TN 25 (02-95)
NL 00804.220 Cost-of-Living Increases
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Used in both November and January COLA notices where the new amount due is an increase,
decrease, or reinstatement.
The amount due (1) beginning (2) will be (3) . (4) (5) .
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(1)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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(4)
Choice 1 - This amount includes $$$.¢¢
Choice 2 - Null
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(5)
Choice 1 - from the State of Alabama
Choice 2 - from the State of Alaska
Choice 3 - from the State of Arizona
Choice 4 - from the State of Arkansas
Choice 5 - from the State of California
Choice 6 - from the State of Colorado
Choice 7 - from the State of Connecticut
Choice 8 - from the State of Delaware
Choice 9 - from the District of Columbia
Choice 10 - from the State of Florida
Choice 11 - from the State of Georgia
Choice 12 - from the State of Hawaii
Choice 13 - from the State of Idaho
Choice 14 - from the State of Illinois
Choice 15 - from the State of Indiana
Choice 16 - from the State of Iowa
Choice 17 - from the State of Kansas
Choice 18 - from the State of Kentucky
Choice 19 - from the State of Louisiana
Choice 20 - from the State of Maine
Choice 21 - from the State of Maryland
Choice 22 - from the State of Massachusetts
Choice 23 - from the State of Michigan
Choice 24 - from the State of Minnesota
Choice 25 - from the State of Mississippi
Choice 26 - from the State of Missouri
Choice 27 - from the State of Montana
Choice 28 - from the State of Nebraska
Choice 29 - from the State of Nevada
Choice 30 - from the State of New Hampshire
Choice 31 - from the State of New Jersey
Choice 32 - from the State of New Mexico
Choice 33 - from the State of New York
Choice 34 - from the State of North Carolina
Choice 35 - from the State of North Dakota
Choice 36 - from the State of Ohio
Choice 37 - from the State of Oklahoma
Choice 38 - from the State of Oregon
Choice 39 - from the State of Pennsylvania
Choice 40 - from the State of Rhode Island
Choice 41 - from the State of South Carolina
Choice 42 - from the State of South Dakota
Choice 43 - from the State of Tennessee
Choice 44 - from the State of Texas
Choice 45 - from the State of Utah
Choice 46 - from the State of Vermont
Choice 47 - from the State of Virginia
Choice 48 - from the State of Washington
Choice 49 - from the State of West Virginia
Choice 50 - from the State of Wisconsin
Choice 51 - from the State of Wyoming
Choice 52 - Null
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In rare cases, the system will issue a COLA notice to records in Goldberg/ Kelly payment
maintenance, but manual inputs and a manual notice are also required.
We have determined that beginning (1) (2) monthly payment amount should be (3) . But we will pay (4) (5) until a decision is made on all determinations still under appeal. Depending on the
outcome of (6) may have to pay back any money (7) not eligible to receive.
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(2)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(4)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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(6)
Choice 1 - your appeal, you
Choice 2 - her appeal, she
Choice 3 - his appeal, he
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(7)
Choice 1 - you are
Choice 2 - she is
Choice 3 - he is
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Used in November and January COLA notices where eligibility terminates due to excess
income.
(1) will stop in (2) .
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(1)
Choice 1 - Your check
Choice 2 - Her check
Choice 3 - His check
Choice 4 - Your eligibility
Choice 5 - Her eligibility
Choice 6 - His eligibility
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Used in November COLA notices when SSI payment is decreased or suspended because of
income.
Even though the law provides for an increase in Supplemental Security Income payments
beginning (1) (2) (3) . (4) (5)
(1) (Month/Year)
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(2)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(3)
Choice 1 - payment will be lowered
Choice 2 - payment will be lowered because of your income
Choice 3 - payment will be lowered because of her income
Choice 4 - payment will be lowered because of his income
Choice 5 - payment will be stopped
Choice 6 - payment will be stopped because your income will be too high for you to
receive payments
Choice 7 - payment will be stopped because her income will be too high for her to
receive payments
Choice 8 - payment will be stopped because his income will be too high for him to
receive payments
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(4)
Choice 1 - This is because there will be an increase in the amount of Social Security
benefits in (Month/Year) which we must count in figuring your Supplemental Security
Income payment.
Choice 2 - This is because there will be an increase in the amount of Social Security
benefits in (Month/Year) which we must count in figuring her Supplemental Security
Income payment.
Choice 3 - This is because there will be an increase in the amount of Social Security
benefits in (Month/Year) which we must count in figuring his Supplemental Security
Income payment.
Choice 4 - Null
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(5)
Choice 1 - Your income will be too high for you to receive payments.
Choice 2 - Her income will be too high for her to receive payments.
Choice 3 - His income will be too high for him to receive payments.
Choice 4 - Null
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Used in November COLA notices when there is an SSI payment increase or reinstatement
due to COLA.
(1) the law provides for an increase in Supplemental Security Income payments in (2) if there was an increase in the cost-of-living during the past (3) .
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(1)
Choice 1 - The amount due you is being raised because
Choice 2 - The amount due her is being raised because
Choice 3 - The amount due him is being raised because
Choice 4 - In starting your payments again, we have increased the amount of your check
because
Choice 5 - In starting her payments again, we have increased the amount of her check
because
Choice 6 - In starting his payments again, we have increased the amount of his check
because
Choice 7 - Your payment is being started again because
Choice 8 - Her payment is being started again because
Choice 9 - His payment is being started again because
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(3)
Choice 1 - year
Choice 2 - 6 months
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Used for November COLA notices for SSA-L8151's only. Income lead-in when there is
an SSI increase or reinstatement and a change in income on the record.
Our records show that the following income used to figure (1) payment has also changed—
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(1)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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Used in November or January COLA, where new SSI due is $0 due to excess income N01.
If at any time in the future you think (1) for payment, please contact us immediately. If (2) not eligible to receive payment for a month before (3) , (4) will have to file a new application to receive payment. Since we cannot make payment
for a month before the month in which an application is filed, a delay in applying
will result in a loss of payment for months before the application is filed.
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(1)
Choice 1 - you qualify
Choice 2 - she qualifies
Choice 3 - he qualifies
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(2)
Choice 1 - you are
Choice 2 - she is
Choice 3 - he is
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(4)
Choice 1 - you
Choice 2 - she
Choice 3 - he
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In rare cases, the system will issue a notice to records where Goldberg/ Kelly payment
maintenance is applicable. Manual action and manual notices are still required for
these records.
This determination regarding (1) Supplemental Security Income eligibility is different from the determination (2) appealing.
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(1)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(2)
Choice 1 - you are
Choice 2 - she is
Choice 3 - he is
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The individual has title II income.
(1) increased Social Security benefits—before deductions for Medicare premiums, if any,
of (2) . (3) should receive the increased check about (4) . (5)
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(1)
Choice 1 - Your
Choice 2 - Her
Choice 3 - His
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(3)
Choice 1 - You
Choice 2 - She
Choice 3 - He
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(5)
Choice 1 - We must count the increase in your benefits for (Month/Year) even though
we are counting your other income for (Month/Year).
Choice 2 - We must count the increase in her benefits for (Month/Year) even though
we are counting her other income for (Month/Year).
Choice 3 - We must count the increase in his benefits for (Month/Year) even though
we are counting his other income for (Month/Year).
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Specific income paragraph—title II income of spouse.
The increased Social Security benefits, before deductions for Medicare premiums, if
any, of (1) received by (2) spouse. This increased check should be received about (3) . We must count the increase in the benefits of (4) spouse even though we are counting the other income, if any, for (5) .
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(2)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(4)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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Overpayment being recovered by withholding.
The amount shown above is the amount we would send (1) each month if we were not recovering an overpayment.
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(1)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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Overpayment recovery is completed with the adjustment of the COL check.
The amount due (1) as shown above is the amount we would send each month if we were not recovering an
overpayment. By withholding (2) from the amount due (3) , we have completed recovery of the overpayment. (4) payment amount will be (5) for (6) . Beginning (7) we will pay you (8) full monthly payment.
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(1)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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(3)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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(4)
Choice 1 - Your
Choice 2 - Her
Choice 3 - His
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(8)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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Overpayment recovery causes reduction in amount of ongoing check.
The amount due (1) as shown above is the amount we would send each month if we were not recovering an
overpayment. We will continue to withhold (2) each month until the overpayment of (3) remaining after (4) , is recovered. (5) payment will be (6) beginning (7) . Please get in touch with any Social Security office if you disagree with the rate
of withholding or if you prefer to make refund.
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(1)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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(5)
Choice 1 - Your
Choice 2 - Her
Choice 3 - His
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Overpayment recovery not completed. Recovery action causes payment amount to be reduced
to zero.
The amount due (1) as shown above is the amount we would send if we were not recovering an overpayment.
Since the rate of recovery previously established is greater than the amount due,
we will withhold all of the amount due (2) until the remaining overpayment of (3) is recovered. Please get in touch with any Social Security office if you disagree
with this rate of withholding or if you prefer to make refund.
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(1)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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(2)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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In November or January COLA when payment is suspended. Remainder of overpayment should
be refunded.
We have been withholding (1) (2) monthly payment to recover an overpayment. Because (3) no longer due payment as shown above, we can no longer recover the overpayment by
withholding (4) payments. Therefore, you should refund (5) , the remainder of the overpayment. Make (6) check or money order payable to the Social Security Administration, Social Security
number (7) , and mail it to any Social Security office. If you cannot refund the full amount,
please get in touch with any Social Security office about making monthly installments.
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(1)
Choice 1 - part of
Choice 2 - Null
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(2)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(3)
Choice 1 - you are
Choice 2 - she is
Choice 3 - he is
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(4)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(6)
Choice 1 - your
Choice 2 - a
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(7)
(Recipient's Social Security Number)
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Specific income paragraph—spouse, parent, or essential person has title II income.
The increased Social Security benefit of (1) for (2) . Medical insurance premiums are deducted from this benefit. This increased check
was paid (3) about (4) .
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(2)
Choice 1 - your parent
Choice 2 - your parents
Choice 3 - your spouse
Choice 4 - her parent
Choice 5 - her parents
Choice 6 - her spouse
Choice 7 - his parent
Choice 8 - his parents
Choice 9 - his spouse
Choice 10 - (Name of Essential Person)
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(3)
Choice 1 - your parent
Choice 2 - your parents
Choice 3 - your spouse
Choice 4 - her parent
Choice 5 - her parents
Choice 6 - her spouse
Choice 7 - his parent
Choice 8 - his parents
Choice 9 - his spouse
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Close-out paragraph—retention of eligibility in nonpayment cases. Even though (1) not due payments, (2) still considered to be eligible under the Supplemental Security Income program. You
should continue to report any event that might affect (3) eligibility or allow (4) to receive payments again.
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(1)
Choice 1 - you are
Choice 2 - she is
Choice 3 - he is
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(2)
Choice 1 - you are
Choice 2 - she is
Choice 3 - he is
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(3)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(4)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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IC and PE: Used to show periods when the individual is subject to the statutory one-third
reduction for January COLA notices only.
The food and shelter (1) (2) in someone else's home or apartment. We raised the value of this food and shelter
to (3) beginning in (4) because there was a cost-of-living increase in SSI payments.
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(1)
Choice 1 - you
Choice 2 - she
Choice 3 - he
Choice 4 - your spouse
Choice 5 - her spouse
Choice 6 - his spouse
Choice 7 - you and your spouse
Choice 8 - she and her spouse
Choice 9 - he and his spoouse
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(2)
Choice 1 - receive
Choice 2 - receives
Choice 3 - received
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(3)
$$$.¢¢(Amount of type J unearned income)
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IC and PE: Used in both November and January COLA notices to inform the recipient
in FLA-B that he/she may be entitled to more money if they are paying their share
of household expenses.
(1) living in someone else's home or apartment. We may be able to pay (2) more SSI money if (3) paying (4) share of the household expenses. Contact us if you think (5) paying (6) share.
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(1)
Choice 1 - You are
Choice 2 - She is
Choice 3 - He is
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(2)
Choice 1 - you
Choice 2 - her
Choice 3 - him
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(3)
Choice 1 - you are
Choice 2 - she is
Choice 3 - he is
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(4)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(5)
Choice 1 - you are
Choice 2 - she is
Choice 3 - he is
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(6)
Choice 1 - your
Choice 2 - her
Choice 3 - his
2835. Situation Where Used:
Individual has type H income—used in January notice re March payment.
The food, clothing or shelter (1) (2) from someone else. We raised the value of this food, clothing or shelter to (3) beginning (4) because there was a cost-of-living increase in SSI payments.
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(1)
Choice 1 - you
Choice 2 - she
Choice 3 - he
Choice 4 - your spouse
Choice 5 - her spouse
Choice 6 - his spouse
Choice 7 - you and your spouse
Choice 8 - she and her spouse
Choice 9 - he and his spouse
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(2)
Choice 1 - receive
Choice 2 - receives
Choice 3 - received
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2836. Situation Where Used:
Lead-in paragraph for any income on the record.
NOTE: This paragraph replaces 2806 and 2809.
Our records show (1) total monthly income which was used to figure (2) SSI payment for (3) is (4) . This is based on the following income—
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(1)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(2)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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2837. Situation Where Used:
Describes the effect of January income on March payment, i.e., RMA. Used in January
COLA notices only.
We normally use income from 2 months earlier when we figure (1) SSI payment for a month. In this case, we use income from January to figure (2) payment for March.
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(1)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(2)
Choice 1 - your
Choice 2 - her
Choice 3 - his
2841. Situation Where Used:
Standard appeal paragraph on all SSA-L8155's.
We won't change (1) check if (2) within 10 days after getting this notice.
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(1)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(2)
Choice 1 - you appeal
Choice 2 - she appeals
Choice 3 - he appeals
Choice 4 - either you or your spouse appeals
Choice 5 - either she or her spouse appeals
Choice 6 - either he or his spouse appeals
2844. Situation Where Used:
OBSOLETE
Signature line
Dorcas R. Hardy,
Commissioner of Social Security
2845. Situation Where Used:
OBSOLETE
Signature line
Herbert R. Doggette, Jr.
Deputy Commissioner, Operations
2846. Situation Where Used:
OBSOLETE
Signature line
Gwendolyn S. King,
Commissioner of Social Security
Manual Paragraphs
COLM50. Situation Where Used:
An appeal is pending and the record is in protected payment status. COLA recomputation
results in an increase or decrease in the recipient's protected payment level (PPL).
If the PPL increases, use on an SSA-L8151-U2, Notice of Change in Payment, following
paragraphs 2801 and 2805. If the PPL decreases, use on an SSA-L8155-U2, Notice of
Planned Action, following paragraphs 2801 and 2804. Use under the caption, “Information About [Your/(Recipient's Name)] Payments.”
We have not decided about (1) appeal. (2) will receive the (3) SSI payment until we make a decision. If (4) appeal, (5) may have to pay back some or all of this money. We will send you another letter to
let you know about (6) appeal.
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(1)
Choice 1 - your
Choice 2 - her
Choice 3 - his
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(2)
Choice 1 - You
Choice 2 - She
Choice 3 - He
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(3)
Choice 1 - higher
Choice 2 - lower
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(4)
Choice 1 - you lose your
Choice 2 - she loses her
Choice 3 - he loses his
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(5)
Choice 1 - you
Choice 2 - she
Choice 3 - he
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(6)
Choice 1 - your
Choice 2 - her
Choice 3 - his
REFERENCES:
COLA coordination notice language and sample notice, SI 02005.015 D.2., 3.
COLA recomputation—correcting the PPL, SI 02301.325 D.
How to correct the PPL during appeal (including COLA), SI 02301.325—manual notice instructions