NL: Notices, Letters and Paragraphs
TN 22 (12-17)
LSP003 LSDP Disallowance – Eligible Spouse was Living in the Same Household as the Number Holder
(1) not qualify for the lump-sum death payment because we are paying it to (2) (3) . Since (4) was living with (5) when (6) died, (7) qualifies for the payment.
Fill-ins:
(1) You do/beneficiary's SN plus “does”/beneficiary's FN plus “does”/beneficiary's First Name plus “does”
(2) NH-FN possessive
(3) “widow”/“widower”
(4) “she”/“he” (refers to surviving “widow”/ “widower”)
(5) NH's SN
(6) “she”/“he” (refers to NH)
(7) “she”/“he” (refers to surviving “widow”/ “widower”)
LSP004 LSDP Disallowance – Child Beneficiary Meets Requirements but Eligible Widow(er) Survivor Exists
(1) not qualify for the lump-sum death payment because we are paying it to (2) (3) . Since (4) was living with (5) when (6) died, or entitled to benefits on (7) record for the month of death, (8) qualifies for the payment.
Fill-ins:
(1) “You do”/beneficiary's First Name plus “does”/beneficiary's FN plus “does”
(2) NH-FN possessive
(3) “widow”/“widower”
(4) “she”/“he” (refers to the “widow”/”widower”)
(5) NH's SN
(6) “she”/“he” (refers to the NH)
(7) “her”/“his” (refers to the NH)
(8) “she”/“he” (refers to the surviving “widow”/”widower”)
LSP007 LSDP Disallowance – Surviving Spouse
(1) not qualify for the lump-sum death payment as a surviving spouse on (2) Social Security record. To qualify (3) must have been living with (4) at the time of (5) death or eligible for regular Social Security benefits on (6) record.
The facts we have do not show that either of these requirements is met.
Fill-ins:
(1) “You do”/“She does”/ “He does”
(2) NH FN possessive
(3) “you”/“she”/ “he”
(4) NH SN
(5) “her”/“his”
(6) “her”/“his”
LSPR08 LSDP Disallowance – Outside U.S. and not U.S. Citizen
(1) not qualify for the lump-sum death payment because (2) :
was not a United States citizen, and
died outside the U.S., and
was not able to receive benefits because (3) was outside the U.S.
Fill-ins:
(1) “You do”/“She does”/“He does”
(2) FN of NH
(3) “she”/“he”
LSP009 LSDP Disallowance
(1) not qualify for the lump-sum death payment because (2) not (3) (4) or child.
Fill-ins:
(1) “You do”/“She does”/“He does”
(2) “you are”/“she is”/“he is”
(3) NH's FN possessive
(4) “widow”/“widower”
LSP011 LSDP Disallowance – Not Within Time Limit
(1) not qualify for the lump-sum death payment because (2) did not apply for it within 2 years of (3) death. Our records show that (4) died on (5) and that (6) applied on (7) .
Fill-ins:
(1) “You do”/“She does”/ “He does”
(2) “you”/“she”/“he”
(3) NH's FN possessive
(4) “she”/“he”
(5) NH's date of death
(6) “you”/FN
(7) CL application date
LSP012 LSDP Disallowance - Child
(1) not qualify for the lump-sum death payment as a child on (2) Social Security record. To qualify, (3) must have been eligible for regular Social Security benefits on (4) record at the time of (5) death.
Fill-ins:
(1) “You do”/ “She does”/ “He does”
(2) NH's FN possessive
(3) “you”/“she”/“he”
(4) NH's SN possessive
(5) “her”/“his”
LSP013 Child Awarded Share of LSDP Along with Another Child(ren)
There are (1) children who were eligible for benefits on (2) Social Security record in the month (3) died. Each child is due an equal share of the lump-sum death payment. The amount we have shown above is (4) share.
Fill-ins:
(1) enter number of PICs in format “two”
(2) Number holder's FN possessive
(3) “she”/“he”
(4) FN possessive/“your”