TN 1 (06-86)

GN 01050.021 Black lung beneficiary identification codes

Form SSA-101-U3 (Determination of Award) will be used to authorize payment of all black lung allowances and will be prepared manually in the Office of Disability Operations. The chief differences between the SSA-101-U3 when used to authorize black lung benefit payments and the SSA-101-U3 when used to authorize disability benefit payments are: (1) the benefit computation data in item 4 of the form will be omitted; (2) the benefit symbol(s) shown in items 6 and 12 will be “LM” for miner, “LW” for widow, etc. and (3) the annotation “BLACK LUNG CASE” will appear in item 11 (Remarks). The following BIC chart reflects the benefit symbols for black lung claimants and auxiliaries.

BLACK LUNG PAYMENT (LIFE) CLAIMS SYMBOLS

Symbol Definition
LM Miner
LS Wife
LS 5 Second Wife
LT Divorced wife
L1-L9 Child

BLACK LUNG PAYMENT (DEATH) CLAIMS SYMBOLS

Symbol Definition
LW Widow
LX Divorced widow
L1-L9 Surviving Child
P1 Natural father
P3 Adopting father
P5 Stepfather
P2 Natural mother
P4 Adopting mother
P6 Stepmother
S1, S3
S5, S7
Brother
S2, S4
S6, S8
Sister

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201050021
GN 01050.021 - Black lung beneficiary identification codes - 01/15/1999
Batch run: 02/11/2014
Rev:01/15/1999