remember

(Use only if one of the paragraphs below applies.)

NL Reference Paragraph Use
NL 00804.220 2834 Recipient is subject to VTR.
2811 Recipient has excess income (N01).
2831 Close-out paragraph. Retention of SSI eligibility in nonpayment cases.
NL 00804.185 2489 Representative payee will receive a copy of notice.
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900803050
NL 00803.050 - Chart for Completing the SSA-L8151-U2, SSA-L8155-U2 and SSA-L8166-U2 Before a COLA - 02/16/1995
Batch run: 09/19/2012
Rev:02/16/1995