NL 00720.060:
BEN Benefit Information
Effective Dates: 05/20/2015 - Present- Effective Dates: 06/28/2018 - Present
TN 4 (08-12)- TN 9 (06-18)
- NL 00720.060 BEN Benefit Information
- BEN031 NOTICE TO N/H WHEN DISABILITY ESTABLISHED IN DIB/RIB CLAIMS NO RECAL PROCESSED (J87)
- (Requested)
- Caption: Your Benefits
- Since (1) now entitled to a higher monthly disability benefit, we are stopping (2) retirement benefits.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Surname is
- Choice 2: you are
- Fill-in (2) - Systems Generated
- Choice 1: her
- Choice 2: his
- Choice 3: your
- BEN032 ADJUSTMENT IN RETROACTIVE BENEFITS IN FIRST/NEXT CHECK (M09)
- (Requested)
- Caption: Your Benefits
- In (1) (2) payment, (3) will receive the difference between the benefits already paid and those now due.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Surname possessive
- Choice 2: Beneficiary Full name possessive
- Choice 3: your
- Fill-in (2) - Requested As A One Position Alpha Character
- Choice 1: (A) first
- Choice 2: (B) next
- Fill-in (3) - Systems Generated
- Choice 1: she
- Choice 2: he
- Choice 3: you
- BEN050 SPECIAL PAYMENT PROVISION FOR CHILDHOOD DISABILITY BENEFICIARY, WIDOW, WIDOWER, MOTHER OR PARENT WHO IS TERMINATED FOR MARRIAGE OR RE MARRIAGE (T09)
- (Requested)
- Caption: Your Benefits
- We might still be able to pay (1) if (2) married a person who is receiving Social Security benefits. Please get in touch with us if this is true.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Beneficiary's Name
- Choice 2: You
- Fill-in (2) - Systems Generated
- Choice 1: he
- Choice 2: she
- Choice 3: you
- BEN051 BENEFICIARY ENTITLED ON MORE THAN ONE ACCOUNT BENEFITS COMBINED INTO ONE CHECK (B16)
- (Requested)
- Caption: Your Benefits
We will send (1) both benefits in one check each month under (2) own claim number.- We will send (1) both benefits in one check each month under (2) own Social Security claim number.
- Fill-in values:
- Fill-in (1) - Systems Generated
Choice 1: youChoice 2: her- Choice 1: Beneficiary's full name
Choice 3: him- Choice 2: you
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- BEN052 BENEFICIARY ENTITLED TO BENEFITS ON MORE THAN ONE ACCOUNT EACH BENEFIT PAID SEPARATELY (B18)
- (Requested)
- Caption: Your Benefits
We will send (1) separate checks each month under each claim number.- We will send (1) separate checks each month under each Social Security claim number.
- Fill-in values:
- Fill-in (1) - Systems Generated
Choice 1: you- Choice 1: Beneficiary's full name
Choice 2: herChoice 3: him- Choice 2: you
- BEN053 DUAL ENTITLEMENT AWARD OF PRIMARY BENEFITS WHEN BENEFICIARY PREVIOUSLY AWARDED AS AN AUXILIARY (B15)
- CAUTION: Use BEN053 only on the primary (BIC A) record. If BEN053 is requested on the auxiliary record, the systems generated fill-ins cannot generate correctly, so a System Bad notice alert will result.
- (Requested)
- Caption: Your Benefits
- We are reducing (1) benefits as a (2) by the amount to which (3) entitled on (4) own Social Security record. This means (5) benefits will now be (6) as a (7) plus (8) on (9) own record.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (2) - Systems Generated
- Choice 1: (A) wife
- Choice 2: (B) husband
- Choice 3: (C) widow
- Choice 4: (D) widower
- Choice 5: (E) mother
- Choice 6: (F) father
- Choice 7: (G) disabled widow
- Choice 8: (H) disabled widower
- Choice 9: (I) disabled divorced widow
- Choice 10: (J) disabled divorced widower
- Fill-in (3) - Systems Generated
- Choice 1: you are
- Choice 2: he is
- Choice 3: she is
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (6) - Systems Generated
- Choice 1: Money Amount
- Fill-in (7) - Systems Generated
- Choice 1: (A) wife
- Choice 2: (B) husband
- Choice 3: (C) widow
- Choice 4: (D) widower
- Choice 5: (E) mother
- Choice 6: (F) father
- Choice 7: (G) disabled widow
- Choice 8: (H) disabled widower
- Choice 9: (I) disabled divorced widow
- Choice 10: (J) disabled divorced widower
- Fill-in (8) - Systems Generated
- Choice 1: Money Amount
- Fill-in (9) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- BEN075 RECOMPUTATION PROVISION NOT PROPERLY APPLIED (A88)
- (Requested)
- Caption: Your Benefits
- We found that we owe (1) money because we had not given (2) credit for earnings (3) had after we first figured (4) benefit amount. We will send (5) a back payment for past months and increase (6) monthly benefit amount.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (6) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- BEN076 NO BENEFITS PAYABLE FOR THE RETROACTIVE PERIOD (B25)
- (Requested)
- Caption: Your Benefits
- There is a limit on how much we can pay on each Social Security record. We have paid all benefits due for (1) . (2) not due any money for this period.
- Fill-in values:
- Fill-in (1) - Requested As A Date In Format In Format Shown Below
- Choice 1: MM/CCYY to MM/CCYY
- Choice 2: MM/CCYY
- Fill-in (2) - Systems Generated
- Choice 1: You are
- Choice 2: Beneficiary's Name is
- BEN077 202(J) (1) CLAIM - ODD AMOUNT PAYABLE FOR RETROACTIVE PERIOD (B26)
- (Requested)
- Caption: Your Benefits
- There is a limit on how much we can pay on each Social Security record. For (1) we have paid all but (2) . For this reason, we will pay (3) to (4) in the next check.
- Fill-in values:
- Fill-in (1) - Requested As A Date In Format In Format Shown Below
- Choice 1: MM/CCYY to MM/CCYY
- Choice 2: MM/CCYY
- Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount
- Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Total amount due
- Fill-in (4) - Requested As A Alpha Character or Name
- Choice 1: A=you
- Choice 2: Name (Name of Beneficiary)
- BEN078 W TO D CONVERSION HIGHER BENEFITS POSSIBLE ON OWN OR PRIOR SPOUSE'S RECORD (B34)
- (Requested)
- Caption: Other Social Security Benefits
- (1) may be able to get a higher benefit on (2) own Social Security record. Also, if (3) married before, (4) may qualify for a higher benefit on the record of a prior spouse. If (5) (6) may be able to get a higher benefit on (7) own or someone else's Social Security record, please contact us.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: You
- Choice 2: Beneficiary's Name
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) - Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- Fill-in (4) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (5) - Systems Generated
- Choice 1: you think
- Choice 2: he thinks
- Choice 3: she thinks
- Fill-in (6) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (7) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- BEN079 PC JURISDICTION OF CLAIM WHERE INQUIRIES SHOULD BE FORWARDED (B38)
- (System Generated)
- Caption: If You Have Any Questions
- If (1) to write to the office that handles (2) case, the address is:
- (3)
- (4)
- (5)
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you need
- Choice 2: Beneficiary's Name needs
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Choice 4: Beneficiary's name possessive
- Fill-in (3) - Systems Generated
- PSC Address Line 1
- Fill in (4) - Systems Generated
- PSC Address Line 2
- Fill-in (4) Systems Generated
- PSC Address Line 2
- Fill-in (5) - Systems Generated
- PSC Address Line 3
- BEN080 NO PAYMENT AWARD ELECTED TO CONTINUE REDUCED RIB (B42)
- (Requested)
- Caption: Your Benefits
- We approved (1) application for disability benefits. However, we will not pay (2) these benefits because (3) chose retirement benefits instead. (4) family would have received less money if (5) chose disability benefits.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Beneficiary's Name possessive
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) - Systems Generated
- Choice 1: Your
- Choice 2: His
- Choice 3: Her
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- BEN081 DIB NOT PAID RIB HIGHER (B44)
- (Requested)
- Caption: Your Benefits
- We considered (1) application for disability benefits. Although (2) eligible for disability benefits, we cannot pay (3) because (4) already receiving higher retirement benefits.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Beneficiary's Name possessive
- Fill-in (2) Systems Generated
- Choice 1: you are
- Choice 2: he is
- Choice 3: she is
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (4) - Systems Generated
- Choice 1: you are
- Choice 2: he is
- Choice 3: she is
- BEN082 CONVERSION BENEFIT INCREASE (NO RATES OR DATES) (B45)
- (System Generated)
- Caption: Your Benefits
- (1) benefit amount includes the recent increase because of the change in the cost of living.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Your
- Choice 2: Beneficiary's name possessive
- BEN083 FUTURE ENTITLEMENT INFORMATION FOR TERMINATING YOUNG SPOUSE, B2, B1, etc. (B46)
- (Requested)
- Caption: Things To Remember
- (1) may be eligible to get benefits again when (2) age 62. The people in any Social Security office will be glad to help (3) at that time.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: You
- Choice 2: Beneficiary Name
- Fill-in (2) - Systems Generated
- Choice 1: you are
- Choice 2: he is
- Choice 3: she is
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 3: her
- BEN084 (B52)
- (Requested)
- Caption: What We Will Pay
- (1) still due back payments for past months. (2) will receive this money over a period of months. We will start paying this money to (3) shortly, and will send (4) another letter explaining how we will pay (5) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: You are
- Choice 2: Beneficiary Name plus is
- Fill-in (2) - Systems Generated
- Choice 1: You
- Choice 2: He
- Choice 3: She
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (4) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- BEN085 SURVIVOR BENEFIT AWARD BASED ON MBR FROM ODO (B54)
- (Requested)
- Caption: The Basis For Our Decision
- We have not yet looked at the facts about (1) case which are in an earlier file. We have requested this file from another office. However, because we do not want to hold up (2) checks while we get the file, we figured (3) benefits using the other facts we had. We will review (4) case after we get the file, and let (5) know if we need to make any changes.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Beneficiary's Name possessive
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- BEN086 GOVERNMENT PENSION FULL OFFSET GP ELIGIBILITY AFTER JUNE 30, 1983 (B69)
- (Requested)
- Caption: Your Benefits
- We reduce Social Security benefits paid to (1) if they also receive a government pension based on their own work. We reduce benefits by two-thirds of the amount of the pension. (2) benefit is less than two-thirds of the amount of the pension. For this reason, we cannot pay (3) .
- Fill-in values:
- Fill-in (1) - Requested As A One Position Alpha Character
- Choice 1: (A) husbands or wives
- Choice 2: (B) widows or widowers
- Fill-in (2) - Systems Generated
- Choice 1: Your
- Choice 2: Beneficiary's name possessive
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- BEN087 ALLEGED MISINFORMATION NOT UPHELD (B74)
- (Requested)
- Caption: Your Benefits
- (1) filed (2) application for benefits on (3) . (4) said (5) did not file earlier because we gave misinformation on (6) . We can give (7) an earlier filing date if:
- * (8) did not file for these benefits before (9) because we misinformed (10) about (11) eligibility for these benefits, or the person who acted for (12) about (13) eligibility for these benefits, and
- * (14) did not get benefits (15) could have
- We looked at the facts and found that we did not misinform (16) about (17) eligibility for these benefits. Therefore, we're sorry, but (18) cannot get an earlier filing date.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: You
- Choice 2: Beneficiary's Name
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Choice 4: Beneficiary's Name possessive
- Fill-in (3) - Requested As A Date In Format Shown Below
- Choice 1: MM/DD/CCYY (date application was filed)
- Fill-in (4) - Systems Generated
- Choice 1: You
- Choice 2: He
- Choice 3: She
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: he
- Fill-in (6) - Requested As A Date In Format Shown Below
- Choice 1: MM/DD/CCYY (date alleged misinformation was given)
- Fill-in (7) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (8) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (9) - Systems Generated (same as Fill -in 3)
- Choice 1: MM/DD/CCYY (date application was filed)
- Fill-in (10) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (11) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (12) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (13) - Systems Generated
- Choice 1: your
- Choice 2: his
- Fill-in (14) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (15) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (16) - Systems Generated
- Choice 1: you
- Choice 2: the person who acted for you
- Fill-in (17) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (18) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- BEN088 RIGHTS AND RESPONSIBILITIES DIB (G33)
- (System Generated)
- Caption: Your Responsibilities
- The decisions we made on (1) claim are based on information (2) gave us. If this information changes, it could affect (3) benefits. For this reason, it is important that (4) changes to us right away. We have enclosed a pamphlet, “What You Need To Know When You Get Social Security Disability Benefits”. It will tell (5) what must be reported and how to report. Be sure to read the parts of the pamphlet which explain what to do if (6) to work or if (7) health improves.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Beneficiary's Name possessive
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (3) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (4) - Systems Generated
- Choice 1: you report
- Choice 2: he reports
- Choice 3: she reports
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (6) - Systems Generated
- Choice 1: you go
- Choice 2: he goes
- Choice 3: she goes
- Fill-in (7) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- BEN089 INTRODUCTORY STATEMENT DUAL ENTITLEMENT AWARD AUXILIARY/SURVIVOR PRIMARY BENEFICIARY IN PAY STATUS (G40)
- (Requested)
- Caption:
We are writing to let (1) know that (2) entitled to monthly (3) benefits on claim number (4) beginning (5) .- We are writing to let (1) know that (2) entitled to monthly (3) benefits on the record of (4) beginning (5) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you
- Choice 2: Beneficiary name
- Fill-in (2) - Systems Generated
- Choice 1: you are
- Choice 2: he is
- Choice 3: she is
- Fill-in (3) - Requested As A One Position Alpha Character
- Choice 1: (A) wife's
- Choice 2: (B) husband's
- Choice 3: (C) widow's
- Choice 4: (D) widower's
- Choice 5: (E) disabled widow's
- Choice 6: (F) disabled widower's
Choice 7: (G) disabled divorced widow'sChoice 8: (H) disabled divorced widower's- Choice 7: (G) child's
Choice 9: (I) child's- Choice 8: (H) mother's
Choice 10: (J) mother's- Choice 9: (I) father's
Choice 11: (K) father's- Fill-in (4) Requested
Fill-in (4) - Requested As A Language- Choice 1: Number holder's name
SSN in format XXX-XX-XXXX- Fill-in (5) Requested As A Date In Format Shown Below
Fill-in (5) - Requested As A Date In Format Shown BelowChoice 1: MM/CCYY- Choice 1: Show the Beneficiary's date of entitlement on the other record in MM/CCYY format
- BEN090 REPLACEMENT NOTICE (M21)
- (Requested)
- Caption: None
- This letter replaces our previous letter (1).
- Fill-in values:
- Fill-in (1) Requested as a Date in the format shown below or Alpha character
Choice 1: (A) = Null- Choice 1: (A) = Null
Choice 2: dated in format MM/DD/CCYY- Choice 2: dated in format MM/DD/CCYY
- BEN100 ACCRUED AMOUNT PAID IN INSTALLMENTS (B24)
- (Requested)
- Caption: Your Benefits
- A payment of (1) is due from (2) through (3) . (4) will receive this money over a period of months. We will send (5) (6) more each month as part of the regular check (7) . We will start paying the extra money with the check (8) on (9) .
- Fill-in values:
- Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
- Total amount due
- Fill-in (2) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (3) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (4) - Systems Generated
- Choice 1: You
- Choice 2: He
- Choice 3: She
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount of installment
- Fill-in (7) - Systems Generated
- Choice 1: you already receive
- Choice 2: he already receives
- Choice 3: she already receives
- Fill-in (8) Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- Fill-in (9) - Requested As A Date In Format Shown Below
- Choice 1: Date in MM/DD/CCYY
- BEN101 (GA6) BOND
- (System Generated)
- Caption: None
- (1) been selected to participate in the Benefit Offset National Demonstration (BOND) project.
- Fill-in values:
- Fill-in (1)
- Choice 1: You have
- Choice 2: Beneficiary's Name has
- BEN102 PAYMENT POSSIBLE TO OTHER FAMILY MEMBERS WHEN PRIMARY BENEFICIARY IS IMPRISONED/CONFINED (G41)
- (Systems Generated)
- Caption: Your Benefits
- Even though (1) benefits will stop, we can pay other members of (2) family if they are entitled on (3) record.
- Fill-in values:
- Fill-in (1)
- Choice 1: Beneficiary's Name possessive
- Choice 2: your
- Fill-in (2)
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3)
- Choice 1: your
- Choice 2: his
- Choice 3: her
- BEN103 GOVERNMENT PENSION PARTIAL OFFSET GP ELIGIBILITY AFTER JUNE 30, 1983 (B68)
- (Requested)
- Caption: Your Benefits
- We reduce Social Security benefits paid to (1) if they also receive a government pension based on their own work. We reduce benefits by two-thirds of the amount of the pension. For this reason, we are reducing (2) benefits beginning (3) , by (4) .
- Fill-in values:
- Fill-in (1) Request as a one position alpha character
- Choice 1: (A) husbands
- Choice 2: (B) wives
- Choice 3: (C) widows
- Choice 4: (D) widowers
- Fill-in (2) System Generated
- Choice 1: your
- Choice 2: Beneficiary's name possessive
- Fill-in (3) Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of reduction
- BEN104 ONE OR MORE CHECKS WITHHELD (M17)
- (Requested)
- Caption: Your Benefits
- Therefore we are withholding (1) (2) (3) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: him
- Fill-in (2) - Requested As A One Position Alpha Character
- Choice 1: (A) check
- Choice 2: (B) checks
- Fill-in (3) - Requested As A Date In Format Shown Below
- Choice 1: for MM/CCYY
- Choice 2: for MM/CCYY and MM/CCYY
- Choice 3: for MM/CCYY through MM/CCYY
- BEN105 BOND NOTIFICATION OF ADJUSTMENT
- (Requested)
- Caption: None
- We may have let (1) know earlier that we would increase (2) benefits to (3) per month due to the rise in the cost of living. We have refigured (4) benefits based on (5) participation in the benefit offset national demonstration project (BOND). This notice corrects the calculation to apply the cost of living increase to (6) original benefit before the reduction for BOND earnings. (7) new monthly amount (before deductions) is (8) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you
- Choice 2: Name
- Fill-in (2) - System Generated
- Choice 1: your
- Choice 2: Name possessive
- Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount (BRI/MBR incorrect monthly benefit amount)
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: Name possessive
- Fill-in (5) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (6) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (7) - Systems Generated
- Choice 1: Your
- Choice 2: Name possessive
- Fill-in (8) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount (new offset monthly benefit amount)
- BEN106 BOND – EOYR Adjustment
- (Requested)
- Caption: Your Benefits
- Based on (1) earnings of (2) for (3) we should have paid (4)
- Amount Date
- (5) (6)
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Name possessive
- Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount (End of year BOND amount)
- Fill-in (3) - Requested As A Date In Format Shown Below
- Choice 1: CCYY
- Choice 2: CCYY and CCYY
- Fill-in (4) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount (MBC in $$$$$.¢¢ format)
- Fill-in (6) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- BEN107 BOND EOYR
- (Requested)
- Caption: Your Benefits
- This means we paid (1) correctly based on the evidence (2) provided for the reconciliation year.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you
- Choice 2: Name
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- BEN108 BOND EOYR Overpayment or Underpayment
- (Requested)
- Caption: Your Benefits
- This (1) resulted from the difference in the yearly amount that (2) estimated (3) would earn during (4) and the actual amount that (5) earned, during that year. We determined the (6) after we recalculated (7) offset amount based on (8) actual BOND countable earnings.
- Fill-in values:
- Fill-in (1) - Requested As A One Position Alpha Character
- Choice 1: (A) overpayment
- Choice 2: (B) underpayment
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: Name
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) - Requested As A Date In Format Shown Below
- Choice 1: Date (Recon year in CCYY format)
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (6) - Requested As A One Position Alpha Character (same as Fill-in 1)
- Choice 1: (A) overpayment
- Choice 2: (B) underpayment
- Fill-in (7) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (8) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- BEN109 BOND – No Longer Eligible For BOND Project – Term Date
- (Requested)
- Caption: Your Benefits
- (1) been a participant in the Benefit Offset National Demonstration (BOND) project. The special rules for the BOND project will no longer apply to (2) beginning (3) . (4) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: You have
- Choice 2: Name has
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (3) - Requested As A Date In Format Shown Below
- Choice 1: MM/DD/CCYY
- Fill-in (4) - Requested As A One Position Alpha Character
- Choice 1: (A) You asked to be withdrawn from the project. If you are receiving benefit payments based on disability, your payments may stop the first month you do substantial gainful work.
- Choice 2: (B) He asked to be withdrawn from the project. If he is receiving benefit payments based on disability, his payments may stop the first month he does substantial gainful work.
- Choice 3: (C) She asked to be withdrawn from the project. If she is receiving benefit payments based on disability, her payments may stop the first month she does substantial gainful work.
- Choice 4: (D) You are no longer eligible for the project, because you have not completed the trial work period by September 30, 2017.
- Choice 5: (E) He is no longer eligible for the project, because he has not completed the trial work period by September 30, 2017.
- Choice 6: (F) She is no longer eligible for the project, because she has not completed the trial work period by September 30, 2017.
- Choice 7: (G) null
- BEN110 BOND – No Longer Eligible For BOND Project - Explanation
- (Requested)
- Caption: Your Benefits
- (1) no longer eligible for the project because (2) (3) . If (4) receiving benefit payments based on disability, (5) payments may stop the first month (6) substantial gainful work.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: You are
- Choice 2: Name is
- Fill-in (2) - Systems Generated
- Choice 1: you have
- Choice 2: he has
- Choice 3: she has
- Fill-in (3) - Requested As A One Position Alpha Character
- Choice 1: (A) had benefits terminated prior to the BOND start date of participation
- Choice 2: (B) participated in another demonstration project before
- Choice 3: (C) moved to a foreign country
- Choice 4: (D) received benefits paid by the railroad
- Choice 5: (E) elected to receive benefits not based on a disability
- Choice 6: (F) no longer met the BOND eligibility criteria
- Fill-in (4) - Systems Generated
- Choice 1: you are
- Choice 2: he is
- Choice 3: she is
- Fill-in (5) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (6) - Systems Generated
- Choice 1: you do
- Choice 2: he does
- Choice 3: she does
- BEN111 BOND Participation End Date
- (Requested)
- Caption: Your Benefits
- (1) participation period ends (2) . Payments may end with the month (3) substantial gainful work after (4) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Your
- Choice 2: Name possessive
- Fill-in (2) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (3) - Systems Generated
- Choice 1: you do
- Choice 2: he does
- Choice 3: she does
- Fill-in (4) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- BEN112 BOND Participation End Date SGA
- (Requested)
- Caption: Your Benefits
- (1) participation period ends (2) . Since (3) not demonstrated an ability to perform work at a substantial gainful activity (SGA) level, payments may end in the second month following the month (4) an ability to perform work at an SGA level.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Your
- Choice 2: Name possessive
- Fill-in (2) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (3) - Systems Generated
- Choice 1: you have
- Choice 2: he has
- Choice 3: she has
- Fill-in (4) - Systems Generated
- Choice 1: you demonstrate
- Choice 2: he demonstrates
- Choice 3: she demonstrates
- BEN113 BOND Special Rules
- (Requested)
- Caption: What Happens When The Special Rules For BOND No Longer Apply
- The special rules for the BOND project will no longer apply to (1) after (2) participation period ends. If (3) benefit payments based on disability after that month, (4) payments will stop the first month (5) substantial gainful work.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you
- Choice 2: Name
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) - Systems Generated
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) - Systems Generated
- Choice 1: you do
- Choice 2: he does
- Choice 3: she does
- BEN114 BOND Adjustment
- (Requested)
- Caption: Why We Cannot Pay You
- We cannot pay (1) benefits for (2) under the rules of the Benefit Offset National Demonstration (BOND) project. This is due to (3) work and earnings. This does not change any current benefits (4) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you
- Choice 2: Name
- Fill-in (2) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (3) - Requested As A Language
- Choice 1: Name (BOND participant)
- Fill-in (4) - Systems Generated
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- BEN115 BOND Refund
- (Requested)
- Caption: None
- (1) will soon receive a check for (2) . This check is for benefits due to (3) for (4) under the rules of the Benefit Offset National Demonstration (BOND) project. (5) due this check because of (6) work and earnings. This does not change any current benefits (7) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: You
- Choice 2: Name
- Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount (refund amount)
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (4) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (5) - Systems Generated
- Choice 1: You are
- Choice 2: Name is
- Fill-in (6) - Requested As A Language
- Choice 1: Name (BOND participant)
- Fill-in (7) - Systems Generated
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- BEN116 BOND Project Contact Information
- (Requested)
- Caption: Your Benefits
- If (1) working and (2) not given us an estimate of (3) expected yearly earnings, please contact Abt Associates immediately. We show their contact information under the heading, “If You Have Questions About the BOND Project”. If (4) not give us an estimate, we may pay (5) incorrect benefit payments.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you are
- Choice 2: Name is
- Fill-in (2) - Systems Generated
- Choice 1: have
- Choice 2: has
- Fill-in (3) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (4) - Systems Generated
- Choice 1: you do
- Choice 2: he does
- Choice 3: she does
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- BEN117 BOND Informational (No Change)
- (Requested)
- Caption: None
- Thank you for giving us information about (1) earnings for last year. (2) asked us to determine if there has been a change in the amount of benefits payable to (3) under BOND because of this information. Based on this evidence we have determined that there is no change to (4) monthly benefit amount for this period. This decision does not change any benefits (5) may be currently receiving.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Name possessive
- Fill-in (2) - Systems Generated
- Choice 1: You
- Choice 2: He
- Choice 3: She
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- BEN118 BOND Informational
- (Requested)
- Caption: Your Benefits
- Thank you for giving us information about (1) earnings for the last year. (2) asked us to determine if there has been a change in the amount of benefits payable to (3) under BOND because of this information.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Name possessive
- Fill-in (2) - Systems Generated
- Choice 1: You
- Choice 2: He
- Choice 3: She
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- BEN119 BOND Request/Decision
- (Requested)
- Caption: None
- We received a request (1) .
- Fill-in values:
- Fill-in (1) - Requested As A One Position Alpha Character
- Choice 1: (A) for an explanation
- Choice 2: (B) that we not collect the overpayment
- Choice 3: (C) that we review our decision
- Choice 4: (D) that we review our decision and not collect the overpayment
- Choice 5: (E) that we withhold a different amount
x
← This means that the line
was removed and
was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.