Program Operations Manual System (POMS)
HI 00825.906 Sample MBR Reply to Combined MBR/HIM Query
Identification |
—111-01-1111 M JONES, 12 PCI |
Address |
—1256 SOUTH ST, 40726 |
Beneficiary |
—M U 0601P 1273 M 0174 MARY J. SMITH |
Current HIB |
—0773 Y 33.00 1273 S33 0773 1273 |
Current SMIB |
—0766 Y 7.20 1273 330 0766 1273 |
Cross-Reference |
—M 316-91-2454 PC 4 —W 33 632324789151
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LINE 1
Identification |
111-01-1111 M JONES, P PSC1 |
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1 2 3 4 5 |
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-
-
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(4)
Unit Identifier (from the SSA-2467)
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LINE 2
Address |
1256 SOUTH ST. |
40726 |
(No city or state shown) |
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1 |
2 |
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(1)
First line of address on MBR
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LINE 3
Beneficiary |
M U 0601 P 1273 M 0174 Mary J. Smith |
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1 2 3 4 5 6 7 8 |
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-
-
-
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-
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LINE 4
Current HIB |
0773 Y 33.00 1273 S33 0773 1273 |
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1 2 3 4 5 6 7 |
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-
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(2)
Current Part A Option Code
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(3)
Premium Amount Collectable Part A
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(4)
Date of Termination Part A
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-
(6)
Third Party Entitlement Date Part A
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(7)
Third Party Termination Date Part A
LINE 5
Current SMIB |
0766 Y 7.20 1273 330 766 1273 |
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1 2 3 4 5 6 7 |
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-
-
(2)
Current Part B Option Date
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(3)
Premium Amount Collectable Part B
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(4)
Date of Termination Part B
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-
(6)
Third Party Entitlement Date Part B
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(7)
Third Party Termination Date Part B
LINE 6
Cross-Reference |
M 316-01-2454 PSC 4 |
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1 2 3 |
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(2)
Cross-reference SSN (up to nine SSN's)
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|
W 33 632324789151 |
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1 2 3 |
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(2)
State code (first two digits of State code)
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(3)
Welfare number (up to twelve digits)
LINE 7
Security Income Data |
A 0174 C 12345 0175 A |
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1 2 3 4 5 6 |
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(1)
Security income file type (SIFT)
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(2)
Security income entitlement/termination date (SIED)
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(3)
Security income status code (SISC)
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(4)
State and county code of residence (SCCR)
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(5)
Security income effective date of residence change (EDRC)
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(6)
Security income living arrangement code (SILAC)