TN 25 (02-95)
1100. Situation Where Used:
Used on SSA-L8030's for denials based on claimant's refusal to provide requested information
on factors other than blindness/disability.
To be eligible for Supplemental Security Income payments, we asked (you) to provide evidence concerning (your) claim. Since (you) did not give us the information we asked for, we must make our determination based
on the information we have. Based on the information in our records, we have determined
that (you) are not eligible to receive payments.
2100. Situation Where Used:
Use when we are suspending payment or eligibility due to N20. For example, the payment
status changes from C01, E01, or N01 in 1619(b) eligibility, to N20 for failure to
furnish requested information on factors other than disability /blindness. Use on
an SSA-L8155-U2, Notice of Planned Action, under the caption, “Why [Your/Recipient's Name][Payment /
Eligibility]Changed.” (When you use this paragraph, be sure to also use paragraph 2508 (paragraph SUSM52
for manual notices) in NL 00804.240.)
NOTE: See paragraph SUSM51, which follows, to use in N20 manual notices.
We notified you that to continue (1) you must furnish us with information concerning (your) claim. Since you have not done so, (2) will be suspended beginning (3) .
|
(1)
|
Choice 1 -
|
receiving Supplemental Security Income payments
|
| |
Choice 2 -
|
to be eligible under the Supplemental Security Income program
|
|
(2)
|
Choice 1 -
|
(your) payments
|
| |
Choice 2 -
|
(your) eligibility
|
|
(3)
|
(Month/Year)
|
SUSM51. Situation Where Used:
Use this language for N20 manual notices. Use it in the same situation as for paragraph
2100 above.
We asked (you) earlier to give us information that we need to (1) . Since (you) have not done this, we will (2) in (3) .
(You) still have time to keep (your) SSI (4) , but we must hear from (you) right away.We will help (you) get any information that we need.
| (1) |
Choice 1 - pay (you) SSI
|
| |
Choice 2 - keep (your) SSI case active
|
| (2) |
Choice 1 - stop (your) SSI
|
| |
Choice 2 - close (your) SSI case
|
| (3) |
Month/Year |
| (4) |
Choice 1 - case active |
| |
Choice 2 - null |
NOTE: When E01 or 1619(b) eligibility changes to N20, select from fill-in (1), Choice 2
and fill-in (2), Choice 2.
2101. Situation Where Used:
Reinstatement based on receipt of requested information. Status changes from N20 to
C01 or E01.
(1) effective (2) since (you) have furnished us with the information we asked for.
| (1) |
Choice 1 - |
(You) are eligible for supplemental security income payments
|
| |
Choice 2 - |
(You) are eligible under the Supplemental Security Income program
|
| (2) |
(Month/Year) |
Manual Paragraphs
PMTM01. Situation Where Used:
IC: Use in award situations to explain a nonpayment month(s) for which you are unable
to determine eligibility (payment status code N05). Use on an SSA-L8025-U2, Notice
of Award, under the caption, “[Your/(Recipient's Name)] Payment Is Based On These Facts.”
(1) cannot get SSI for (2) because you could not give us all of the facts we needed about (3) . We also tried, but could not get these facts.
-
(1)
Choice 1 - You
Choice 2 - She
Choice 3 - He
-
(2)
Choice 1 - Month/Year
Choice 2 - Month/Year and Month/Year
Choice 3 - Month/Year through Month/Year
-
(3)
Description of missing information (e.g., your income)
PMTM02. Situation Where Used:
PE: Use in reinstatement cases for previous nonpayment month(s) for which you are
unable to determine eligibility (payment status code N05). Use under the caption,
“[Your/(Recipient's Name)] Payment Is Based On These Facts.” Use on an SSA-L8151-U2, Notice of Change in Payment, when the ongoing rate equals
or exceeds the last benefit amount. Use on an SSA-L8155-U2, Notice of Planned Action,
when the ongoing rate is less than the last benefit amount. Use on an SSA-L8166-U2,
Notice of Important Information, when effectuating an appellate reversal.
(1) cannot get SSI for (2) because you did not give us all of the facts we needed about
(3) . If (4) can give us more information, we might be able to pay (5) for that period. We will be glad to help (6) get the information that we need.
-
(1)
Choice 1 - You
Choice 2 - She
Choice 3 - He
-
(2)
Choice 1 - Month/Year
Choice 2 - Month/Year and Month/Year
Choice 3 - Month/Year through Month/Year
-
(3)
Description of missing information (e.g., your income)
-
(4)
Choice 1 - you
Choice 2 - she
Choice 3 - he
-
(5)
Choice 1 - you
Choice 2 - her
Choice 3 - him
-
(6)
Choice 1 - you
Choice 2 - her
Choice 3 - him
REFERENCE:
Unconfirmed Eligibility (N05), SI 02301.220—manual notice instructions