Use WDS026 when more than one month is needed for WDS025. This will continue the columns
at the end of the WDS025. No further language required. Repeat as many times as needed.
New Language:
$350.00 May 2018
New Language with Fill-Ins:
*F1 *F2
Fill-ins:
*F1-1: Monthly offset amount in $$$$$.¢¢ format
*F2-1: Date in MM/CCYY format
Sample Notices
1. POD Reminder – No earnings submission for three months
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[LIS004 – Approved]
We are writing to give you new information about the *F1 (Disability) benefits which
*F2 (you receive) on this Social Security record.
[INFC08 – Approved] – Things to Remember
[POD UTI BEN133]
If *F1 (you are) working and *F2 (you have) not submitted *F3 (your) earnings, please
contact Abt Associates immediately. We show their contact information under the heading,
“If You Have Questions About POD”. If *F4 (you do) not submit earnings, we may pay
*F5 (you) incorrect benefit payments.
[RCT053 – Approved]
*F1 (You) must promptly report any changes that may affect *F2 (your) benefits. Failure
to do so could mean *F3 (you) may have to repay any benefits not due. Let us know
if:
-
•
*F4 (You) went to work since *F5 (your) last report or *F6 (you return) to work in
the future; or
-
•
*F7 (You) already reported *F8 (your) work, but *F9 (your) duties or pay changed.
(Remember to keep records of work and earnings such as pay statements from the employer);
or
-
•
*F10 (Your) doctor says *F11 (your) condition has improved even if *F12 (you return)
to work now; or
-
•
*F13 (You) applied for, start getting or have a change in the amount of *F14 (your)
workers compensation or another public disability benefit; or
-
•
*F15 (You start) paying for work expenses related to *F16 (your) disability such as
special transportation or the amount paid for these work expenses changes or *F17 (you)
no longer *F18 (pay) for such expenses. (Remember to keep records and proof of payment
for any work expenses.)
[POD Caption REFC08] - If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions That Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
2. POD Earnings Offset Notice
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[LIS004 – Approved]
We are writing to give you new information about the *F1 (Disability) benefits which
*F2 (you receive) on this Social Security record.
[POD Caption DIBC14] – Promoting Opportunity Demonstration (POD)
[POD UTI WDS024]
In POD, a qualified individual is provided an opportunity to work and earn over a
*F1 (TWP rate) threshold and have $1 of benefits withheld for every $2 earned over
this amount.
[CHKC09 – Approved] – Your Benefits
[POD UTI ERN096] Use ERN097 to continue paragraph if more than one month submitted
*F1 (You) submitted earnings of
Amount Date
*F2 (earnings) *F3 (month).
[POD UTI ERN095] Repeat if more than one month of earnings supplied
*F1 (You have) submitted impairment-related work expenses that have raised the threshold
to *F2 (approved IRWE amount) for *F3 (month). This threshold will return to *F4 (TWP
amount) next month if you do not submit impairment-related work expenses for that
month.
[POD UTI WDS025] Use WDS026 to continue paragraph if more than one month submitted
We determine how much to reduce *F1 (your) benefit payments under the $1 for $2 offset
based on *F2 (your) submitted earnings from the prior month.
Next, we subtract the POD threshold amount from the earnings *F5 (you) submitted and
divide the remaining amount by two. This is the monthly offset amount. The monthly
offset amount is the amount by which *F6 (your) benefits are reduced under the benefit
offset. Based on the earnings *F7 (you) submitted and the computations above, *F8
(your) monthly offset is
Amount Date
*F9 (POD offset amount) *F10 (first month).
[POD UTI BEN139] Use BEN140 to continue paragraph if more than one month submitted
Based on *F1 (your) earnings *F2 (your) monthly benefits are
Amount Date
*F3 (POD MBC) *F4 (first month)
[PAYC38 – Approved] – What We Will Pay
[RNS034 – Approved]
-
•
You will soon receive a payment for $$$$$.¢¢, which is the money you are due through
MM/YYYY.
-
•
After that you will receive $$$$$.¢¢ on or about the 3rd of each month.
[POD UTI BRR081] Use if offset results in beneficiary coming out of suspense status in current month
Because of *F1 (your) work and earnings, benefits are payable to *F2 (you) under the
rules of the Promoting Opportunity Demonstration (POD). If *F3 (your) work or earnings
change, we may not be able to pay some benefits in the future.
[POD UTI BRR082] Use if offset ends in suspense in current month
Because of *F1 (Your) work and earnings, no benefits are payable to *F2 (you) now
under the rules of the Promoting Opportunity Demonstration (POD). If *F3 (your) work
or earnings change, we may be able to pay some benefits in the future.
[POD UTI BEN136] Use if late earnings are submitted and back payment is due
*F1 (You) will soon receive a check for *F2 (PMA amount). This check is for benefits
due to *F3 (you) for *F4 (months adjusted) under the rules of the Promoting Opportunity
Demonstration (POD). *F5 (You are) due this check because of a change in *F6 (your)
work and earnings. This does not change any current benefits *F7 (you receive).
[ALSC01 – Approved] – Do You Think We Are Wrong
[POD UTI ALS101]
If *F1 (you) think this information is not correct or *F2 (you want) to report any
changes in *F3 (your) work plans or earnings, please get in touch with *F4 (your)
benefits counselor at Abt Associates. Please call their toll-free number at 1-888-771-9188
to report any changes.
Optional paragraphs, only use if Medicare Part B is being deducted from benefits
[HIBC01 - Approved] - Information About Medicare
[HIB187—Approved]
We will continue to deduct Medicare premiums from your monthly checks.
[POD Caption REFC08] – If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is *1-888-771-9188. They will help you by phone or they will set
up an appointment with the POD local office that serves your area. When you call,
please have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
3. POD BRI Adjustment Notice
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[LIS004 – Approved]
We are writing to give you new information about the *F1 (Disability) benefits which
*F2 (you receive) on this Social Security record.
[POD UTI BEN128]
We may have let *F1 (you) know earlier that we would increase *F2 (your) benefits
to *F3 (MBA that appears on MBR) per month due to the rise in the cost of living.
Because of *F4 (your) participation in the Promoting Opportunity Demonstration (POD),
we have refigured *F5 (your) benefits. This notice corrects the calculation to apply
the cost of living increase to *F6 (your) original benefit before the reduction for
POD earnings. *F7 (Your) new monthly amount (before deductions) is *F8 (MBA after
POD BRI).
[ALSC01 – Approved] – Do You Think We Are Wrong
[POD UTI ALS101]
If *F1 (you) think this information is not correct or *F2 (you want) to report any
changes in *F3 (your) work plans or earnings, please get in touch with *F4 (your)
benefits counselor at Abt Associates. Please call their toll-free number at 1-888-771-9188
to report any changes.
[POD Caption REFC08– If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
4. POD End of Year Reconciliation Notice
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[LIS004 – Approved] Use if there is an underpayment
We are writing to give you new information about the *F1 (disability) benefits which
*F2 (you receive) on this Social Security record.
[OPT161 – Approved] Use if there is an overpayment
We are writing to give *F1 new information about the *F2 (disability) benefits which
*F3 (you receive) on this Social Security record. In the rest of this letter, we will
tell *F4 (you):
How we paid *F5 (you) *F6 (amount of overpayment) too much in benefits; and
What to do if *F7 (you think) we are wrong about the overpayment.
[CHKC09 – Approved] – Your Benefits
[BEN106 - Approved]
Based on *F1 (your) earnings of *F2 (earnings amount) for *F3 (year of EOYR), we should
have paid *F5 (new POD MBC) *F6 (first adjusted month).
[BEN120 – Approved] Use with BEN106 for all subsequent months if more than one month adjusted
[OPT179 – Approved]
We paid *F1 (you) $*F2 (MBC Paid) for *F3 (mm/ccyy, mm/ccyy through mm/ccyy). Since
we should have paid *F4 (you) $*F5 (MBC should have been paid) for *F6 (mm/ccyy, mm/ccyy
through mm/ccyy), we paid *F7 (you) $*F8 (amount of overpayment/underpayment) *F9
(more, less) than *F10 (you were) due.
[POD UTI BEN132] Use if an underpayment or overpayment is generated
This *F1 (overpayment/underpayment) resulted from the difference in the total amount
of earnings that *F2 (you) submitted during *F3 (EOYR year) and the actual amount
that *F4 (you) earned, during that year. We determined the *F5 (overpayment/underpayment)
after we recalculated *F6 (your) offset based on *F7 (your) actual annual earnings.
[POD UTI BEN138] Use if EOYR is run after POD period is over
*F1 (You have) been a participant in the Promoting Opportunity Demonstration (POD).
The special rules for POD will no longer apply to *F2 (you) beginning *F3 (month after
POD end date).
[OPTC05 – Approved] – How To Pay Us Back Only used in case of overpayment
[RFU001 – Approved] Use if the current LAF indicates anything other than current pay or deferred
You should refund this overpayment within 30 days. Please make your check or money
order payable to "Social Security Administration," and send it to us in the enclosed
envelope. Include *F1 (your) claim number (as shown above) on your check or money
order.
If you cannot refund the full *F2 (overpayment amount) now, please send:
A partial payment
An explanation of why you cannot pay the full amount now, and
A plan to repay the money.
[RFU012 – Approved] Use if the current LAF indicates current pay or deferred
You should refund this overpayment of *F1 (overpayment amount) within 30 days. Please
make your check or money order payable to "Social Security Administration," and send
it to us in the enclosed envelope. Include *F2 (your) claim number (as shown above)
on your check or money order.
If we do not receive your refund within 30 days, we will hold back *F3 (your) full
benefits starting with the payment you would normally receive about *F5 (end date
of deferral). We will continue holding back *F6 (your) benefits until we recover the
overpayment.
If you cannot refund the full overpayment now or cannot afford to have us hold back
*F7 (your) full benefits, you may ask us to hold back a smaller amount each month.
Contact us to discuss your plan for repaying the balance. You may need to show us
proof of *F8 (your) assets, monthly income, and expenses.
[OPT165 – Approved] Use if REFU012 is used above
We will pay you a monthly check of *F1 (current month benefit) until we start to collect
the overpayment.
[ALSC06 – Approved] – Do You Think We Are Wrong About The Overpayment Use for overpayment
[WAV002 – Approved]
You have certain rights with respect to this overpayment and its recovery.
-
1.
Right to Appeal: If you disagree in any way with this overpayment determination, you have the right,
within 60 days of the date you receive this notice, to request that the determination
be reconsidered. If you request this independent review of the overpayment determination,
please submit any additional information you have which pertains to the overpayment.
-
2.
Right to Request Waiver: You also have the right to request a determination concerning
the need to recover the overpayment. An overpayment must be refunded or withheld from
benefits unless both of the following are true:
-
The overpayment was not your fault in any way; and
-
You could not meet your necessary living expenses if we recovered the overpayment,
or recovery would be unfair for some other reason.
If you request waiver, we may need a statement of your assets and monthly income and
expenses.
If you request reconsideration and/or waiver within 30 days, the overpayment will
not have to be recovered until the case is reviewed. This review is described in more
detail on the attached Form SSA-3105, Important Information About Your Appeal and
Waiver Rights. The people in any Social Security office will be glad to help you complete
the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration)
and/or waiver (SSA-632-F4, Overpayment Recovery Questionnaire).
Even if you do not want to request reconsideration or waiver, please call, write or
visit any Social Security office if you have any questions or need more information.
Please take this letter with you if you do visit an office.
[ALSC27 – Approved] – If You Want To Appeal
[ALS120 – Approved]
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case. We will correct any mistakes. We will review those parts of
the decision which you believe are wrong and will look at any new facts you have.
We may also review those parts which you believe are correct and may make them unfavorable
or less favorable to you.
[POD Caption REFC08] – If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
5. POD Auxiliary Notice – action ends in suspense
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[LIS004 – Approved] Use if there is an underpayment
We are writing to give you new information about the *F1 (disability) benefits which
*F2 (you receive) on this Social Security record.
[OPT161 – Approved] Use if there is an overpayment
We are writing to give *F1 new information about the *F2 (disability) benefits which
*F3 (you receive) on this Social Security record. In the rest of this letter, we will
tell *F4 (you):
How we paid *F5 (you) *F6 (amount of overpayment) too much in benefits; and
What to do if *F7 (you think) we are wrong about the overpayment.
[CHKC09 – Approved] – Your Benefits
[POD UTI BEN135]
We cannot pay *F1 (you) benefits for *F2 (mm/ccyy) under the rules of the Promoting
Opportunity Demonstration (POD). This is due to *F3 (Name of POD participant's) work
and earnings. This does not change any current benefits *F4 (you receive).
[OPT169 – Approved] Use if there is an overpayment
Since we paid *F1 (you) *F2 (amount paid) for *F3 (dates paid), we paid *F4 (you) *F5
(amount of overpayment/underpayment) *F6 (more/less) than *F7 (you were) due.
[OPTC05 – Approved] – How To Pay Us Back Only used in case of overpayment
[RFU001 – Approved] Use if the current LAF indicates anything other than current pay or deferred
You should refund this overpayment within 30 days. Please make your check or money
order payable to "Social Security Administration," and send it to us in the enclosed
envelope. Include *F1 (your) claim number (as shown above) on your check or money
order.
If you cannot refund the full *F2 (overpayment amount) now, please send:
-
-
An explanation of why you cannot pay the full amount now, and
A plan to repay the money.
[RFU012 – Approved] Use if the current LAF indicates current pay or deferred
You should refund this overpayment of *F1 (overpayment amount) within 30 days. Please
make your check or money order payable to "Social Security Administration," and send
it to us in the enclosed envelope. Include *F2 (your) claim number (as shown above)
on your check or money order.
If we do not receive your refund within 30 days, we will hold back *F3 (your) full
benefit starting with the payment you would normally receive about *F5 (end date of
deferral). We will continue holding back *F6 (your) benefits until we recover the
overpayment.
If you cannot refund the full overpayment now or cannot afford to have us hold back
*F7 (your) full benefit, you may ask us to hold back a smaller amount each month.
Contact us to discuss your plan for repaying the balance. You may need to show us
proof of *F8 (your) assets, monthly income, and expenses.
[OPT165 – Approved] Use if REFU012 is used above
We will pay you a monthly check of *F1 (current month benefit) until we start to collect
the overpayment.
[ALSC06 – Approved] – Do You Think We Are Wrong About The Overpayment Use for overpayment
[WAV002 – Approved]
You have certain rights with respect to this overpayment and its recovery.
-
1.
Right to Appeal: If you disagree in any way with this overpayment determination, you have the right,
within 60 days of the date you receive this notice, to request that the determination
be reconsidered. If you request this independent review of the overpayment determination,
please submit any additional information you have which pertains to the overpayment.
-
2.
Right to Request Waiver: You also have the right to request a determination concerning
the need to recover the overpayment. An overpayment must be refunded or withheld from
benefits unless both of the following are true:
-
The overpayment was not your fault in any way; and
-
You could not meet your necessary living expenses if we recovered the overpayment,
or recovery would be unfair for some other reason.
If you request waiver, we may need a statement of your assets and monthly income and
expenses.
If you request reconsideration and/or waiver within 30 days, the overpayment will
not have to be recovered until the case is reviewed. This review is described in more
detail on the attached Form SSA-3105, Important Information About Your Appeal and
Waiver Rights. The people in any Social Security office will be glad to help you complete
the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration)
and/or waiver (SSA-632-F4, Overpayment Recovery Questionnaire).
Even if you do not want to request reconsideration or waiver, please call, write or
visit any Social Security office if you have any questions or need more information.
Please take this letter with you if you do visit an office.
[ALSC27 – Approved] – If You Want To Appeal
[ALS023– Approved]
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case. We will correct any mistakes. We will review those parts of
the decision, which you believe are wrong and will look at any new facts you have.
We may also review those parts, which you believe are correct and may make them unfavorable
or less favorable to you.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show you did not get it within the 5-day period.
You must have a good reason for waiting more than 60 days to ask for an appeal.
You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2,
called “Request for Reconsideration”. Contact one of our offices if you want help.
Please read the enclosed pamphlet: Your Right to Question the Decision Made on Your
Social Security Claim”. It contains more information about the appeal.
[POD Caption REFC08] – If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD UTI REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
6. POD Auxiliary Notice – action puts auxiliary back in pay status
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[LIS004 – Approved]
We are writing to give you new information about the *F1 (disability) benefits which
*F2 (you receive) on this Social Security record.
[PAYC38 – Approved] – What We Will Pay
[POD UTI BEN136]
*F1 (You) will soon receive a check for *F2 (amount). This check is for benefits due
to *F3 (you) for *F4 (months of backpay) under the rules of the Promoting Opportunity
Demonstration (POD). *F5 (You are) due this check because of a change in *F6 (POD
participant's) work and earnings. This does not change any current benefits *F7 (you
receive).
[ALSC27 – Approved] – If You Want To Appeal
[ALS023– Approved]
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case. We will correct any mistakes. We will review those parts of
the decision, which you believe are wrong and will look at any new facts you have.
We may also review those parts, which you believe are correct and may make them unfavorable
or less favorable to you.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show you did not get it within the 5-day period.
You must have a good reason for waiting more than 60 days to ask for an appeal.
You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2,
called “Request for Reconsideration”. Contact one of our offices if you want help.
Please read the enclosed pamphlet: Your Right to Question the Decision Made on Your
Social Security Claim”. It contains more information about the appeal.
[POD Caption REFC08] – If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
7. EOYR Reconsideration – no change in benefits
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[POD UTI BEN137]
We received a request *F1 (that we review our decision).
[CHKC09 – Approved] – Your Benefits
[POD UTI BEN130]
Thank you for providing us with information about *F1 (your) earnings for last year.
*F2 (You) asked us to determine if there has been a change in the amount of benefits
payable to *F3 (you) under POD because of this information. Based on this evidence,
we have determined that there is no change to *F4 (your) monthly benefit amount for
this period. This decision does not change any benefits *F5 (you) may be currently
receiving.
[BEN107 – Approved]
This means we paid *F1 (you) correctly based on the evidence *F2 (you) provided for
the reconciliation year.
[ALSC01 – Approved] – Do You Think We Are Wrong
[POD UTI ALS101]
If *F1 (you) think this information is not correct or *F2 (you want) to report any
changes in *F3 (your) work plans or earnings, please get in touch with *F4 (your)
benefits counselor at Abt Associates. Please call their toll-free number at 1-888-771-9188
to report any changes.
[ALSC27 – Approved] – If You Want To Appeal
[ALS023– Approved]
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case. We will correct any mistakes. We will review those parts of
the decision, which you believe are wrong and will look at any new facts you have.
We may also review those parts, which you believe are correct and may make them unfavorable
or less favorable to you.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show you did not get it within the 5-day period.
You must have a good reason for waiting more than 60 days to ask for an appeal.
You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2,
called “Request for Reconsideration”. Contact one of our offices if you want help.
Please read the enclosed pamphlet: Your Right to Question the Decision Made on Your
Social Security Claim”. It contains more information about the appeal.
[POD Caption REFC08] – If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
8. EOYR Reconsideration – change in benefits
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[POD UTI BEN137]
We received a request *F1 (that we review our decision).
[CHKC09 – Approved] – Your Benefits
[POD UTI BEN129]
Thank you for providing us with information about *F1 (your) earnings for the last
year. *F2 (You) asked us to determine if there has been a change in benefits payable
to *F3 (you) under POD because of this information.
[OPT179 – Approved]
We paid *F1 (you) *F2 (MBC Paid) for *F3 (period of EOYR). Since we should have paid
*F4 (you) *F5 (MBC should have been paid) for *F6 (period of EOYR), we paid *F7 (you)
*F8 (amount of overpayment/underpayment) *F9 (more, less) than *F10 (you were) due.
[POD UTI BEN132]
This *F1 (overpayment/underpayment) resulted from the difference in the total amount
of earnings that *F2 (you) submitted during *F3 (EOYR year) and the actual amount
that *F4 (you) earned, during that year. We determined the *F5 (overpayment/underpayment)
after we recalculated *F6 (your) offset based on *F7 (your) actual POD earnings.
[POD UTI BEN138] Use if EOYR reconsideration is run after POD period is over
*F1 (You have) been a participant in the Promoting Opportunity Demonstration (POD).
The special rules for POD will no longer apply to *F2 (you) beginning *F3 (month after
POD end date). *F4
[ALSC01 – Approved] – Do You Think We Are Wrong
[RCN021 – Approved]
We changed our earlier decision because of new facts we received.
If you think we are wrong, you have the right to request a hearing. At the hearing,
a person who has not seen your case before will look at it. That person is an Administrative
Law Judge. In the rest of our letter, we will call this person an ALJ. The ALJ will
review those parts of the decision, which you believe are wrong. The ALJ will look
at any new facts you have and correct any mistakes. The ALJ may also review those
parts, which you believe are correct and make them unfavorable or less favorable to
you.
You have 60 days to ask for a hearing.
The 60 days start the day after you get this letter.
You must have a good reason if you wait more than 60 days to ask for a hearing.
You have to ask for a hearing in writing. If you want to make a request, please contact
one of our offices. We can help you complete the required form.
Please read the enclosed pamphlet, "Your Right To An Administrative Law Judge Hearing
And Appeals Council Review Of Your Social Security Case." It contains more information
about the hearing.
[POD Caption REFC08] – If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
9. POD End Date of Participation
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[LIS004 – Approved]
We are writing to give you new information about the *F1 (disability) benefits which
*F2 (you receive) on this Social Security record.
[CHKC09 – Approved] – Your Benefits
[POD UTI BEN138]
*F1 (You have) been a participant in the Promoting Opportunity Demonstration (POD).
The special rules for POD will no longer apply to *F2 (you) beginning *F3 (first day
of the month after POD end date). *F4.
*F4-A: You asked to be withdrawn from the project. If you are receiving benefit payments
based on disability, your payments may stop the first month you do substantial gainful
work.
*F4-B: They asked to be withdrawn from the project. If they are receiving benefit
payments based on disability, their payments may stop the first month they do substantial
gainful work.
*F4-C They asked to be withdrawn from the project. If they are receiving benefit payments
based on disability, their payments may stop the first month they do substantial gainful
work.
*F4-D: Null
[POD UTI BEN134] Use if BEN138 fill-in 4 is A, B, or C)
*F1 (You are) no longer eligible for the project because *F2 (you have) *F3 (no longer
met the POD eligibility criteria). If *F4 (you are) receiving benefit payments based
on disability, *F5 (your) payments may stop the first month *F6 (you do) substantial
gainful work.
[POD UTI BEN131] Use if BEN138 fill-in 4 is D)
*F1 (Your) participation period ends *F2 (POD end date). Payments may end with the
month *F3 (you do) substantial gainful work after *F4 (POD end date).
[POD Caption REFC08] – If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]
10. POD Termination Notice
Social Security Administration
Retirement, Survivors and Disability Insurance
Date:
Claim
Number:
Name and address
[TER039 – Approved]
We are writing to tell *F1 (you) that *F2 (you no longer qualify) for *F3 (disability)
benefits beginning *F4 (termination date).
[CHKC09 – Approved] – Your Benefits
[POD UTI TER035]
*F1 (You have) been receiving $0 in benefits for twelve consecutive months because
of work. Therefore, *F2 (you are) no longer disabled as of *F3 (termination date)
according to POD rules. The last month for which *F4 (you are) eligible to receive
benefits is *F5 (month before termination date).
If *F6 (you) receive disability benefits in the future, contact Abt Associates to
report your earnings. We show their contact information under the heading, “If You
Have Questions About POD”.
[ALSC01 – Approved] – Do You Think We Are Wrong
[POD UTI ALS101]
If *F1 (you) think this information is not correct or *F2 (you want) to report any
changes in *F3 (your) work plans or earnings, please get in touch with *F4 (your)
benefits counselor at Abt Associates. Please call their toll-free number at 1-888-771-9188
to report any changes.
[ALSC27 – Approved] – If You Want To Appeal
[ALS023– Approved]
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case. We will correct any mistakes. We will review those parts of
the decision, which you believe are wrong and will look at any new facts you have.
We may also review those parts, which you believe are correct and may make them unfavorable
or less favorable to you.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show you did not get it within the 5-day period.
You must have a good reason for waiting more than 60 days to ask for an appeal.
You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2,
called “Request for Reconsideration”. Contact one of our offices if you want help.
Please read the enclosed pamphlet: “Your Right to Question the Decision Made on Your
Social Security Claim”. It contains more information about the appeal.
[POD Caption REFC08] – If You Have Questions About POD
[POD UTI REF172]
If you have any questions about POD, you may call our partner Abt Associates. Their
toll-free number is 1-888-771-9188. They will help you by phone or they will set up
an appointment with the POD local office that serves your area. When you call, please
have this letter with you. It will help the counselors at Abt answer your questions.
[POD Caption REFC09] – If You Have Questions that Are Not About POD
[CTDO – Approved]
If you have any questions, you may call us at *F1 (1-800-772-1213) or call your local
Social Security office at *F2 (Local FO#). We can answer most questions over the phone.
You may also write or visit any Social Security office. The office that serves your
area is located at:
*F3 (FO Address)
*F4 (FO Address)
*F5 (FO Address)
*F6 (FO Address)
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly.
[Signature]