PAYB02 – PRIOR MONTH ACCRUAL AMOUNT (PAMT) PAID WITH CURRENT TITLE II REDESIGN
RUN DATE
You will receive (1) around (2).
Fill-in values:
|
Fill-in (1)
|
Prior Month Accrual Amount (PAMT) in the Schedule Pay field on the post-MBR
|
Fill-in (2)
|
Run Date plus 15 days in the format Month DD, CCYY
|
PAYB04 – CURRENT OR DEFERRED PAYMENT AMOUNT DUE AND CURRENT AMOUNT (CAMT)
> $0.00
You will receive (1) for (2) around (3).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Payment amount in the format $$$$$.¢¢ or $$$$$ [Special Payment Amount (SPA) or Monthly
Benefit Payable(MBP)]
|
Choice 2
|
Current Amount (CMA) in the format $$$$$.¢¢ or $$$$$
|
Fill-in (2)
|
|
Choice 1
|
Current Operating Month (COM) in the format Month CCYY
|
Choice 2
|
Deferred Payment Date (DPD) in the format Month CCYY
|
Fill-in (3)
|
|
Choice 1
|
Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current
Operating Month (COM) check will be paid
|
Choice 2
|
Using the Payment Cycle Indicator (PCI), show the calendar date in which the Deferred
Payment Date (DPD) check will be paid
|
PAYB09 – TELLS BENEFICIARY THEIR MONTHLY BENEFIT PAYMENT
(1) After that, you will receive (2) (3) (4) (5).
Fill-in values:
|
Fill-in (1)
|
Null
|
Fill-in (2)
|
Monthly Benefit Payable (MBP) in the format $$$$$.¢¢
|
Fill-in (3)
|
|
Choice 1
|
for
|
Choice 2
|
through
|
Choice 3
|
on or about the
|
Fill-in (4)
|
|
Choice 1
|
third
|
Choice 2
|
second Wednesday
|
Choice 3
|
third Wednesday
|
Choice 4
|
fourth Wednesday
|
Choice 5
|
Current Operating Month (COM) + 1 month in the format Month CCYY
|
Choice 6
|
Work Resumption Diary Date 1 (WRDD1) - 1 month in the format Month CCYY
|
Fill-in (5)
|
|
Choice 1
|
of each month
|
Choice 2
|
Null
|
PAYB15 – MATURING ACTIONS - PAYMENT MONTH
(1) will receive (2) around (3). This is the money, after all deductions, (4) due
for (5).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
He
|
Choice 2
|
She
|
Choice 3
|
You
|
Fill-in (2)
|
Current Amount (CAMT) in the format $$$$$.¢¢
|
Fill-in (3)
|
Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current
Operating Month (COM) check will be paid
|
Fill-in (4)
|
|
Choice 1
|
he is
|
Choice 2
|
she is
|
Choice 3
|
you are
|
Fill-in (5)
|
Show the Current Operating Month (COM) in the format Month CCYY
|
PAYB16 – MATURING ACTIONS SMI AND/OR VOLUNTARY TAX WITHHOLDING DEDUCTED
BENEFITS
We withheld (1) (2) from this payment.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Supplemental Medical Insurance Premium Due Amount (SMI-PREMIUM-AMOUNT) deducted in
the format $$$$
|
Choice 2
|
Voluntary Tax Current Payment Withholding Amount (VCAMT) in the format $$$$
|
Choice 3
|
Total Supplemental Medical Insurance Premium Due Amount (SMI-PREMIUM-AMOUNT) plus
the Voluntary Tax Current Payment Withholding Amount (VCAMT) in the format $$$$
|
Fill-in (2)
|
|
Choice 1
|
for medical insurance premiums
|
Choice 2
|
for voluntary tax withholding
|
Choice 3
|
for medical insurance premiums and for voluntary tax withholding
|
PAYC01 – CAPTION
What We Will Pay and When
PAYC07 – CAPTION
Information About (1) Payments
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
Your
|
PAYC12 – CAPTION
Why We Cannot Pay Current Benefits
PAYC27 – CAPTION
How (1) Benefits Can Be Paid
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
Your
|
PAY037 – PRIOR AERO ACTION DIFFERENCE IN CURRENT MONTHLY ACCRUAL (CMA) CHECK -
SAME CURRENT OPERATING MONTH (COM)
You will receive (1) increase in benefits in a separate payment.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
your
|
PAY084 – BENEFICIARY'S NOTICE PAYEE CHANGE – CURRENT AMOUNT (CAMT)
PAID
We are sending your regular monthly check of (1) to (2) around (3).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Amount in the Special Payment Amount (SPA) in the format $$$$$.¢¢ or $$$$$$
|
Choice 2
|
Current Amount (CAMT) in the format $$$$$.¢¢ or $$$$$$
|
Choice 3
|
Monthly Benefit Payable (MBP) in the format $$$$$.¢¢ or $$$$$$
|
Fill-in (2)
|
New Payee's Name
|
Fill-in (3)
|
|
Choice 1
|
Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current
Operating Month (COM) check will be paid
|
Choice 2
|
Using the Payment Cycle Indicator (PCI), show the calendar date in which the Deferred
Payment Date (DPD) check will be paid
|
PAY085 – BENEFICIARY’S NOTICE - PAYEE CHANGE PRIOR MONTH ACCRUAL AMOUNT (PAMT)
AND CURRENT AMOUNT (CAMT) BOTH PAID
We are sending (1) to (2) for you around (3). We will begin sending your regular monthly
check of (4) to your payee around (5).
Fill-in values:
|
Fill-in (1)
|
Prior Month Accrual Amount (PAMT) > $0.00
|
Fill-in (2)
|
New Payee's Name
|
Fill-in (3)
|
Trigger Run Date (TR-RUN-DATE) plus 15 days in format Month DD, CCYY
|
Fill-in (4)
|
|
Choice 1
|
Amount in the Special Payment Amount (SPA) in the format $$$$$.¢¢ or $$$$$$
|
Choice 2
|
Current Amount (CAMT) in the format $$$$$.¢¢ or $$$$$$
|
Choice 3
|
Monthly Benefit Payable (MBP) in the format $$$$$.¢¢ or $$$$$$
|
Fill-in (5)
|
|
Choice 1
|
Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current
Operating Month (COM) check will be paid
|
Choice 2
|
Using the Payment Cycle Indicator (PCI), show the calendar date in which the Deferred
Payment Date (DPD) check will be paid
|
PAY092 – USED WITH PARAGRAPH PAY002 WHEN PAYING A
PRIOR MONTHLY ACCRUAL (PMA) CHECK
This is the (1) money (2) (3) due (4) (5) (6) (7).
Fill-in values:
|
Fill-in (1)
|
Null
|
Fill-in (2)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 2
|
Beneficiary’s Given Name (BGN)
|
Choice 3
|
you
|
Fill-in (3)
|
|
Choice 1
|
are
|
Choice 2
|
is
|
Fill-in (4)
|
through
|
Fill-in (5)
|
Show end the date associated with the Prior Month Accrual Amount (PAMT) in the format
May 1998
|
Fill-in (6)
|
Null
|
Fill-in (7)
|
Null
|
PAY116 – BENEFITS TERMINATE CURRENT OPERATING MONTH (COM) + 1 – CURRENT AMOUNT
(CAMT) PAID FOR CURRENT OPERATING MONTH (COM)
This is the last payment (1) will receive.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
Mr. plus Beneficiary Last Name (BLN)
|
Choice 2
|
Ms. plus Beneficiary Last Name (BLN)
|
Choice 3
|
you
|
PAY126 – BENEFICIARY'S NOTICE - PAYEE CHANGE – PRIOR MONTH ACCRUAL AMOUNT (PAMT)
PAID
We are sending (1) to (2) for you around (3).
Fill-in values:
|
Fill-in (1)
|
Prior Month Accrual Amount (PAMT) > $0.00
|
Fill-in (2)
|
New Payee's Name
|
Fill-in (3)
|
Prior Month Accrual Amount Payment Date (PAMT- PAID-REL-D) associated with the Prior
Month Accrual Amount (PAMT) > $0.00
|
PAY148 – DEFERRED FOR OVERDUE OVERPAYMENT OR PARTIAL RECOVERY
ESTABLISHED
We are withholding (1) of (2) monthly benefits (3) (4) to recover (5).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
all
|
Choice 2
|
some
|
Choice 3 |
Monthly Recovery Amount (MRA) on the Post-MBR |
Fill-in (2)
|
|
Choice 1
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 2
|
your
|
Fill-in (3)
|
|
Choice 1 |
beginning |
Choice 2 |
Null |
Fill-in (4)
|
|
Choice 1
|
Current Operating Month (COM) + 1 in the format Month CCYY
|
Choice 2
|
Current Operating Month (COM) in the format Month CCYY
|
Choice 3 |
Null |
Fill-in (5)
|
|
Choice 1 |
an overpayment |
Choice 2 |
past due medical insurance premiums |
Choice 3 |
an overpayment and past due medical insurance premiums |
PAY161 – LEDGER ACCOUNT FILE (LAF) = C AND CURRENT AMOUNT (CAMT) =
$0.00
No payment is due at this time because of adjustments made to (1) benefits.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
his
|
Choice 2
|
her
|
Choice 3
|
your
|
PAY176 – PART B REFUND DUE TO INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA)
AND REFUND PAID AS A PRIOR MONTH ACCRUAL AMOUNT (PAMT) OR IN THE CURRENT AMOUNT
(CAMT) CHECK
Based on the information we have, (1) (2) due a Medicare Part B premium refund.
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
|
PAY218 – EXPLAINS THAT BENEFITS CANNOT CURRENTLY BE PAID
We cannot pay you (1) regular monthly benefit at this time.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
PAY219 – EXPLAINS THAT INCREASE ONLY APPLIES TO PAST BENEFITS – CURRENT MONTHLY
BENEFIT REMAINS THE SAME
The increase applies only to past benefits. It does not affect (1) monthly payment
of (2).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 3
|
his
|
Choice 4
|
her
|
Fill-in (2)
|
Net Amount of check to be issued
|
PAY220 – EXPLAINS THAT THE CHECK CONTAINS THE CURRENT MONTHLY
BENEFIT PLUS ANY INCREASED AMOUNT DUE FOR PRIOR MONTHS
This payment includes (1) new monthly benefit amount. This payment also includes any
increase in benefits we owe (2).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 3
|
his
|
Choice 4
|
her
|
Fill-in (2)
|
|
Choice 1
|
you
|
Choice 2
|
him
|
Choice 3
|
her
|
PAY221 – DUALLY ENTITLED BENEFICIARIES – RECEIVING A PIA INCREASE ON OWN ACCOUNT
AND ONGOING MONTHLY PAYMENT AMOUNT REMAINS THE SAME
(1) will continue to receive the same amount each month. When we add the amounts of
the two benefits together, the total amount does not change.
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
You
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
|
Choice 3
|
He
|
Choice 4
|
She
|
PAY222 – DUALLY ENTITLED BENEFICIARIES – PIA CHANGES – PROVIDES AMOUNT DUE ON
EACH RECORD
The new monthly benefit on (1) Social Security record will be (2). (3) new monthly
benefit on the other record will be (4).
Fill-in values:
|
Fill-in (1)
|
|
Choice 1
|
your
|
Choice 2
|
Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
|
Choice 3
|
his
|
Choice 4
|
her
|
Fill-in (2)
|
Smaller Actuarially Reduced Monthly Benefit Amount (SAMBA)
|
Fill-in (3)
|
|
Choice 1
|
Your
|
Choice 2
|
His
|
Choice 3
|
Her
|
Fill-in (4)
|
Larger Excess Monthly Benefit Amount (LEMBA)
|