NL: Notices, Letters and Paragraphs
TN 9 (06-18)
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 Social Security claim number.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's full name
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 Social Security claim number.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's full name
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 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) child's
Choice 8: (H) mother's
Choice 9: (I) father's
Fill-in (4) Requested
Choice 1: Number holder's name
Fill-in (5) Requested As A Date In Format Shown Below
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 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