TN 32 (07-23)
2021. Situation Where Used:
In rare situations, the system identifies an input for one month only which affects
the budget month and causes the due amount to be reduced or suspended. However, payment
is protected per Goldberg/Kelly at the old rate. In these cases, the system will issue
this paragraph on an SSA-L8100.
Even though (1) for (2) , we will not (3) (4) payment of (5) . This is to give
(6) time to appeal this decision. However, you may have to pay back any money (7) not eligible to receive. We will let you know later if payment for (8) changes. (9)
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(1)
Choice 1 - you are not due any money
Choice 2 - they are not due any money
Choice 3 - you are due only ($$$.¢¢)
Choice 4 - they are due only ($$$.¢¢)
(2) (Month/Year)
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(3)
Choice 1 - stop
Choice 2 - reduce
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(4)
Choice 1 - your
Choice 2 - their
(5) $$$.¢¢
-
(6)
Choice 1 - you
Choice 2 - them
-
(7)
Choice 1 - you are
Choice 2 - they are
(8) (Month/Year)
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(9)
Choice 1 - In spite of the above, we must withhold all of the amount we would have
sent because excess payments were previously received.
Choice 2 - In spite of the above, we will send ($$$.¢¢) and withhold ($$$.¢¢) because
excess payments were previously received.
Choice 3 - Null
2022. Situation Where Used:
Payment is being adjusted, advance notice is required.
Even though (1) for (2) , we would (3) (4) payment. This was to give (5) time to appeal this decision. However, because (6) overpaid previously, we must (7) withhold (8) (9) . We will let you know later if payment for (10)
changes.
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(1)
Choice 1- you are not due any money
Choice 2 - they are not due any money
Choice 3 - you are due only ($$$.¢¢)
Choice 4 - they are due only ($$$.¢¢)
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-
(3)
Choice 1 - not have stopped
Choice 2 - not have reduced
Choice 3 - have sent
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(4)
Choice 1 - your
Choice 2 - their
Choice 3- you a
Choice 4 - your representative payee a
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(5)
Choice 1 - you
Choice 2 - them
-
(6)
Choice 1 - you were
Choice 2 - they were
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(7)
Choice 1 - continue to
Choice 2 - Null
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(8)
Choice 1 - all of the ($$$.¢)
Choice 2 - ($$$.¢¢) and will send ($$$.¢¢)
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(9)
Choice 1 - to your bank or other financial institution
Choice 2 - Null
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2370. Situation Where Used:
Recipient appeals—payment maintenance applicable.
We will pay (1) (2) a month while (3) (4) request (5) is being considered.
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(1)
Choice 1 - you
Choice 2 - them
Choice 3 - your representative payee
-
-
(3)
Choice 1 - your
Choice 2 - their
-
(4)
Choice 1 - reconsideration
Choice 2 - hearing
Choice 3 - appeal
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(5)
Choice 1 - of (Month/Year)
Choice 2 - Null
2371. Situation Where Used:
Recipient appeals and requests payment maintenance for only selected factors. (No
supplemental check or OTP.) (Used with paragraphs 2370 and 2375.)
This payment amount, as you requested, is based on changes in (1) case other than those involved in the determination (2) appealing.
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(1)
Choice 1 - your
Choice 2 - their
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(2)
Choice 1 - you are
Choice 2 - they are
2372. Situation Where Used:
Recipient is in payment maintenance—subsequent action causes a new payment due which
is different from the established prior payment level.
We have determined that beginning (1) (2) monthly payment amount should be (3) . But we will (4) (5) , until a decision is made on all determinations still under appeal.
-
-
(2)
Choice 1 - your
Choice 2 - their
-
-
(4)
Choice 1 - pay you
Choice 2 - pay them
Choice 3 - pay your representative payee
Choice 4- continue to pay you
Choice 5 - continue to pay them
Choice 6 - continue to pay your representative payee
-
2373. Situation Where Used:
Recipient is in payment maintenance—subsequent action (other than excess income) causes
suspension or termination (fill-in 3, choices 1, 2, or 3); or, the new payment due
is greater than the prior payment level (fill-in 3, choices 4, 5, or 6).
This determination regarding (1) Supplemental Security Income eligibility is different from the determination (2) appealing.
(3)
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(1)
Choice 1 - your
Choice 2 - their
-
(2)
Choice 1 - you are
Choice 2 - they are
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(3)
Choice 1 - We will stop your check as shown above unless you also appeal this determination.
Choice 2 - We will stop their check as shown above unless you also appeal this determination.
Choice 3 - When a decision is made on your appeal, we will let you know if it changes
this new payment amount.
Choice 4 - When a decision is made on their appeal, we will let you know if it changes
this new payment amount.
2375. Situation Where Used:
Recipient appeals adverse action—notification of potential overpayment.
Depending on the outcome of (1) appeal, (2) may have to pay back any money (3) not eligible to receive.
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(1)
Choice 1 - your
Choice 2 - their
-
(2)
Choice 1 - you
Choice 2 - they
-
(3)
Choice 1 - you are
Choice 2 - they are
2377. Situation Where Used:
Recipient appeals and requests payment maintenance the same month the State terminates
contract for Federal administration of State supplement.
This payment amount is based on (1) payment in (2)
less (3) which was from the (4) . The (5) has decided to administer its own supplement and will now send (6) a separate monthly check for any additional money due (7)
.
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(1)
Choice 1 - your
Choice 2 - their
-
-
-
(4)
Choice 1 - State of
Choice 2 - District of Columbia
-
(5)
Choice 1 - State of
Choice 2 - District of Columbia
-
(6)
Choice 1 - you
Choice 2 - them
Choice 3- your representative
-
(7)
Choice 1 - you
Choice 2 - them
2381. Situation Where Used:
Adverse action occurs—notification of payment continuation.
Recipient appeals and requests payment maintenance for only selected factors—OTP or
supplemental payment made.
(1) should receive a check for (2) within a few days. This is what we will continue to pay (3) each month until (4) is decided.
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(1)
Choice 1 - You
Choice 2 - Your representative payee
-
-
(3)
Choice 1 - you
Choice 2 - your representative payee
-
(4)
Choice 1 - your reconsideration
Choice 2 - their reconsideration
Choice 3- your hearing
Choice 4 - their hearing
Choice 5 - your appeal
Choice 6 - their appeal
2841. Situation Where Used:
Standard appeal paragraph on all SSA-L8155's.
NOTE: This replaces paragraph 2374.
We won't change (1) check if (2) within 10 days after getting this notice.
Manual Paragraphs
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(1)
Choice 1 - your
Choice 2 - their
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(2)
Choice 1 - you appeal
Choice 2 - they appeal
Choice 3- either you or your spouse appeals
Choice 4 - either they appeal or their spouse appeals
GBKM01. Situation Where Used:
Recipient appeals and requests payment maintenance—OTP or supplemental payment made.
You should receive a separate check for (1) within a few days. This is the difference between what you received or will shortly
receive (2) and what (3) continued monthly payment will be until (4)
is decided.
-
-
(2)
Choice 1 - for (Month/Year)
Choice 2 - for (Month/Year) through (Month/Year)
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(3)
Choice 1 - your
Choice 2 - their
-
(4)
Choice 1 - your reconsideration
Choice 2 - their reconsideration
Choice 3 your hearing
Choice 4- their hearing
Choice 5- your appeal
Choice 6- their appeal
GBKM02. Situation Where Used:
Recipient is in payment maintenance status—State terminates contract for Federal administration
of State supplement. (Federal and State money previously payable.)
We have been sending (1) (2) while (3) (4) is being considered. This included (5) from the (6) . The (7) has decided to administer its own supplement and will now send (8) a separate monthly check for any additional money due (9) .
-
(1)
Choice 1 - you
Choice 2 - them
Choice 3 - your representative payee
-
-
(3)
Choice 1 - your reconsideration
Choice 2 - their reconsideration
Choice 3- your hearing
Choice 4 - their hearing
Choice 5 - your appeal
Choice 6 - their appeal
-
(4)
Choice 1 - of (Month/Year)
Choice 2 - Null
-
-
(6)
Choice 1 - State of
Choice 2 - District of Columbia
-
(7)
Choice 1 - State of
Choice 2 - District of Columbia
-
(8)
Choice 1 - you
Choice 2 - them
Choice 3 - your representative payee
-
(9)
Choice 1 - you
Choice 2 - them
GBKM03. Situation Where Used:
Recipient is in payment maintenance status—State terminates contract for Federal administration
of State supplement. (State money only previously payable.)
We have been sending (1) (2) while (3) (4) is being considered. This check was for money from the (5)
. The (6) has decided to administer its own supplement and will now send (7) a monthly check for any money due (8)
.
-
(1)
Choice 1 - you
Choice 2 - them
Choice 3 - your representative payee
-
-
(3)
Choice 1 - your reconsideration
Choice 2 - their reconsideration
Choice 3- your hearing
Choice 4- their hearing
Choice 5 - your appeal
Choice 6 - their appeal
-
(4)
Choice 1 - (of (Month/Year)
Choice 2 - Null
-
(5)
Choice 1 - State of
Choice 2 - District of Columbia
-
(6)
Choice 1 - State of
Choice 2 - District of Columbia
-
(7)
Choice 1 - you
Choice 2 - them
Choice 3 - your representative payee
-
(8)
Choice 1 - you
Choice 2 - them
GBKM04. Situation Where Used:
Recipient requests payment maintenance the same month the State terminates contract
for Federal administration of State supplement. (State supplement only payable.)
The money we have been sending (1) from the (2)
only. The (3) has decided to administer its own supplement and will now send (4) a check each month for any money due (5)
.
-
(1)
Choice 1 - you was money due you
Choice 2 - you was money due them
Choice 3 - your representative was money due you
-
(2)
Choice 1 - State of
Choice 2 - District of Columbia
-
(3)
Choice 1 - State of
Choice 2 - District of Columbia
-
(4)
Choice 1 - you
Choice 2 - them
Choice 3 - your representative payee
-
(5)
Choice 1 - you
Choice 2 - them
GBKM05. Situation Where Used:
Death of one member of an eligible couple. Prior adverse action for both members for
which payment maintenance is in effect.
Because (1) requested appeal within 10 days of our earlier determination to (2) (3) payments, we continued (4) payments pending outcome of that appeal. (5) paid (6) even though (7) entitled to (8) . Because we have not yet made a decision on (9) appeal, we will continue to pay (10) (11) , although (12) now (13)
as an individual.
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(1)
Choice 1 - you and your spouse
Choice 2 - they and their spouse
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(2)
Choice 1 - stop
Choice 2 - reduce
-
(3)
Choice 1 - your
Choice 2 - their
-
(4)
Choice 1 - your
Choice 2 - their
-
(5)
Choice 1 - You were
Choice 2 - they were
-
-
(7)
Choice 1 - you were
Choice 2 - they were
-
-
(9)
Choice 1 - your
Choice 2 - their
-
(10)
Choice 1 - you
Choice 2 - them
-
-
(12)
Choice 1 - you are
Choice 2 - they are
-
(13)
Choice 1 - entitled to $$$.¢¢
Choice 2 - not eligible
GBKM06. Situation Where Used:
Use to stop multiple payments and pay the correct amount. Use on an SSA-L8165-U2,
Important Information, under the caption, “[Your/(Recipient's Name)] Payment Is Based On These
Facts.” Use paragraph GBKM08 for appeal language.
By mistake, we have been sending you more than one monthly SSI check. Our records
show that we paid (1) the following checks:
(2) for (3)
Based on the facts we have, we should have paid (4) :
(5) for (6)
Beginning (7) we will send you only one monthly payment.
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(1)
Choice 1 - you
Choice 2 - them
-
-
(3)
Month/Year (date check paid)
-
(4)
Choice 1 - you
Choice 2 - them
-
(5)
$$$.¢¢ (amount that should have been paid)
-
-
(7)
Month/Year (date of payment)
NOTE: For fill-ins (2) for (3) and (5) for (6), show all check amounts. For example:
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$325 for March 1993
$195 for March 1993
$350 for April 1993
$195 for April 1993
GBKM07. Situation Where Used:
Use to correct erroneous payments over the payment ceiling and pay the correct amount.
Use on an SSA-L8165-U2, Important Information, under the caption, “[Your/(Recipient's Name)] Payment
Is Based On These Facts.” Use paragraph GBKM08 for appeal language.
By mistake, we sent you SSI check(s) for the wrong amount. This amount was more than
the highest SSI check we could pay a person in (1) situation.
Our records show that we paid (2) :
(3) for (4)
Based on the facts we have, we should have paid (5) :
(6) for (7)
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(1)
Choice 1 - your
Choice 2 - their
-
(2)
Choice 1 - you
Choice 2 - them
-
-
(4)
Month/Year (date of payment)
-
(5)
Choice 1 - you
Choice 2 - them
-
(6)
$$$.¢¢ (amount that should have been paid)
-
NOTE: If more than one month is involved, repeat the fill-ins in a column. For example:
-
$395 for March 1993
$395 for April 1993
$350 for May 1993
GBKM08. Situation Where Used:
Use this appeal language with paragraph GBKM06 or GBKM07 on an SSA-L8165-U2, Important
Information, when correcting erroneous payment. DO NOT use the 10-day payment continuation caption and paragraph in certain payment ceiling
cases when there is no right to payment continuation during appeal. (See SI 02301.315.E for instructions.)
NOTE: This paragraph replaces paragraph 2551 (NL 00804.224) in this situation.
Do You Disagree With The Decision?
If you disagree with the decision, you have the right to appeal. We will review your
case and consider any new facts you have.
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•
You have 60 days to ask for an appeal.
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•
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
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•
You must have a good reason for waiting more than 60 days to to ask for an appeal.
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•
You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2,
called “Request for Reconsideration.” Contact one of our offices if you want help.
Appeal In 10 Days To Receive A Monthly Check For (1)
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•
If you appeal within 10 days we will send you monthly checks for (2) . This is the most we can pay (3) while we look at (4)
appeal.
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•
The 10 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
If you lose your appeal, you might have to pay back some or all of this money.
How To Appeal
There are three ways to appeal. You can pick the one you want. If you meet with us
in person, it may help us decide your case.
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•
Case Review. You have a right to review the facts in your file. You can give us more facts to add
to your file. Then we will decide your case again. You will not meet with the person
who decides your case. This is the only kind of appeal you can have to appeal a medical
decision.
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•
Informal Conference. You will meet with the person who decides your case. You can tell that person why
you think you are right. You can give more facts to help prove you are right. You
can bring other people to help explain your case.
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•
Formal Conference. This is a meeting like an informal conference. The difference is we can make people
come to help prove you are right. We can make them bring important papers about your
case, even if they do not want to help you. You can question these people at your
meeting.
If You Want Help With Your Appeal
You can have a friend, lawyer or someone else help you. There are groups that can
find you a lawyer or give you free legal services if you qualify. There are also lawyers
who do not charge unless you win your appeal. Your local Social Security office has
a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before they can collect it.
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-
-
(3)
Choice 1 - you
Choice 2 - them
-
(4)
Choice 1 - your
Choice 2 - their
REFERENCE:
Erroneous Payments and Payment Continuation—manual notice instructions,
SI 02301.315