GARC01 – CAPTION
If You Disagree With The Court Order
GAR012 – GARNISHMENT AMOUNT DEDUCTED FROM PRIOR MONTHLY ACCRUAL (PMA) AND/OR CURRENT
MONTHLY ACCRUAL (CMA)
We took out (1) from (2) benefits due (3) through (4) to pay (5) child support, alimony,
or court ordered victim restitution.
Fill-in values:
|
|
Fill-in (1)
|
|
Choice 1
|
Deductions/Additions History Amount (DAH-AMOUNT) for Deductions/Additions History
Item Code (DAH-ITEM) 465 (Garnishment) and a Deductions/Additions History Type of
Payment (DAH-TOP) = PMA (P)
|
Choice 2
|
Deductions/Additions History Amount (DAH-AMOUNT) for Deductions/Additions History
Item Code (DAH-ITEM) 465 (Garnishment) and Deductions Additions History Type of Payment
(DAH-TOP) = RCMA (R) or PCMA (C)
|
Fill-in (2)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Fill-in (3)
|
|
Choice 1
|
you
|
Choice 2
|
him
|
Choice 3
|
her
|
Fill-in (4)
|
|
Choice 1
|
Current Operating Month (COM) in the format Month CCYY
|
Choice 2
|
Deferred Payment Date (DPD) in the format Month CCYY
|
Fill-in (5)
|
|
Choice 1
|
your
|
Choice 2
|
his
|
Choice 3
|
her
|
GAR013 – GARNISHMENT AMOUNT DEDUCTED FROM THE MONTHLY BENEFIT PAYABLE (MBP)
We will take out (1) from (2) benefit each month to pay (3) child support, alimony,
or court ordered victim restitution.
Fill-in values:
|
|
Fill-in (1)
|
Deductions/Additions History Amount (DAH-AMOUNT) for Deductions/Additions History
Item Code (DAH-ITEM) 465 (Garnishment) and Deductions/Additions Type of Payment (DAH-TOP)
= MBP (M)
|
Fill-in (2)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Fill-in (3)
|
|
Choice 1
|
your
|
Choice 2
|
his
|
Choice 3
|
her
|
GAR014 – GARNISHMENT DEDUCTION STARTS – LEDGER ACCOUNT FILE (LAF) = C and CURRENT
AMOUNT (CAMT) = $0.00
We withheld (1) from (2) monthly payment to pay child support, alimony, or court ordered
victim restitution.
Fill-in values:
|
|
Fill-in (1)
|
Deductions/Additions History Amount (DAH-AMOUNT) for Deductions/Additions History
Item Code (DAH-ITEM) 465 (Garnishment) and Deductions Additions History Type of Payment
(DAH-TOP) = RCMA (R) or PCMA (C)
|
Fill-in (2)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
your
|
GAR015 – GARNISHMENT DEDUCTION AMOUNT CHANGES – CLOSED PERIOD CHANGE ONLY
We changed the amount we take out of (1) monthly benefit to pay (2) child support,
alimony, or court ordered victim restitution.
Fill-in values:
|
|
Fill-in (1)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Fill-in (2)
|
|
Choice 1
|
your
|
Choice 2
|
his
|
Choice 3
|
her
|
GAR016 – GARNISHMENT AMOUNT NO LONGER BEING DEDUCTED FROM SOCIAL SECURITY ADMINISTRATION
BENEFITS
We stopped taking money out of (1) benefits for child support, alimony, or court-ordered
victim restitution.
Fill-in values:
|
|
Fill-in (1)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
GAR062 – GARNISHMENT REFUND AND ANOTHER TITLE II REDESIGN INTRODUCTORY PARAGRAPH IS
GENERATED
This payment includes a refund of money we withheld to pay for (1) child support,
alimony, or court ordered victim restitution.
Fill-in values:
|
|
Fill-in (1)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) possessive
|
GAR063 – GARNISHMENT REFUND AND NO OTHER TITLE II REDESIGN INTRODUCTORY PARAGRAPH
GENERATED
(1) due a refund of money we withheld to pay child support, alimony, or court ordered
victim restitution.
Fill-in values:
|
|
Fill-in (1)
|
|
Choice 1
|
You are
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is”
|
GAR088 – NO APPEAL RIGHTS APPLY FOR GARNISHMENT DEDUCTION BUT APPEAL RIGHTS APPLY
FOR ANOTHER TITLE II REDESIGN REASON
The appeal rights discussed below do not apply to the court ordered child support,
alimony, or court ordered victim restitution. If you disagree with the court order,
you will need to contact the court directly, or have a lawyer do it for you.
GAR091 – GARNISHMENT DEDUCTION AMOUNT CHANGES – ONGOING
We made a change in (1) child support, alimony or court ordered victim restitution
because (2) monthly benefit amount changed. (3) current court order may not have changed.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Fill-in (2)
|
|
Choice 1
|
your
|
Choice 2
|
his
|
Choice 3
|
her
|
Fill-in (3)
|
|
Choice 1
|
Your
|
Choice 2
|
His
|
Choice 3
|
Her
|
GAR092
We are writing to you about court order number *F1. We stopped taking money out of
*F2 Social Security payments because *F3. The *F4 that we sent you in *F5 was the
last payment due.
Fill-Ins
*F1-1 case
*F1-2 civil action number
*F2-1 full name as it appears on the order possessive
*F3-1 he is no longer receiving payments
*F3-2 she is no longer receiving payments
*F3-3 you ordered that we no longer withhold this money
*F3-4 he has paid more than the court order required
*F3-5 she has paid more than the court order required
*F4-1 dollar amount of last payment
*F5-1 month and year
RCYC01
GAR093
(Enclosure: Refund Envelope: The enclosure will appear at the end of the notice)
*F1 should not have received the *F2 that we sent after that date. Please return the
*F3 to us by check or money order. Make it payable to the Social Security Administration.
Be sure to put *F4 claim number on the check or money order.
IMPORTANT: Please use the Refund Envelope enclosed in our letter to mail your payment to us.
Always include the claim number on the check or money order. If you no longer have
the envelope, please mail your payment to:
Social Security Administration
Mid Atlantic Program Service Center
PO Box 3430
Philadelphia PA 19122-9985
Enclosure: Refund Envelope
Fill-Ins:
*F1-1 “You” (NOTE: Use this fill-in when sending this notice directly to the receiver. The receiver
could be the court or another party.)
*F1-2 Name of receiver of garnished payments if other than the court (Use Name of
receiver of garnished payments if other than the court, when sending this notice to
the court asking them to return money they ordered us to send the receiver.)
*F2-1 combined dollar amount of all the checks that we shouldn't have sent
*F3-1 combined dollar amount of all the checks that we shouldn't have sent
*F4-1 Beneficiary’s name possessive
OPTIONAL:
OPTC02
OPTIONAL:
GAR094
If *F1 receiving payments again, we will need a new court order before we can start
withholding money for child support, alimony, or court ordered victim restitution.
(NOTE: Use this sentence only when using choice 1 or 2 of fill-in 3 for GAR 092, i.e., he
or she is not currently receiving Social Security payments.)
*F1-1 you start
*F1-2 Beneficiary’s name starts
REQUIRED Either CTDO or 3901D
Enclosures:
Refund Envelope