TN 3 (05-92)
NL 00803.065 Chart for Completing the SSA-L8155-U2 in the Effective Month of the COLA
Use the following chart to find the captions and paragraphs appropriate for the recipient's situation when a COLA and increase in the PMV or VTR result in a payment reduction. Instructions in NL 00802.001B also apply for using this chart.
See instructions in NL 00803.020 for completing COLA notices.
NOTE: We labeled the captions with capital letters in alphabetic order as a place-keeping device due to the length of the chart.
B. Information about your payments
(See the list of paragraphs under this caption in the chart in NL 00803.050 above. The only paragraphs that are not also used on this SSA-L8155-U2 are paragraphs 2804 and 2805.)
C. Your payment is based on these facts
|NL 00804.220||2836||Lead-in paragraph for any income on the record.|
|2835||Value of PMV increased because of COLA.|
|2833||Value of VTR increased because of COLA.|
|2829||Spouse or parent(s) received an increase in title II benefits.|
|2837||Explanation of retrospective monthly accounting.|
|NL 00804.175||1232||Describes type, period and amount of countable income. (Use with paragraph 2836 above.)|
|1248||Spouse or parent(s) has income deemed to recipient.|
|1234||Spouse, parent(s) or sponsor(s) has income change - Recipient has deemed income.|
D. Information about medicaid
(Use this caption only when paragraph 1152 below applies.)
|NL Reference||Paragraph|| |
|NL 00804.110||1152 (or 1170 for Texas)||Mandatory paragraph if recipient lives in a State where SSA makes Medicaid determinations and recipient will be N01.|
E. Things to remember
(Consider the list of paragraphs under this caption in the chart in NL 00803.050.)