BENC05 – CAPTION
You May Choose Not To Receive Benefits Right Now
BENC06 – CAPTIONS
Social Security Benefits Can Affect SSI Payments
BENH01 – REFER TO WORKSHEET HEADER NL 00730.149C
BEN008 – EXPLAINS VOLUNTARY DELAYED RETIREMENT CREDITS (DRC) TO THE BENEFICIARY
(1) may choose to delay benefits on (2) own Social Security number beginning (3).
Social Security benefits increase by a certain percentage if (4) retirement. We call
this a delayed retirement credit. (5) can earn a credit for each full month after
age (6) that (7) not receive a monthly benefit. (8) can earn credits for any months
before age 70.
While we cannot give financial advice, we can point out some things to consider. For
example, (9) may want to consider:
-
•
How (10) monthly benefit amount in the future would compare with (11) monthly benefit
amount today;
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•
How long it will take for future higher benefits to make up for benefits (12) not
to receive now; and
-
•
The effect that Social Security benefits may have on (13) income taxes or private
pension(s).
Please go to our Internet website at www.socialsecurity.gov for more information about delayed retirement credits. At this website, you can find
out how much (14) benefit may increase.
Please contact us right away if (15) would like to earn these delayed retirement credits
instead of receiving benefits. Please use the telephone number or address shown below.
If (16) to earn these credits and later (17) mind, just contact us and we will start
(18) monthly retirement benefits.
Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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You
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Fill-in (2)
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Choice 1
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his
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Choice 2
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her
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Choice 3
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your
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Fill-in (3)
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Full Retirement Age (FRA) attainment month and year in the format Month CCYY
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Fill-in (4)
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Choice 1
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he delays
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Choice 2
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she delays
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Choice 3
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you delay
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Fill-in (5)
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Choice 1
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He
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Choice 2
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She
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Choice 3
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You
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Fill-in (6)
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Choice 1
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65
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Choice 2
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65 and 2 months
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Choice 3
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65 and 4 months
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Choice 4
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65 and 6 months
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Choice 5
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65 and 8 months
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Choice 6
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65 and 10 months
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Choice 7
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66
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Choice 8
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66 and 2 months
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Choice 9
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66 and 4 months
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Choice 10
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66 and 6 months
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Choice 11
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66 and 8 months
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Choice 12
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66 and 10 months
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Choice 13
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67
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Fill-in (7)
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Choice 1
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he does
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Choice 2
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she does
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Choice 3
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you do
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Fill-in (8)
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Choice 1
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He
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Choice 2
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She
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Choice 3
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You
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Fill-in (9)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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you
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Fill-in (10)
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Choice 1
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his
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Choice 2
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her
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Choice 3
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your
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Fill-in (11)
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Choice 1
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his
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Choice 2
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her
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Choice 3
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your
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Fill-in (12)
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Choice 1
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he chooses
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Choice 2
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she chooses
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Choice 3
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you choose
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Fill-in (13)
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Choice 1
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his
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Choice 2
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her
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Choice 3
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your
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Fill-in (14)
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Choice 1
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his
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Choice 2
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her
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Choice 3
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your
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Fill-in (15)
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Choice 1
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he
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Choice 2
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she
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Choice 3
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you
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Fill-in (16)
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Choice 1
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he chooses
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Choice 2
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she chooses
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Choice 3
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you choose
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Fill-in (17)
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Choice 1
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changes his
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Choice 2
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changes her
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Choice 3
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change your
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Fill-in (18)
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Choice 1
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his
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Choice 2
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her
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Choice 3
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your
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BEN010 – EXPLAINS TO THE WORKING BENEFICIARY THAT BENEFITS FOR A PRIOR YEAR ARE CHANGING
We changed (1) benefits for (2). Our records show that (3) earned (4) in (5).
Fill-in values:
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Fill-in (1)
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Choice 1
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your
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) possessive
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Fill-in (2)
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Year of Earnings Report (YOER) in format CCYY
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Fill-in (3)
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Choice 1
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you
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Choice 2
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he
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Choice 3
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she
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Fill-in (4)
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Amount of Reported Earnings (AORE) in the format $$$$$¢¢
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Fill-in (5)
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Year of Earnings Report (YOER) in format CCYY
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BEN011 – EXPLAINS TO THE WORKING BENEFICIARY THAT HE OR SHE HAS BEEN INCORRECTLY PAID
FOR THE CURRENT YEAR
We changed (1) benefits for (2). Our records show that (3) to earn (4) (5).
Fill-in values:
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Fill-in (1)
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Choice 1
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your
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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Fill-in (2)
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Year of Earnings Report (YOER) in format CCYY
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Fill-in (3)
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Choice 1
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you expect
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Choice 2
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he expects
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Choice 3
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she expects
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Fill-in (4)
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Amount of Reported Earnings (AORE) in the format $$$$$¢¢
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Fill-in (5)
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this year
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BEN012 – EXPLAINS TO THE WORKING BENEFICIARY THAT HIS OR HER BENEFITS FOR MULTIPLE
YEARS ARE CHANGING
We changed (1) benefits for the following years:
Fill-in values:
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Fill-in (1)
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Choice 1
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your
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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BEN013 – A CHART HEADING UTI ALONG WITH BEN014, PROVIDES THE WORKING BENEFICIARY THE
EARNINGS PREVIOUSLY ON THE RECORD AND THE EARNINGS NOW REPORTED
Year Earnings You Reported Earnings On Our Records
BEN014 – PROVIDES THE WORKING BENEFICIARY INFORMATION ABOUT EARNINGS PREVIOUSLY ON
THE RECORD AND THE EARNINGS BEING NEWLY REPORTED IN A CHART - FOLLOWS BEN013
(1) (2) (3)
Fill-in values:
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Fill-in (1)
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Year of Earnings Report (YOER) in format CCYY
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Fill-in (2)
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Amount of Reported Earnings (AORE) in the format $$$$$¢¢
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Fill-in (3)
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Pre-MBR Amount of Reported Earnings (AORE) in the format $$$$$¢¢
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BEN015 – TELLS THE BENEFICIARY THAT MONTHLY BENEFITS CAN BE PAID WHEN THE ANNUAL REPORT
DATA IS CHANGING
We can (1) pay (2) monthly benefits.
Fill-in values
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Fill-in (1)
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Choice 1
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continue to
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Choice 2
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now
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Fill-in (2)
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Choice 1
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him
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Choice 2
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her
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Choice 3
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you
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BEN016 – LEDGER ACCOUNT FILE (LAF) S TO LAF S, NO CHANGE IN HISTORY REASON FOR SUSPENSION
OR TERMINATION (HRFST) BUT MONTHLY BENEFIT AMOUNT (MBA) CHANGE
We cannot pay (1) monthly benefits at this time.
Fill-in values:
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Fill-in (1)
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Choice 1
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him
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Choice 2
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her
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Choice 3
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you
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BEN017 – EXPLAINS THE MONTH OR MONTHS BENEFITS WILL BE WITHHELD TO RECOVER AN OVERPAYMENT
We must withhold your benefits for (1).
Fill-in values:
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Fill-in (1)
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Choice 1
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Current Operating Month (COM) in the format Month CCYY
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Choice 2
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Current Operating Month (COM) plus ”and” plus the Deferred Payment Date -1 month in
the format Month CCYY
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Choice 3
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Current Operating Month (COM) plus ”through” plus the Deferred Payment Date -1 month
in the format Month CCYY
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BEN019 – THIS PARAGRAPH SHOULD BE ON ALL NOTICES WHERE SUPPLEMENTAL SECURITY INCOME
(SSI) WINDFALL OFFSET IS INVOLVED
The Social Security benefits you receive count as income and resources and can lower
the amount of SSI payments you can receive. When a person receives SSI money for a
month and later becomes entitled to Social Security for the same month, we have to
refigure the SSI payment. We hold back some of the Social Security benefits while
we do this, so the person doesn't owe us if we've paid too much SSI.
BEN021 – SUPPLEMENTAL SECURITY INCOME (SSI) WINDFALL OFFSET IS DETERMINED AND THE
HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF WINDFALL OFFSET (WINFAL) IS
REMOVED
In an earlier letter, we told you that (1) entitled to Social Security but that we
were holding back benefits for (2). We withheld (3) in Social Security benefits.
We did this because our records showed (4) could have been getting Supplemental Security
Income (SSI) when we started paying (5) Social Security benefits. And Social Security
benefits can lower the amount of SSI payments (6) can receive.
Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus ”was”
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Choice 2
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you were
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Choice 3
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you
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Fill-in (2)
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Choice 1
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History Start date of the first month where Reason for Suspension = WINFAL in the
format Month CCYY
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Choice 2
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Start date that corresponds to the Reason for Suspension = WINFAL plus ”and” plus
the Stop date of the last WINFAL Suspension month in the format Month CCYY
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Choice 3
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History Start date of the first month where Reason for Suspension = WINFAL plus “through”
plus the Stop date of the last WINFAL Suspension month in the format Month CCYY
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Fill-in (3)
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Windfall Total Amount (WTA) in the format $$$$$.¢¢
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Fill-in (4)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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you
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Fill-in (5)
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Choice 1
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him
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Choice 2
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her
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Choice 3
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you
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Fill-in (6)
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Choice 1
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he
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Choice 2
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she
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Choice 3
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you
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BEN022 – EXPLAINS TO THE BENEFICIARY STARTING FULL RETIREMENT AGE (FRA) THAT BENEFITS
ARE NO LONGER WITHHELD
Since (1) (2) full retirement age in (3), we will not withhold (4) benefits because
of earnings in that month or later.
Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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you
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Fill-in (2)
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Choice 1
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was
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Choice 2
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will be
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Choice 3
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were
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Fill-in (3)
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Full Retirement Age (FRA) attainment in the format Month CCYY
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Fill-in (4)
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Choice 1
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his
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Choice 2
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her
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Choice 3
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your
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BEN023 – INFORMS THE BENEFICIARY OF THE OPTION TO EARN VOLUNTARY DELAYED RETIREMENT
CREDITS (DRC)
In this letter, we explain that (1) can choose to delay being paid benefits now. If
(2) retirement benefits, (3) can earn special credit that may increase the amount
of benefits (4) later.
Fill-in values:
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Fill-in (1)
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Choice 1
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you
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Fill-in (2)
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Choice 1
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you delay
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Choice 2
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he delays
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Choice 3
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she delays
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Fill-in (3)
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Choice 1
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you
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Choice 2
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he
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Choice 3
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she
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Fill-in (4)
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Choice 1
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you receive
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Choice 2
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he receives
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Choice 3
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she receives
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Choice 4
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Beneficiary’s Given Name (BGN) plus “receives”
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BEN026 – TELLS THE BENEFICIARY THERE IS NO ADJUSTMENT OF BENEFITS AT THIS TIME
No change to (1) benefits is necessary at this time.
Fill-in values:
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Fill-in (1)
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Choice 1
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your
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Choice 2
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his
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Choice 3
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her
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Choice 4
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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BEN028 – EARNINGS CHANGE TO ZERO IN A PRIOR YEAR OR YEARS AND BENEFITS ARE CHANGING
We changed (1) benefits for (2). Our records show that (3) did not have any earnings
in (4).
Fill-in values:
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Fill-in (1)
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Choice 1
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your
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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Fill-in (2)
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Choice 1
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Year benefits changed in the format CCYY
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Choice 2
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and
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Choice 3
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comma (,)
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Fill-in (3)
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Choice 1
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you
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Choice 2
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he
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Choice 3
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she
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Fill-in (4)
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Choice 1
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Year of no earnings in the format CCYY
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Choice 2
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and
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Choice 3
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comma (,)
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BEN029 – EARNINGS CHANGE TO ZERO ONLY IN THE CURRENT YEAR AND BENEFITS ARE CHANGING
- THIS UTI WILL ONLY APPEAR ON A WORKING BENEFICIARY NOTICE
We changed (1) benefits for (2). Our records show that (3) not plan to have any earnings
(4).
Fill-in values:
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Fill-in (1)
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Choice 1
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your
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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Fill-in (2)
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Year benefits changed in the format CCYY
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Fill-in (3)
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Choice 1
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you do
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Choice 2
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he does
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Choice 3
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she does
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Fill-in (4)
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this year
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BEN045 – NON-SERVICE MONTHS CHANGE FOR A PAST PERIOD
(1) due full benefits for (2). This is because we used a special rule to count (3)
earnings. We explain this rule in the enclosed fact sheet, "How Work Affects Your
Social Security."
Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “was”
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Choice 2
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You were
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Fill-in (2)
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Choice 1
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First non-service month greater than or equal to the Current Date of Entitlement (DOEC)
in the format Month CCYY
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Choice 2
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and
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Choice 3
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through
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Choice 4
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comma (,)
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Fill-in (3)
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Choice 1
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his
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Choice 2
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her
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Choice 3
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your
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BEN050 – INFORMATIONAL - BENEFICIARY TERMINATES DUE TO MARRIAGE
We might still be able to pay (1) if (2) married a person who is receiving Social
Security benefits. Please get in touch with us if this is true.
Fill-in values:
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Fill-in (1)
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Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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you
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Fill-in (2)
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Choice 1
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he
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Choice 2
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she
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Choice 3
|
you
|
BEN051 – DUALLY ENTITLED - COMBINE PAYMENTS
We will send (1) both benefits in one check each month under (2) own Social Security
claim number.
Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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you
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Fill-in (2)
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Choice 1
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your
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Choice 2
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his
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Choice 3
|
her
|
BEN052 – DUALLY ENTITLED - SPLIT PAYMENTS
We will send (1) separate checks each month under each Social Security claim number.
Fill-in values:
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Fill-in (1)
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Choice 1
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
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Choice 2
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you
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BEN057 – LEDGER ACCOUNT FILE (LAF) S TO LAF S MONTHLY BENEFIT AMOUNT (MBA) CHANGE
- NO HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) CHANGE
We cannot pay (1) monthly benefits for (2).
Fill-in values:
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Fill-in (1)
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Choice 1
|
him
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Choice 2
|
her
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Choice 3
|
you
|
Fill-in (2)
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Choice 1
|
this month
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Choice 2
|
these months
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BEN103 – MONTHLY BENEFIT REDUCED DUE TO RECEIPT OF A GOVERNMENT PENSION – BENEFICIARY
IDENTIFICATION CODE (BIC) B, D, E OR W ONLY
We reduce Social Security benefits paid to (1) if they also receive a government pension
based on their own work. We reduce benefits by two-thirds of the amount of the pension.
For this reason, we are reducing (2) benefits beginning (3), by (4).
Fill-in values:
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Fill-in (1)
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Choice 1
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husbands
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Choice 2
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wives
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Choice 3
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widows
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Choice 4
|
widowers
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Fill-in (2)
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Choice 1
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your
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Choice 2
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Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
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Fill-in (3)
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Government Pension Monthly Start Date (GPM-START-REL) in the format Month CCYY
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Fill-in (4)
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Government Pension Monthly Amount Withheld (GPM-WTHLD-AMT) in the format $$$$$.¢¢
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BEN125- REFER TO “YOUR MONTHLY BENEFITS” FACT SHEET
Please see the enclosed Fact Sheet “Your Monthly Benefits” for more information on
(1) (2).
Fill-in values:
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Fill-in (1)
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Choice 1
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your
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Choice 2
|
his
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Choice 3
|
her
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Fill-in (2)
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Choice 1
|
overpayment
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Choice 2
|
underpayment
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