Program Operations Manual System (POMS)
Basic (05-11)
LIS004 INTRODUCTORY STATEMENT A 20, A21, A 22 ADJUSTMENT NOTICE (G52)
(System Generated)
Caption: None
We are writing to give you new information about the (1) benefits which (2) on this Social Security record.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: disability
Choice 2: retirement
Choice 3: wife's
Choice 4: husband's
Choice 5: child's
Choice 6: widow's
Choice 7: widower's
Choice 8: mother's
Choice 9: father's
Choice 10: disabled widow's
Choice 11: disabled widower's
Choice 12: disabled divorced widow's
Choice 13: disabled divorced widower's
Choice 14: Medicare
Choice 15: null
Fill-in (2) - Systems Generated
Choice 1: you receive
Choice 2: Beneficiary Name receives