TN 1 (07-97)

The Form SSA-666 should be prepared in duplicate. The carbon copy will be filed on the left side of the folder and the original forwarded to the Fiscal Control and Audit Branch by the Records Analysis Clerk in batches of 50 or less, as required. The Form SSA-666 must be completed as follows:

Complete the “From” block indicating the appropriate module number.

A. BLOCK 1

Enter the social security number and BIC.

B. BLOCK 2

Enter the Beneficiary's name (last name, first name).

C. BLOCK 3

Enter the amount of money being transferred.

D. BLOCK 4

Check the box representing the trust fund that should be charged with the amount of money shown in block 3.

E. BLOCK 5

Check the box representing the trust fund that should be credited with the amount of money shown in block 3.

F. BLOCK 6

Check the box which indicates whether the adjustment in trust funds should be immediate or deferred. In some cases, the adjustment cannot be made until an overpayment has been recovered, in which case, the “deferred” box must be checked. If the deferred box is checked, enter the month and year in which the action will mature.

If prior to the maturity of the deferred action, it is necessary to revise the original determination, a revised form should be prepared and the carbon copy of the incorrect form should be removed from the folder and marked “Cancelled.” The Records Analysis Clerk should forward the cancelled form to the Fiscal Control and Audit Branch. The Fiscal Control and Audit Branch is responsible for pulling the original SSA-666 and destroying both forms.

Enter under “Remarks” any information which may be helpful in effecting the adjustment in the trust fund accounts.