XRP001 PROVISIONAL PAYMENT ALLOWANCE (P01)

(Requested)

Caption: None

We are writing to tell you that  (1)  will receive provisional Social Security disability benefits based on  (2)  request for reinstatement.

Under the Ticket to Work and Work Incentives Improvement Act of 1999, we can pay  (3)  up to 6 months of provisional benefits while  (4)  request for reinstatement is being decided.  (5)  will receive another letter when we make our decision on  (6)  request.

XRP002 PROVISIONAL PAYMENTS BASED ON MONTHLY AMOUNT (P02)

(Requested)

Caption: What We Will Pay

The amount of  (1)  monthly provisional benefit is based on the amount of  (2)  last monthly Social Security benefit plus cost of living increases.

XRP003 6 MONTHS PROVISIONAL PAYMENTS PAID IN SINGLE PAYMENT (P03)

(Requested)

Caption: What We Will Pay

Because this is  (1)  payment for 6 months of provisional benefits,  (2)  will not receive any additional provisional benefits.

XRP004 WHEN PROVISIONAL PAYMENTS WILL END (P04)

(Requested)

Caption: When provisional benefits end

Under the law,  (1)  provisional benefits will end with the earliest of:

• •

  The month we make a determination about  (2)  request for reinstatement; or

• •

  The month  (3)  substantial gainful activity; or

• •

  The month before  (4)  full retirement age; or

The fifth month following the month  (5)  made  (6)  request. This means that if none of the other conditions apply, then  (7)  provisional benefits will end  (8)  .

XRP005 EXPLANATION THAT PROVISIONAL BENEFITS MAY NOT HAVE TO BE REPAID (P05)

(Requested)

Caption: Other information

If we deny  (1)  request for reinstatement,  (2)  generally will not have to repay the provisional benefits  (3)  received unless we determine that  (4)  knew or should have known that  (5)  did not meet the reinstatement requirements.

XRP006 TERMINATION OF PROVISIONAL BENEFITS - 6 MONTHS PROVISIONAL BENEFIT PAID (P15)

(Requested)

Caption: Why Your Provisional Benefits Ended

We are writing to tell you that  (1)  no longer can receive provisional Social Security disability benefits based on  (2)  request for reinstatement. The last month for which  (3)  can receive provisional benefits is  (4)  .

Under the law, we can pay  (5)  up to 6 months of provisional benefits while  (6)  request for reinstatement is being decided. Our records show that we have paid these benefits for 6 months.  (7)  will receive another letter when we make our decision on  (8)  request.

XRP007 MEDICARE COVERAGE TERMINATED - PROVISIONAL BENEFITS ENDED (P13)

(Requested)

Caption: Information About Medicare

As we told you in our earlier notice  (1)  would have Medicare  (2)  insurance coverage while  (3)  received provisional benefits. Because  (4)  provisional benefits have ended,  (5)  Medicare  (6)  insurance coverage will end at the same time.

XRP008 TERMINATION OF PROVISIONAL BENEFITS - BENEFICIARY ATTAINED FULL RETIREMENT AGE (FRA) (P14)

(Requested)

Caption: None

We are writing to tell you that  (1)  no longer can receive provisional Social Security disability benefits based on  (2)  request for reinstatement.  (3)  will receive another letter when we make our decision on  (4)  request.

XRP009 PROVISIONAL BENEFITS TERMINATED - BENEFICARY PERFORMING SUBSTANTIAL GAINFUL WORK (P18)

(Requested)

Caption: Why Your Provisional Benefits Ended

The Ticket to Work and Work Incentives Improvement Act of 1999 provides that an individual's provisional benefits shall end if the individual performs substantial gainful work. The evidence in  (1)  case shows that  (2)  began performing substantial gainful work in  (3)  . Accordingly, the last provisional benefit  (4)  may receive is for the month of  (5)  .

XRP010 MEDICAL AND/OR HOSPITAL INSURANCE TERMINATED - PROVISIONAL BENEFITS ENDED (P19)

(Requested)

Caption: Information About Medicare

Since  (1)  no longer receiving provisional monthly Social Security benefits, we are stopping  (2)   (3)  insurance coverage. This coverage ends the last day of  (4)  . Please destroy  (5)  Medicare card after coverage ends.

XRP012 PROVISIONAL BENEFITS ENDED - BENFICIARY REACHED FULL RETIREMENT AGE (P16)

(Requested)

Caption: Why Your Provisional Benefits Ended

 (1)  can no longer receive provisional benefits based on  (2)  request for reinstatement because benefits related to disability cannot be paid after an individual reaches full retirement age. Our records show that  (3)  reached full retirement age  (4)  in  (5)  . Accordingly, the last provisional benefit  (6)  may receive is for the month of  (7)  .

XRP013 MEDICARE CONTINUES - BENEFICIARY AGE 65 OR OLDER (P17)

(Requested)

Caption: Information About Medicare

 (1)  Medicare coverage will continue because  (2)  age 65 or older.

XRP018 TERMINATION OF PROVISIONAL BENEFITS - LEAD IN UTI (P12)

(Requested)

Caption: Why Your Provisional Benefits Ended

 (1)  no longer can receive provisional Social Security disability benefits based on  (2)  request for reinstatement. The last month for which  (3)  can receive provisional benefits is  (4)  .