TN 2 (09-11)
FUG031 FUGITIVE FELON DUE PROCESS INFORMATION (S42)
(System Generated)
Caption: Your Benefits
If none of the above apply, we also may pay (1) if you contact us within 12 months from the date of this letter and can show us that:
-
•
The crime for which the warrant was issued or the probation or parole violation was
both nonviolent and not drug related and, if a probation or parole violation is involved,
the original crime(s) for which (2) paroled or put on probation was both nonviolent and not drug related.
And
-
•
(3) neither been convicted of nor pled guilty to another felony crime since the date
of the warrant
And The law enforcement agency that issued the warrant reports that it will not extradite
(4) for the charges on the warrant or that it will not take action on the warrant for
(5) arrest.
Or
-
•
The crime for which the warrant was issued or the probation or parole violation was
both nonviolent and not drug related and, if probation or parole violation is involved,
the original crime(s) for which (6) paroled or put on probation was both nonviolent and not drug related.
And
-
•
(7) neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
-
•
The only existing warrant was issued 10 or more years ago.
And
-
•
(8) medical condition impairs (9) mental capability to resolve the warrant; or (10) incapable of managing (11) benefits; or (12) legally incompetent; or Social Security has appointed a representative payee to handle
(13) benefits or (14) residing in a long-term care facility, such as a nursing home or mental treatment/care
facility.
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: Beneficiary's Name
Choice 2: you
Fill-in (2) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was
Fill-in (3) Systems Generated
Choice 1: You have
Choice 2: He has
Choice 3: She has
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (6) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was
Fill-in (7) Systems Generated
Choice 1: You have
Choice 2: He has
Choice 3: She has
Fill-in (8) Systems Generated
Choice 1: Your
Choice 2: His
Choice 3: Her
Fill-in (9) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (10) Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (11) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (12) Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (13) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (14) Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
FUG058 BENEFICIARY CANNOT BE PAID – OUTSTANDING ARREST WARRANT (S38)
(System Generated)
Caption: Your Benefits
We cannot pay benefits to (1) because (2) an outstanding arrest warrant for a (3) .
Fill-in values:
Fill-in (1)
Choice 1: Beneficiary's name
Choice 2: him
Choice 3: her
Choice 4: you
Fill-in (2)
Choice 1: he has
Choice 2: she has
Choice 3: you have
Choice 4: you
Fill-in (3)
Choice 1: felony crime
Choice 2: violation of a condition of probation or parole under Federal or State law
FUG059 BENEFITS SUSPENDED – FUGITIVE FELON (S39)
(System Generated)
Caption: Your Benefits
Our records show that the (1) (2) (3) issued a warrant for (4) arrest for a felony crime or a violation of Federal or State probation or parole
on (5) .
(6)
(7) (8)
(9) (10)
(11) (12)
Social Security cannot provide further information about the warrant. (13) (14) (15)
Fill-in values:
Fill-in (1)
Choice 1: (Warrant Agency)
Choice 2: (Warrant Agency Address)
Fill-in (2)
Choice 1: (Warrant Agency Address)
Choice 2: Null
Fill-in (3)
Choice 1: Phone: + (Warrant Agency Phone)
Choice 2: Null
Fill-in (4)
Choice 1: Beneficiary's name (possessive))
Choice 2: his
Choice 3: her
Choice 4: your
Fill-in (5)
Choice 1: (Warrant Date)
Fill-in (6)
Choice 1: The warrant information we have is:
Choice 2: Null
Fill-in (7)
Choice 1: Warrant number:
Choice 2: Null
Fill-in (8)
Choice 1: Warrant number:
Choice 2: Null
Fill-in (9)
Choice 1: OCA Number:
Choice 2: Null
Fill-in (10)
Choice 1: OCA Number:
Choice 2: Null
Fill-in (11)
Choice 1: OCA Number:
Choice 2: Null
Fill-in (12)
Choice 1: NCIC Number
Choice 2: Null
Fill-in (13)
Choice 1: Please contact the
Choice 2: Null
Fill-in (14)
Choice 1: Warrant Agency Address
Choice 2: Null
Fill-in (15)
Choice 1: directly
Choice 2: Null
FUG060 FUGITIVE FELON SUSPENDED – NO T2 OVERPAYMENT OR T2 OVERPAYMENT NOT DUE TO FUGITIVE
FELON DPOT 73 OR 74(S40)
(System Generated)
Caption: Your Benefits
We will pay (1) if you contact us at any time and can show us that any of the following apply:
-
•
The warrant was issued incorrectly in (2) name because someone stole (3) identity. To prove this, submit a copy of the police report that (4) filed as a victim of identity theft or another official document from the court or
the warrant issuing agency stating that the warrant was erroneously issued in (5) name.
-
•
(6) found not guilty of the criminal offense. To prove this, submit a copy of the court
docket indicating (7) found not guilty of the criminal charges or a copy of the court decision showing
that (8) found not guilty of the criminal charges.
-
•
The underlying charges relating to the criminal offense were dismissed. To prove this,
submit a copy of the court docket indicating charges were dismissed or another official
court or law enforcement agency document stating that it dismissed the criminal charges.
-
•
The warrant for (9) arrest for the criminal offense was withdrawn. To prove this, submit a copy of the
court docket or another official document from the issuing agency, indicating the
warrant in question was withdrawn.
-
•
(10) otherwise cleared of the criminal offense. To prove this, submit a copy of the court
docket or other court document indicating (11) cleared of the criminal charges.
Fill-in values:
Fill-in (1)
Choice 1: Beneficiary's name
Choice 2: him
Choice 3: her
Choice 4: you
Fill-in (2)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (3)
Choice 1: his
Choice 2: her
Choice 3: you
Fill-in (4)
Choice 1: he
Choice 2: she
Choice 3: you
Fill-in (5)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (6)
Choice 1: He was
Choice 2: She was
Choice 3: You were
Fill-in (7)
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (8)
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (9)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (10)
Choice 1: He was
Choice 2: She was
Choice 3: You were
Fill-in (11)
Choice 1: he was
Choice 2: she was
Choice 3: you were
FUG061 INITIAL AWARD – BENEFICIARY SUSPENDED FUGITIVE FELON (S41)
(System Generated)
Caption: Your Benefits
If none of the above applies, we also may pay (1) benefits if you contact us within 12 months from the date of this letter and can
show us that:
-
•
The crime for which the warrant was issued or the probation or parole violation was
both nonviolent and not drug related and, if a probation or parole violation is involved,
the original crime(s) for which (2) paroled or put on probation was both nonviolent and not drug related.
And
-
•
(3) neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
-
•
The law enforcement agency that issued the warrant reports that it will not extradite
(4) for the charges on the warrant or that it will not take action on the warrant for
(5) arrest.
Or
-
•
The crime for which the warrant was issued is based on or the probation or parole
violation was both nonviolent and not drug related and, if a probation or parole violation
is involved, the original crime(s) for which (6) paroled or put on probation was both nonviolent and not drug related.
And
-
•
(7) neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
-
•
The only existing warrant was issued 10 or more years ago.
And
-
•
(8) medical condition impairs (9) mental capability to resolve the warrant; or (10) incapable of managing (11) benefits; or (12) legally incompetent; or Social Security has appointed a representative payee to handle
(13) benefits or (14) residing in a long-term care facility, such as a nursing home or mental treatment/care
facility.
Fill-in values:
Fill-in (1)
Choice 1: Beneficiary's name
Choice 2: him
Choice 3: her
Choice 4: you
Fill-in (2)
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (3)
Choice 1: He has
Choice 2: She has
Choice 3: You have
Fill-in (4)
Choice 1: him
Choice 3: her
Choice 4: you
Fill-in (5)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (6)
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (7)
Choice 1: He has
Choice 2: She has
Choice 3: You have
Fill-in (8)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (9)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (10)
Choice 1: he is
Choice 2: she is
Choice 3: you are
Fill-in (11)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (12)
Choice 1: he is
Choice 2: she is
Choice 3: you are
Fill-in (13)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (14)
Choice 1: he is
Choice 2: she is
Choice 3: you are
FUG063 MANDATORY GOOD CAUSE EXPLANATION – BENEFITS SUSPENDED FUGITIVE FELON – T2 OVERPAYMENT
RESULTS (S43)
(System Generated)
Caption: Your Benefits
(1) will not be overpaid for the months that (2) had an outstanding felony warrant for a crime or a warrant for a probation or parole
violation if you contact us at any time and can show us that any of the following
apply:
-
•
The warrant was issued incorrectly in (3) name because someone stole (4) identity. To prove this, submit a copy of the police report that (5) filed as a victim of identity theft or another official document from the court or
the warrant issuing agency stating that the warrant was erroneously issued in (6) name.
-
•
(7) found not guilty of the criminal offense. To prove this, submit a copy of the court
docket indicating (8) found not guilty of the criminal charges or a copy of the court decision showing
that (9) found not guilty of the criminal charges.
-
•
The underlying charges relating to the criminal offense were dismissed. To prove this,
submit a copy of the court docket indicating charges were dismissed or another official
court or law enforcement agency document stating that it dismissed the criminal charges.
-
•
The warrant for (10) arrest for the criminal offense was withdrawn. To prove this, submit a copy of the
court docket or another official document from the issuing agency, indicating the
warrant in question was withdrawn.
-
•
(11) otherwise cleared of the criminal offense. To prove this, submit a copy of the court
docket or other court document indicating you were cleared of the criminal charges.
Fill-in values:
Fill-in (1)
Choice 1: Beneficiary's name
Choice 2: You
Fill-in (2)
Choice 1: he
Choice 2: she
Choice 3: you
Fill-in (3)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (4)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (5)
Choice 1: he
Choice 2: she
Choice 3: you
Fill-in (6)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (7)
Choice 1: He was
Choice 2: She was
Choice 3: You were
Fill-in (8)
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (9)
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (10)
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (11)
Choice 1: He was
Choice 2: She was
Choice 3: You were
FUG064 DISCRETIONARY GOOD CAUSE-FUGITIVE FELON SUSPENSION RESULTS IN AN OVERPAYMENT-ADVANCE
NOTICE NOT SENT (S44)
(Requested/Generated)
Caption: Your Benefits
If none of the above applies, we also may not consider (1) overpaid (2) for the month(s) of (3) (4) (5) if you contact us within 12 months from the date of this notice and can show us that:
• The crime for which the warrant was issued or the probation or parole violation
was both nonviolent and not drug related and, if a probation or parole violation is
involved, the original crime(s) for which (6) paroled or put on probation was both nonviolent and not drug related.
And
• (7) neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
• The law enforcement agency that issued the warrant reports that it will not extradite
(8) for the charges on the warrant or that it will not take action on the warrant for
(9) arrest.
Or
• The crime for which the warrant was issued is based on or the probation or parole
violation was both nonviolent and not drug related and, if a probation or parole violation
is involved, the original crime(s) for which (10) paroled or put on probation was both nonviolent and not drug related.
And
• (11) neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
• The only existing warrant was issued 10 or more years ago.
And
• (12) medical condition impairs (13) mental capability to resolve the warrant; or (14) incapable of managing (15) benefits; or (16) legally incompetent; or Social Security has appointed a representative payee to handle
(17) benefits or (18) residing in a long-term care facility, such as a nursing home or mental treatment/care
facility.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's name
Choice 2: you
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: amount
Fill-in (3) - Requested As A Date In Format Shown Below
Date MM/CCYY
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) and
Choice 2: (B) through
Choice 3: (C) null
Fill-in (5) - Requested As A Date In Format Shown Below or As A One Position Alpha
Character
Choice 1: Date MM/CCYY
Choice 2: (B) null
Fill-in (6) - Systems Generated
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (7) - Systems Generated
Choice 1: He has
Choice 2: She has
Choice 3: You have
Fill-in (8) - Systems Generated
Choice 1: him
Choice 2: her
Choice 3: you
Fill-in (9) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (10) - Systems Generated
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (11) - Systems Generated
Choice 1: He has
Choice 2: She has
Choice 3: You have
Fill-in (12) - Systems Generated
Choice 1: His
Choice 2: Her
Choice 3: Your
Fill-in (13) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (14) - Systems Generated
Choice 1: he is
Choice 2: she is
Choice 3: you are
Fill-in (15) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (16) - Systems Generated
Choice 1: he is
Choice 2: she is
Choice 3: you are
Fill-in (17) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (18) - Systems Generated
Choice 1: he is
Choice 2: she is
Choice 3: you are
FUG065 DISCRETIONARY GOOD CAUSE – FUGITIVE FELON SUSPENSION RESULTS IN AN OVERPAYMENT –ADVANCE
NOTICE SENT (S45)
(Requested/Generated)
Caption: Your Benefits
If none of the above applies, we also may not consider (1) overpaid (2) for the month(s) of (3) (4) (5) if you contact us within 12 months from (6) and can show us that:
• The crime for which the warrant was issued or the probation or parole violation
was both nonviolent and not drug related and, if a probation or parole violation is
involved, the original crime(s) for which (7) paroled or put on probation was both nonviolent and not drug related.
And
• (8) neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
• The law enforcement agency that issued the warrant reports that it will not extradite
(9) for the charges on the warrant or that it will not take action on the warrant for
(10) arrest.
Or
• The crime for which the warrant was issued is based on or the probation or parole
violation was both nonviolent and not drug related and, if a probation or parole violation
is involved, the original crime(s) for which (11) paroled or put on probation was both nonviolent and not drug related.
And
• (12) neither been convicted of nor pled guilty to another felony crime since the date
of the warrant.
And
• The only existing warrant was issued 10 or more years ago.
And
• (13) medical condition impairs (14) mental capability to resolve the warrant; or (15) incapable of managing (16) benefits; or (17) legally incompetent; or Social Security has appointed a representative payee to handle
(18) benefits or (19) residing in a long-term care facility, such as a nursing home or mental treatment/care
facility.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's name
Choice 2: you
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Amount
Fill-in (3) - Requested As A Date In Format Shown Below
Date MM/CCYY
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) and
Choice 2: (B) through
Choice 3: (C) null
Fill-in (5) - Requested As A Date In Format Shown Below or As A One Position Alpha
Character
Choice 1: Date MM/CCYY
Choice 2: (B) null
Fill-in (6) - Requested As A Date In Format Shown Below
Date MM/DD/CCYY
Fill-in (7) - Systems Generated
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (8) - Systems Generated
Choice 1: He has
Choice 2: She has
Choice 3: You have
Fill-in (9) - Systems Generated
Choice 1: him
Choice 2: her
Choice 3: you
Fill-in (10) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (11) - Systems Generated
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (12) - Systems Generated
Choice 1: He has
Choice 2: She has
Choice 3: You have
Fill-in (13) - Systems Generated
Choice 1: His
Choice 2: Her
Choice 3: Your
Fill-in (14) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (15) - Systems Generated
Choice 1: he is
Choice 2: she is
Choice 3: you are
Fill-in (16) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (17) - Systems Generated
Choice 1: he is
Choice 2: she is
Choice 3: you are
Fill-in (18) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (19)
Choice 1: he is
Choice 2: she is
Choice 3: you are
FUG104 MARTINEZ RESUMPTION (S47)
(System Generated)
Caption: Information About The Martinez Settlement
We have reviewed (1) claim because of the settlement of the Martinez court case. This settlement changes
the types of arrest warrants that we can use to affect the payment of benefits. Our
records show that (2) an outstanding arrest warrant that we will no longer use to affect the payment of
(3) benefits.
Fill-in values:
Fill-in (1)
Choice 1: Name possessive
Choice 2: your
Fill-in (2)
Choice 1: Name has
Choice 2: you have
Fill-in (3)
Choice 1: his
Choice 2: her
Choice 3: your
FUG105 MARTINEZ RESUMPTION BENEFICIARY EFFECTIVE 4/1/09 OR LATER (S48)
(System Generated)
Caption: Information About The Martinez Settlement
We have reviewed (1) claim because of the settlement of the Martinez court case. Starting April 1, 2009,
this settlement changes the types of arrest warrants that we can use to affect the
payment of benefits. Our records show that (2) an outstanding arrest warrant that we will no longer use to affect the payment of
(3) benefits.
Fill-in values:
Fill-in (1)
Choice 1: Name possessive
Choice 2: your
Fill-in (2)
Choice 1: Name has
Choice 2: you have
Fill-in (3)
Choice 1: his
Choice 2: her
Choice 3: your
FUG106 MARTINEZ SETTLEMENT OVERPAYMENT CANCELLATION OR REDUCTION (S49)
(System Generated)
Caption: Information About The Martinez Settlement
(1) (2) overpayment on our records because of the settlement of the Martinez court case.
This settlement changes the types of arrest warrants that we can use to affect the
payment of benefits.
Fill-in values:
Fill-in (1)
Choice 1: We removed
Choice 2: We reduced
Fill-in (2)
Choice 1: your
Choice 2: Name possessive
FUG114 MARTINEZ DENAIL
(Requested)
Caption: Information About The Martinez Settlement
We have looked at the earlier decision we made on (1) case to see if the Martinez Settlement affects that decision. We found that this
court settlement does not change our earlier decision. We cannot (2) (3) (4) for the fugitive suspension period, because we cannot disregard (5) type of unsatisfied (6) .
Our earlier decision remains the final decision of the agency in (7) case.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's name
Choice 2: your
Fill-in (2) - Requested As A One Position Alpha Character
Choice 1: (A) reinstate
Choice 2: (B) resume
Choice 3: (C) cancel
Choice 4: (D) reduce
Fill-in (3) - Systems Generated
Choice 1: Beneficiary's name
Choice 2: your
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) payment
Choice 2: (B) overpayment
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: Beneficiary's name Possessive
Fill-in (6) - Requested As A One Position Alpha Character
Choice 1: (A) parole violation warrant
Choice 2: (B) probation violation warrant
Choice 3: (C) felony warrant
Fill-in (7) - Systems Generated
Choice 1: Beneficiary's name
Choice 2: your
FUG118 CLARK V. ASTRUE COURT CASE- OUTSTANDING WARRANT WILL NO LONGER AFFECT BENEFITS
(Requested)
Caption: Information About the Clark Court Case
We have reviewed (1) benefits because of the Clark v. Astrue court case. This case changes the types of
warrants that we can use to affect the payment of benefits. Our records show that
(2) an outstanding warrant that we will no longer use to affect the payment of (3) benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary’s Name (Possessive)
Fill-in (2) - Systems Generated
Choice 1: you have
Choice 2: Beneficiary’s Name has
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 2: her
FUG121 REDUCING OR CANCELING AN OVERPAYMENT BECAUSE OF CLARK COURT CASE
(Requested)
Caption: Information About the Clark Court Case
(1) an overpayment (2) (3) record because of the Clark v. Astrue court case. This case changes the types of
warrants that we can use to affect the payment of (4) benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: We removed
Choice 2: We reduced
Fill-in (2) - Systems Generated
Choice 1: from
Choice 2: on
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: Beneficiary’s Name (Possessive)
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 2: her
FUG122 NO RELIEF IS DUE TO THE BENEFICARY BECAUSE OF CLARK V. ASTRUE
(Requested)
Caption: Information About the Clark Court Case
We also looked at the earlier decision we made on (1) case to see if the Clark v. Astrue court case could change that decision. We found
that this court case does not affect our earlier decision. No other relief is due
(2) because of Clark for months that we did not pay (3) because of an outstanding warrant. Our earlier decision remains the final decision
of the agency in (4) case.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary’s Name (Possessive)
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: Beneficiary’s Name
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: him
Choice 2: her
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her