TN 27 (01-23)
NL 00720.065 BRR Beneficiary Reporting Responsibility
BRR004 RIGHTS AND RESPONSIBILITIES RSI, DOMESTIC OR FOREIGN (G34)
(System Generated)
Caption: Your Responsibilities
(1) benefits are based on the information (2) gave us. If this information changes, it could affect (3) benefits. For this reason, it is important that you report changes to us right away.
We have enclosed a pamphlet, (4) . It tells you what must be reported and how to report. (5)
Fill-in values:
Fill-in (1)
Choice 1: Mr. Beneficiary's Name possessive
Choice 2: Ms. Beneficiary's Name possessive
Choice 3: Beneficiary's Name possessive
Choice 4: Your
Fill-in (2)
Choice 1: he
Choice 2: she
Choice 3: you
Fill-in (3)
Choice 1: his
Choice 2: her
Choice 3: you
Fill-in (4)
Choice 1: "Your Payments While You Are Outside the United
States"
Choice 2: "What You Need To Know When You Get Retirement Or Survivors
Benefits"
Choice 3: "What You Need To Know When You Get Social Security Disability
Benefits"
Fill-in (5)
Choice 1: NULL
BRR006 DISABILITY IMPROVEMENT INFORMATION (G12)
(System Generated)
Caption: Things To Remember
If (1) health gets worse and you think (2) disabled before (3) full retirement age, (4) (5) (6) (7) , you should contact us about applying again for disability benefits. Also, please
get in touch with us three months before (8) age 62 to find out whether (9) for retirement benefits.
Fill-in values:
Fill-in (1)
Choice 1: Beneficiary's Last Name
Choice 2: you
Fill-in (2)
Choice 1: she is
Choice 2: he is
Choice 3: you are
Fill-in (3)
Choice 1: she reaches
Choice 2: he reaches
Choice 3: you reach
Fill-in (4)
Choice 1: full retirement age at which FRA is effective (without additional
months, if applicable) in the format: 65
Fill-in (5)
Choice 1: and
Choice 2: null
Fill-in (6)
Choice 1: If present, show additional FRA months in the format:
2
Choice 2: null
Fill-in (7)
Choice 1: months
Choice 2: null
Fill-in (8)
Choice 1: she reaches
Choice 2: he reaches
Choice 3: you reach
Fill-in (9)
Choice 1: she qualifies
Choice 2: you qualify
Choice 3: he qualifies
BRRO06 INDIVIDUAL AGE 62-65 (NO RIB CLAIM FILED) (T26)
(Requested)
Caption: Things To Remember
If (1) health gets worse and you think (2) disabled before (3) full retirement age, (4) (5) (6) (7) , you should contact us about applying again for disability benefits. Also, please
get in touch with us three months before (8) age 62 to find out whether (9) for retirement benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's Last name
Choice 2: you
Fill-in (2) - Systems Generated
Choice 1: she is
Choice 2: he is
Choice 3: you are
Fill-in (3) - Systems Generated
Choice 1: she reaches
Choice 2: he reaches
Choice 3: you reach
Fill-in (4) - Systems Generated
Choice 1: full retirement age at which FRA is effective (without additional
months, if applicable) in the format: 65
Fill-in (5) - Systems Generated
Choice 1: and
Choice 2: null
Fill-in (6) - Systems Generated
Choice 1: If present, show additional FRA months in the format:
2
Choice 2: null
Fill-in (7) - Systems Generated
Choice 1: months
Choice 2: null
Fill-in (8) - Systems Generated
Choice 1: she reaches
Choice 2: he reaches
Choice 3: you reach
Fill-in (9) - Systems Generated
Choice 1: she qualifies
Choice 2: you qualify
Choice 3: he qualifies
BRR016 RIGHTS AND RESPONSIBILITIES NON-DIB, RRB DOM. OR FOR (G35)
(System Generated)
Caption: Your Responsibilities
The decisions we made on your claim are based on information you gave us. If this
information changes, it could affect your benefits. For this reason, it is important
that you report changes to us or to the Railroad Retirement Board right away. We have
enclosed a pamphlet which tells you what must be reported and how to report.
Fill-in values:
NONE
BRR026 REPORTING RESPONSIBILITIES - PROVISIONAL BENEFITS (P11)
(Requested)
Caption: Your Responsibilities
You must tell us right away about any changes that may affect (1) benefits. You should tell us if:
-
-
•
(3) to work or (4) work hours;
-
•
(5) doctor says (6) condition has improved;
-
•
(7) to leave the United States for 30 days or more;
-
•
(8) been convicted of a criminal offense; or
-
•
(9) benefits have been reinstated as either a disabled widow/widower or a disabled adult
child.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: null
Fill-in (2) - Systems Generated
Choice 1: You change your
Choice 2: He changes his
Choice 3: She changes her
Fill-in (3) - Systems Generated
Choice 1: You return
Choice 2: He returns
Choice 3: She returns
Fill-in (4) - Systems Generated
Choice 1: you increase your
Choice 2: he increases his
Choice 3: she increases her
Fill-in (5) - Systems Generated
Choice 1:Your
Choice 2: His
Choice 3: Her
Fill-in (6) - Systems Generated
Choice 1:Your
Choice 2: His
Choice 3: Her
Fill-in (7) - Systems Generated
Choice 1: You plan
Choice 2: He plans
Choice 3: She plans
Fill-in (8) - Systems Generated
Choice 1: You have
Choice 2: He has
Choice 3: She has
Fill-in (9) - Systems Generated
Choice 1: You marry and your
Choice 2: He marries and his
Choice 3: She marries and her
BRR040 FACILITY OF PAYMENT WORKER'S RESPONSIBILITIES (G36)
(System Generated)
Caption: Your Responsibilities
Please let us know if any of the following things happen:
-
•
The amount of money (1) (2) to make changes; or
-
•
Another family member starts working; or
-
•
A family member moves out of the household.
The way we pay benefits could change if any of these things happen.
Fill-in values:
Fill-in (1)
Choice 1: you
Choice 2: she
Choice 3: he
Fill-in (2)
Choice 1: expects
Choice 2: expects
BRR057 RIB BENEFITS AT 62 MAY BE HIGHER FOR FAMILY THAN DIB (J72)
(Requested)
Caption: Things To Remember
You should get in touch with us about 3 months before (1) (2) age 62. At that time, you can find out whether (3) family would receive higher benefits if (4) for retirement benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's Name
Choice 2: you
Fill-in (2) - Systems Generated
Choice 1: reach
Choice 2: reaches
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: her
Choice 3: his
Fill-in (4) - Systems Generated
Choice 1: you file
Choice 2: he files
Choice 3: she files
BRR075 REMINDER TO INCLUDE CLAIM NUMBER ON CORRESPONDENCE (G80)
(System Generated)
Caption: If You Disagree With The Decision
Always give (1) Social Security claim number on any letter or notice you send about (2) claim.
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: your
Fill-in (2) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
BRR076 REMINDER TO KEEP LETTER AS PERMANENT RECORD (G81)
(System Generated)
Caption: If You Disagree With The Decision
KEEP AS A PERMANENT RECORD – DO NOT DESTROY
Fill-in values:
NONE
Caption:
(System Generated)
Because of (1) work and earnings, no benefits are payable to you at this time under the rules of
the Benefit Offset National Demonstration (BOND) project. If (2) work or earnings change, we may be able to pay some benefits in the future.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: BOND Beneficiary's Name possessive
Fill-in (2) - Systems Generated
Choice 1: BOND Beneficiary's Name possessive
Caption:
(System Generated)
Because of (1) work and earnings, benefits are payable to you at this time under the rules of the
Benefit Offset National Demonstration (BOND) project. If (2) work or earnings change, some benefits may not be payable in the future.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: BOND Beneficiary's Name possessive
Fill-in (2) - Systems Generated
Choice 1: BOND Beneficiary's Name possessive
BRR080 REMINDER TO REPORT CHANGES IN WORK OR EARNINGS (W67)
(Requested)
Caption: Your Responsibilities
Please be sure to let us know right away if (1) work or earnings change, because changes could affect the amount of (2) benefits.
Fill-in values:
Fill-in (1) – System Generated
Choice 1: your
Choice 2: Beneficiary's Name
possessive
Fill-in (2) – System Generated
Choice 1: your
Choice 2: his
Choice 3: her
BRR084 REPORTING RESPONSIBILITIES FOR SUPPLEMENTAL MEDICAL INSURANCE PREMIUM IMMUNOSUPPRESSIVE
DRUG BENEFICIARIES
(Systems Generated)
Caption: Your Responsibilities
Call Social Security at 1-877-465-0355 between 8:30 a.m. – 6:00 p.m. EST, Monday through
Friday, within 60 days of signing up for certain other health insurance coverage.
You can’t keep the immunosuppressive drug benefit once your other coverage starts.
BRRR13 CURRENT YEAR S.E.I. USED PENDING RECEIPT OF TAX RETURN (C06)
(Requested)
Caption: Your responsibility
(1) benefits are partly based on self-employment income for (2) . As soon as the taxable year is over, (3) should report this income on a Federal tax return.
Then, you must send us a copy of the return. Also, send us a cancelled check or other
proof to show that (4) filed the return. Otherwise, we will stop (5) benefits and ask you to return any money we have sent you.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Your
Choice 2: Her
Choice 3: His
Fill-in (2) - Requested As A Year In Format CCYY
Choice 1: Year
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: her
Choice 3: his