ENT004 – MATURING ACTION – LEDGER ACCOUNT FILE (LAF) C TO LAF S FOR LESSDO FOR
SUPPLEMENTAL MEDICAL INSURANCE
We told (1) earlier that when we started paying (2) benefits, we would adjust them
for medical insurance premiums.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
you
|
Fill-in (2)
|
|
Choice 1
|
him
|
Choice 2
|
her
|
Choice 3
|
you
|
ENT007 – MATURING ACTION – SUPPLEMENTAL MEDICAL INSURANCE DEDUCTED FROM BENEFITS
(1) will get benefits starting (2). We told (3) earlier that when we started paying
(4) benefits, we would adjust them for medical insurance premiums.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
You
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Fill-in (2)
|
Current Operating Month (COM) in the format Month CCYY
|
Fill-in (3)
|
|
Choice 1
|
you
|
Choice 2
|
him
|
Choice 3
|
her
|
Fill-in (4)
|
|
Choice 1
|
you
|
Choice 2
|
him
|
Choice 3
|
her
|
ENT009 – LUMP SUM DEATH PAYMENT (LSDP) PAID TO WIDOW(ER) – NUMBER HOLDER (NH) DIED
(1) (2) entitled to a Social Security payment of (3) because of the death of (4) (5).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
You
|
Fill-in (2)
|
|
Choice 1
|
is
|
Choice 2
|
are
|
Fill-in (3)
|
Lump Sum Amount Paid (LSAP) in the format $$$$$.¢¢
|
Fill-in (4)
|
NH-NAME
|
Fill-in (5)
|
Null
|
ENT026 – FOR CERTAIN AWARDS, FULL RETIREMENT AGE (FRA), ENTITLEMENT CONVERSIONS
(1) (2) entitled to monthly (3) benefits beginning (4).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
You
|
Fill-in (2)
|
|
Choice 1
|
is
|
Choice 2
|
are
|
Fill-in (3)
|
|
Choice 1
|
father's
|
Choice 2
|
mother's
|
Choice 3
|
child's
|
Choice 4
|
retirement
|
Choice 5
|
widower's
|
Choice 6
|
widow's
|
Fill-in (4)
|
Historical Date of Entitlement Start (BCLM-DOE-START-REL)
|
ENT036 – BENEFICIARY IDENTIFICATION CODE (BIC) B OR E TERMINATED DUE TO LAST CHILD
IN
CARE
(1) may be able to receive payments once more if (2) (3) taking care of a child of
(4). The child must be under age 16 or disabled and qualify for child's payments.
If (5) (6) to do this, (7) should get in touch with us again.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
You
|
Fill-in (2)
|
|
Choice 1
|
they
|
Choice 2
|
you
|
Fill-in (3)
|
|
Choice 1
|
again start
|
Fill-in (4)
|
Number Holder’s Name (NH-NAME)
|
Fill-in (5)
|
|
Choice 1
|
they
|
Choice 2
|
you
|
Fill-in (6)
|
|
Choice 1
|
start
|
Fill-in (7)
|
|
Choice 1
|
they
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Choice 2
|
you
|
ENT039 – STUDENT TERMINATION PRIOR TO AGE 19
(1) may be able to receive payments again if (2) (3) an elementary or secondary level
school full-time during any month before age 19. If this happens, (4) should get in
touch with us again.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
You
|
Fill-in (2)
|
|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (3)
|
|
Choice 1
|
attends
|
Choice 2
|
attend
|
Fill-in (4)
|
|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
ENT041 – BENEFICIARY IDENTIFICATION CODE (BIC) B2 TO B BASED ON AGE
(1) entitled to spouse benefits based on having a child in (2) care for (3). Beginning
(4), (5) became entitled to spouse benefits based on (6) age.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is”
|
Choice 2
|
You are
|
Fill-in (2)
|
|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
Fill-in (3)
|
|
Choice 1
|
Historical Date of Entitlement Start (BCLM-DOE-START-REL) date in format Month CCYY
|
Choice 2
|
Historical Date of Entitlement Start (BCLM-DOE-START-REL) date plus “and” plus the
BCLM-DOE-START-REL plus 1 month in the format Month CCYY and Month CCYY
|
Choice 3
|
Historical Date of Entitlement Start (BCLM-DOE-START-REL) plus “through” plus the
Historical Date of Entitlement Termination (BCLM-DOE-TERM-REL) date minus 1 month
in the format Month CCYY through Month CCYY
|
Fill-in (4)
|
Historical Date of Entitlement Start (BCLM-DOE-START-REL) for the new Beneficiary
Claim Data (BCLM) occurrence for PIC B
|
Fill-in (5)
|
|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (6)
|
|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
ENT047 – STUDENT AWARD OR STUDENT CHILDHOOD DISABILITY BENEFIT (CDB) AWARD
(1) (2) for child's payments as a student beginning (3).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
You
|
Fill-in (2)
|
|
Choice 1
|
qualifies
|
Choice 2
|
qualify
|
Fill-in (3)
|
Historical Date of Entitlement Start (BCLM-DOE-START-REL) in the Beneficiary Claim
Data (BCLM) occurrence with the Historical Current Entitlement Code (BCLM-CEC) = Student
(S)
|
ENT049 – STUDENT AWARD OR STUDENT REINSTATEMENT
Based on the information we have, (1) entitlement will continue through (2). We will
send (3) another letter when (4) entitlement ends.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
your
|
Fill-in (2)
|
|
Choice 1
|
No Longer in Full-Time Attendance Date (SRD-NLFTA-REL) in the format Month CCYY
|
Choice 2
|
End of Full-Time Attendance Date (SRD-EFTA-REL) in the format Month CCYY
|
Choice 3
|
Student Entitlement High School Graduation Date (SRD-HSGRAD-REL) in the format Month
CCYY
|
Choice 4
|
End of Full-Time Attendance Date (SRD-EFTA-REL) in the format Month CCYY
|
Fill-in (3)
|
|
Choice 1
|
him
|
Choice 2
|
her
|
Choice 3
|
you
|
Fill-in (4)
|
|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
ENT053 – MONTHLY BENEFIT AMOUNT (MBA) EQUAL ZERO DUE TO DISABILITY MAXIMUM (DMAX)
- (HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF TECHNICAL ENTITLEMENT (TECENT)
We cannot pay benefits because all of the money we can pay on this record is already
being paid to (1).
Fill-in values:
|
Fill-in (1)
|
Number Holder Name (NH-NAME)
|
ENT060 – B TO D CONVERSION WHEN NUMBER HOLDER DIES
We have not determined the amount of (1) monthly (2) benefit payment. When we complete
our review of (3) record, you will receive another notice explaining (4) entitlement
to (5) benefits.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
your
|
Fill-in (2)
|
|
Choice 1
|
widower's
|
Choice 2
|
widow's
|
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
|
widower's
|
Choice 2
|
widow's
|
ENT061 – STUDENT TERMINATION PRIOR TO AGE 19
(1) also may be able to receive payments again if (2) (3) disabled before age 22 and
(4) not married since (5) last entitlement, unless the marriage is void or annulled.
If this happens, (6) should get in touch with us again.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
You
|
Fill-in (2)
|
|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (3)
|
|
Choice 1
|
becomes
|
Choice 2
|
become
|
Fill-in (4)
|
|
Choice 1
|
has
|
Choice 2
|
have
|
Fill-in (5)
|
|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
Fill-in (6)
|
|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
ENT062 – NO CHANGE IN THE MONTH OF ELECTION (MOEL) DATA BASED ON THE ANNUAL REPORT
DATA
We reviewed (1) record. When (2) applied, (3) asked us to start (4) benefits in (5).
We found that (6) is still the month when benefits should start.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
your
|
Fill-in (2)
|
|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (3)
|
|
Choice 1
|
he
|
Choice 2
|
she
|
Choice 3
|
you
|
Fill-in (4)
|
|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
Fill-in (5)
|
Pre-MBR Historical Date of Entitlement Start (BCLM-DOE-START-REL)
|
Fill-in (6)
|
Post-MBR Historical Date of Entitlement Start (BCLM-DOE-START-REL)
|
ENT070 – DISABILITY INSURANCE BENEFITS (DIB) TO RETIREMENT INSURANCE BENEFITS (RIB)
AT FULL RETIREMENT AGE (FRA) WHEN PAYMENT IDENTIFICATION CODE (PIC) A CONFIRMS DATE
OF BIRTH
Based on the information given to us, (1) born on (2).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “was”
|
Choice 2
|
you were
|
Fill-in (2)
|
Payment Identification Code (PIC) A's date of birth in the format Month DD, CCYY
|
ENT071 – DISABILITY INSURANCE BENEFITS (DIB) TO RETIREMENT INSURANCE BENEFITS (RIB)
AT FULL RETIREMENT AGE (FRA) FOR PIC A
We are changing the type of benefit (1) from Social Security. Beginning (2), (3) entitled
to retirement benefits. (4) no longer entitled to disability benefits because (5)
reached full retirement age.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “receives”
|
Choice 2
|
you receive
|
Fill-in (2)
|
Full Retirement Age (FRA) attainment month for Payment Identification Code (PIC) A
in the format Month CCYY
|
Fill-in (3)
|
|
Choice 1
|
he is
|
Choice 2
|
she is
|
Choice 3
|
you are
|
Fill-in (4)
|
|
Choice 1
|
He is
|
Choice 2
|
She is
|
Choice 3
|
You are
|
Fill-in (5)
|
|
Choice 1
|
he has
|
Choice 2
|
she has
|
Choice 3
|
you have
|