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NL 00730.102: A Paragraphs and Captions

changes
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  • Effective Dates: 10/13/2016 - Present
  • Effective Dates: 11/02/2017 - Present
  • TN 25 (10-16)
  • NL 00730.102 A Paragraphs and Captions
  • List of “A” Paragraphs and Captions
  • A. ACT Universal Text Identifier – Privacy Act
  • ACT003 – PAPERWORK/PRIVACY ACT NOTICE PRINTED WHEN PAYMENT STUB IS PRINTED
  • Privacy Act Statement
  • The Social Security Administration (SSA) has authority to collect the information requested on the PAYMENT STUB under section 204 of the Social Security Act. Giving us this information is voluntary. You do not have to do it. We will need this information only if you choose to make payment by credit card. You do not need to fill out the credit card information if you choose another means of payment (for example, by check or money order).
  • If you choose the credit card payment option, we will provide the information you give us to the banks handling your credit card account and SSA's account. This will allow you to repay your overpayment with your credit card. We may also provide this information to another person or government agency to comply with federal laws requiring the release of information from our records. You can find these and other routine uses of information provided to SSA listed in the Federal Register. If you want more information about this, you may call or write any Social Security office.
  • We may also use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, State, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it.
  • Explanations about these and other reasons why information you provide us may be used or given out are available in Social Security offices. If you want to learn more about this, contact any Social Security office.
  • B. ADJ Universal Text Identifiers – Adjustment
  • ADJ048 – UNDERPAYMENT TRANSFERRED FROM DECEASED BENEFICIARY TO SPOUSE
  • (1) will soon receive a payment of (2) because we owed money to (3). This payment is in addition to any monthly payments (4) may receive.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • You
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • Fill-in (2)
  • Fill-in (2)
  • Amount of underpayment transferred from deceased beneficiary to spouse
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) of deceased beneficiary (if Beneficiary Identification Code (BIC) is A)
  • Choice 2
  • Choice 2
  • your spouse
  • Choice 3
  • Choice 3
  • his spouse
  • Choice 4
  • Choice 4
  • her spouse
  • Choice 5
  • Choice 5
  • NOT USED BY T2R
  • Name of deceased beneficiary (non-possessive)
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • he
  • Choice 3
  • Choice 3
  • she
  • C. AET Universal Text Identifier – Annual Earnings Test
  • AETC02 – CAPTION
  • You May Be Due More Benefits
  • AETC06 – CAPTION
  • What We Will Do
  • AETC07 – CAPTION
  • The Yearly Earnings Limit
  • AETC08 – CAPTION
  • A Special Rule That Applies To Earnings In One Year
  • AETC09 – CAPTION
  • If Your Expected Earnings Change
  • AETC10 – CAPTION
  • If You Work For Wages
  • AETC11 – CAPTION
  • If You Are Self-Employed
  • AETC12 – CAPTION
  • If You Work For Wages and Are Self-Employed
  • AETC14 – CAPTION
  • How We Calculate Earnings
  • If You Work For Wages and Are Self-Employed
  • AETH01 – HEADER
  • How Work Affects Your Social Security
  • AETH02 – HEADER
  • How To Estimate Earnings
  • AET036 – INFORMATIONAL PARAGRAPH TO THE BENEFICIARY ABOUT HOW EARNINGS HAVE AFFECTED HIS OR HER SOCIAL SECURITY BENEFITS
  • Please read the rest of this letter carefully. In it, we explain the changes we are making to (1) benefits. We also tell you how (2) earnings have affected (3) benefits and what to do if you disagree with any of our decisions.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • AET037 – REFER TO WORKSHEET HEADER NL 00730.149D
  • AET037 – REFER TO WORKSHEET HEADER NL 00730.149D
  • AET038 – PROVIDES THE LAST MONTHLY EARNINGS TEST YEAR’S INCOME LIMITS AND THE BENEFICIARY'S NON-SERVICE MONTHS FOR THE LAST MONTHLY EARNINGS TEST YEAR
  • In addition, you told us that (1) did not (2) more than (3) a month and did not work over 45 hours a month in self-employment (4) (5).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • Choice 2
  • Choice 2
  • you
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • expect to earn
  • Choice 2
  • Choice 2
  • earn
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Full Retirement Age (FRA) year exempt amount divided by 12 in the format $$$$$.¢¢
  • EXAMPLE:
  • If the FRA year = 2012, then the exempt amount = $38, 880. Divide the exempt amount by 12.
  • $38,880 12 = 3240
  • (show this amount in Fill-in (3))
  • Choice 2
  • Choice 2
  • Pre-Full Retirement Age (FRA) year exempt amount divided by 12 in the format $$$$$.¢¢
  • EXAMPLE:
  • If the PRE-FRA year = 2012 and the exempt amount = $14,640,
  • Divide $14,640 12 =1220 (show this amount in Choice 2)
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • from
  • Choice 2
  • Choice 2
  • in
  • Choice 3
  • Choice 3
  • through
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • First non-service month
  • Choice 2
  • Choice 2
  • and
  • Choice 3
  • Choice 3
  • comma (,)
  • AET039 – INTRODUCTORY PARAGRAPH FOR THE BENEFICIARY ABOUT THE ANNUAL EARNINGS LIMIT FOR SPECIFIC YEARS
  • AET039 – INTRODUCTORY PARAGRAPH FOR THE BENEFICIARY ABOUT THE ANNUAL EARNINGS LIMIT FOR SPECIFIC YEARS
  • The earnings limit for (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11). If (12) over the allowed amount for the year, we withhold $1 in benefits for every (13) (14) above the limit. We have enclosed a worksheet to show how we applied the earnings limit to (15) earnings to figure (16) benefits.
  • For more information about the earnings limit, see the enclosed fact sheet called, "How Work Affects Your Social Security."
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • CCYY plus ”is”
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Annual Earnings Test (AET) amount for this Year of Earnings Report (YOER) in the format $$$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • and for
  • Choice 2
  • Choice 2
  • comma (,)
  • Choice 3
  • Choice 3
  • Null
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • CCYY plus ”is”
  • Choice 2
  • Choice 2
  • Null
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • Annual Earnings Test (AET) amount for this Year of Earnings Report (YOER) in the format $$$$$$.¢¢
  • Choice 2
  • Choice 2
  • Null
  • Fill-in (6)
  • Fill-in (6)
  •  
  • Choice 1
  • Choice 1
  • and for
  • Choice 2
  • Choice 2
  • comma (,)
  • Choice 3
  • Choice 3
  • Null
  • Fill-in (7)
  • Fill-in (7)
  •  
  • Choice 1
  • Choice 1
  • CCYY plus ”is”
  • Choice 2
  • Choice 2
  • Null
  • Fill-in (8)
  • Fill-in (8)
  •  
  • Choice 1
  • Choice 1
  • Annual Earnings Test (AET) amount for this Year of Earnings Report (YOER) in the format $$$$$$¢¢
  • Choice 2
  • Choice 2
  • Null
  • Fill-in (9)
  • Fill-in (9)
  •  
  • Choice 1
  • Choice 1
  • and for
  • Choice 2
  • Choice 2
  • Null
  • Fill-in (10)
  • Fill-in (10)
  •  
  • Choice 1
  • Choice 1
  • CCYY plus ”is”
  • Choice 2
  • Choice 2
  • Null
  • Fill-in (11)
  • Fill-in (11)
  •  
  • Choice 1
  • Choice 1
  • Annual Earnings Test (AET) amount for this Year of Earnings Report (YOER) in the format $$$$$$¢¢
  • Choice 2
  • Choice 2
  • Null
  • Fill-in (12)
  • Fill-in (12)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “works and earns”
  • Choice 2
  • Choice 2
  • “you” plus “work and earn”
  • Fill-in (13)
  • Fill-in (13)
  •  
  • Choice 1
  • Choice 1
  • $2
  • Choice 2
  • Choice 2
  • $3
  • Choice 3
  • Choice 3
  • $2 or $3
  • Fill-in (14)
  • Fill-in (14)
  •  
  • Choice 1
  • Choice 1
  • he earns
  • Choice 2
  • Choice 2
  • she earns
  • Choice 3
  • Choice 3
  • you earn
  • Fill-in (15)
  • Fill-in (15)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • Fill-in (16)
  • Fill-in (16)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • AET040 – PARAGRAPH TO A NON-RESPONDER (NRP) WITH A MID-YEAR MAILER INDICATOR ON THE MASTER BENEFICIARY RECORD (MBR) EXPLAINING THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR, WE WILL USE LAST YEAR'S EARNINGS AS THE CURRENT YEAR ESTIMATE
  • AET040 – PARAGRAPH TO A NON-RESPONDER (NRP) WITH A MID-YEAR MAILER INDICATOR ON THE MASTER BENEFICIARY RECORD (MBR) EXPLAINING THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR, WE WILL USE LAST YEAR'S EARNINGS AS THE CURRENT YEAR ESTIMATE
  • Earlier we asked you to estimate (1) earnings for (2). We need this estimate to decide how much Social Security benefits to pay (3) for (4). We have not heard from you. Unless you contact us with a new estimate, we will use the same estimate we used in (5) to decide (6) benefits for (7).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  • Current Operating Year (COY) in the format CCYY
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Fill-in (4)
  • Fill-in (4)
  • Current Operating Year (COY) in the format CCYY
  • Fill-in (5)
  • Fill-in (5)
  • Current Operating Year (COY) – 1 (the last year for which we have an estimate) in the format CCYY
  • Fill-in (6)
  • Fill-in (6)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (7)
  • Fill-in (7)
  • Current Operating Year (COY) in the format CCYY
  • AET041 – PARAGRAPH TO A NON-RESPONDER (NRP) WITH NO MID-YEAR MAILER INDICATOR ON THE MASTER BENEFICIARY RECORD (MBR) EXPLAINING THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR. WE WILL USE LAST YEAR’S EARNINGS AS THE CURRENT YEAR ESTIMATE.
  • AET041 – PARAGRAPH TO A NON-RESPONDER (NRP) WITH NO MID-YEAR MAILER INDICATOR ON THE MASTER BENEFICIARY RECORD (MBR) EXPLAINING THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR. WE WILL USE LAST YEAR’S EARNINGS AS THE CURRENT YEAR ESTIMATE.
  • We base the amount of Social Security benefits (1) due on (2) estimated earnings. In (3), (4) earnings estimate was (5). Unless you contact us with a new estimate, we will use that same estimate to decide (6) benefits for (7).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • you are
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “is”
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (3)
  • Fill-in (3)
  • Current Operating Year (COY) – 1 (the last year for which we have an estimate in the format CCYY
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (5)
  • Fill-in (5)
  • Post-MBR Amount of Reported Earnings (AORE) from the last estimate in the format $$$$$¢¢
  • Fill-in (6)
  • Fill-in (6)
  • Current Operating Year (COY) in the format CCYY
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (7)
  • Fill-in (7)
  • Current Year in the format CCYY
  • AET042 – PARAGRAPH TO A WORKING BENEFICIARY THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR, WE WILL USE THE EARNINGS REPORTED BY HIS OR HER EMPLOYER LAST YEAR AS THE CURRENT YEAR ESTIMATE.
  • AET042 – PARAGRAPH TO A WORKING BENEFICIARY THAT SINCE HE OR SHE DID NOT PROVIDE AN ESTIMATE OF EARNINGS FOR THE CURRENT YEAR, WE WILL USE THE EARNINGS REPORTED BY HIS OR HER EMPLOYER LAST YEAR AS THE CURRENT YEAR ESTIMATE.
  • In (1), we based the amount of (2) Social Security benefits on earnings of (3) that (4) employer reported. We will use the same amount of earnings to decide (5) benefits in (6). That is, unless you contact us with a new estimate of (7) expected earnings for (8).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Current Operating Year (COY) – 1 in the format CCYY
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (3)
  • Fill-in (3)
  • Post-MBR Amount of Reported Earnings (AORE) in the format $$$$$¢¢
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • Fill-in (6)
  • Fill-in (6)
  • Current Operating Year (COY) in the format CCYY
  • Fill-in (7)
  • Fill-in (7)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • Fill-in (8)
  • Fill-in (8)
  • Current Operating Year (COY) in the format CCYY
  • AET043 – REQUEST TO BENEFICIARY ASKING THEM TO NOTIFY SOCIAL SECURITY ADMINISTRATION IF HIS OR HER WORK ESTIMATE IS NOT CORRECT
  • AET043 – REQUEST TO BENEFICIARY ASKING THEM TO NOTIFY SOCIAL SECURITY ADMINISTRATION IF HIS OR HER WORK ESTIMATE IS NOT CORRECT
  • (1) work plans may have changed and we want to make sure that we are paying (2) correctly. So, please check (3), and let us know right away if you think (4) will earn more or less than (5) in (6).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • Your
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • him
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • you
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • his estimate
  • Choice 2
  • Choice 2
  • her estimate
  • Choice 3
  • Choice 3
  • your estimate
  • Choice 4
  • Choice 4
  • his expected earnings
  • Choice 5
  • Choice 5
  • her expected earnings
  • Choice 6
  • Choice 6
  • your expected earnings
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • he
  • Choice 2
  • Choice 2
  • she
  • Choice 3
  • Choice 3
  • you
  • Fill-in (5)
  • Fill-in (5)
  • Amount of Reported Earnings (AORE) in the format $$$$$¢¢
  • Fill-in (6)
  • Fill-in (6)
  • The Year of Earnings Report (YOER) in the format CCYY
  • AET044 – EXPLAINS TO A DIVORCED AUXILIARY SPOUSE THAT A FORMER SPOUSE'S WORK NO LONGER AFFECTS BENEFITS
  • AET044 – EXPLAINS TO A DIVORCED AUXILIARY SPOUSE THAT A FORMER SPOUSE'S WORK NO LONGER AFFECTS BENEFITS
  • (1) told us (2) divorce was final in (3). Once (4) been divorced for 2 years, (5) former spouse’s work no longer affects (6) benefits. Therefore, beginning (7), we will no longer withhold or reduce (8) benefits because of (9) former spouse's work.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • You
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 3
  • Choice 3
  • his
  • Choice 4
  • Choice 4
  • her
  • Fill-in (3)
  • Fill-in (3)
  • Marriage End Date (MARR-END-REL-D)
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • you have
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “has”
  • Choice 3
  • Choice 3
  • he has
  • Choice 4
  • Choice 4
  • she has
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Choice 4
  • Choice 4
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (6)
  • Fill-in (6)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (7)
  • Fill-in (7)
  • Effective date of change in the format Month CCYY
  • Fill-in (8)
  • Fill-in (8)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Choice 4
  • Choice 4
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • Fill-in (9)
  • Fill-in (9)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • AET045 – REFER TO WORKSHEET HEADER NL 00730.149A
  • AET045 – REFER TO WORKSHEET HEADER NL 00730.149A
  • AET046 – REFER TO WORKSHEET HEADER NL 00730.149A
  • AET047 – REFER TO WORKSHEET HEADER NL 00730.149A
  • AET048 – REFER TO WORKSHEET HEADER NL 00730.149B
  • AET049 – REFER TO WORKSHEET HEADER NL 00730.149B
  • AET050 – REFER TO WORKSHEET HEADER NL 00730.149B
  • AET051 – REFER TO WORKSHEET HEADER NL 00730.149D
  • AET052 – REFER TO WORKSHEET HEADER NL 00730.149D
  • D. AGE Universal Text Identifier – Age
  • AGE002 – EXPLANATION OF FULL RETIREMENT AGE (FRA) ATTAINMENT WHEN BORN ON THE FIRST DAY OF THE MONTH
  • Because (1) born on the first day of the month, we consider (2) (3) the month before.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus ”was”
  • Choice 2
  • Choice 2
  • you were
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • him
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • you
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Null
  • Choice 2
  • Choice 2
  • to have reached full retirement age
  • E. ALS Universal Text Identifiers – Appeals
  • ALSC04 – CAPTION
  • If You Disagree With The Decision
  • ALSC06 – CAPTION
  • Do You Think We Are Wrong About The Overpayment
  • ALS017 – APPEALS LANGUAGE FOR MONTHLY BENEFIT PAYABLE (MBP) CHANGE DUE TO A THIRD-PARTY ACTION
  • If you disagree with the change we have made to (1) monthly payment, you have the right to appeal. We will review your case and look at any new facts you have. A person who did not make the first decision will decide your case.
  • * You have 60 days to ask for an appeal.
  • * The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.
  • * You must have a good reason if you wait more than 60 days to ask for an appeal.
  • * 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.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (4)
  • Fill-in (4)
  • www.socialsecurity.gov/online/
  • ALS020 – GENERAL APPEALS LANGUAGE
  • ALS020 – GENERAL APPEALS LANGUAGE
  • If you do not agree with this decision, you have the right to appeal. We will review your case and look at any new facts you have. A person who did not make the first decision will decide your case. We will review the parts of the decision that you think are wrong and correct any mistakes. We may also review the parts of our decision that you think are right. We will make a decision that may or may not be in your favor.
  • * You have 60 days to ask for an appeal in writing.
  • * The 60 days start the day after you receive 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.
  • * You must have a good reason if you wait more than 60 days to ask for an appeal.
  • * You can file an appeal with any Social Security office. You must ask for an appeal in writing. Please use our “Request for Reconsideration” form, SSA-561. You may go to our website at (1) to find the form SSA-561. You can also contact us by phone, mail, or come into an office to request the form. If you need help to fill out the form, we can help you by phone or in person.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • www.socialsecurity.gov/online/
  • F. ANP Universal Text Identifier – Outside the U.S.
  • ANP003 – BENEFICIARY OUTSIDE U.S. (Pub-05-10137)
  • Please read the enclosed pamphlet, “Social Security: Your Payments While You Are Outside the United States.” It explains what (1) will need to do to start receiving payments again.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • “Mr.” plus Beneficiary’s Last Name (BLN)
  • Choice 2
  • Choice 2
  • “Ms.” plus Beneficiary’s Last Name (BLN)
  • Choice 3
  • Choice 3
  • you
  • G. AST Universal Text Identifier – Equitable relief
  • ASTC02 – CAPTION
  • Information About (1) Installment Payment
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • Your
  • H. ATY Universal Text Identifiers – Representative Fee
  • ATYC01 – CAPTION
  • Information About (1) Fees
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Lawyer’s
  • Choice 2
  • Choice 2
  • Representative’s
  • ATYC03 – CAPTION
  • ATYC03 – CAPTION
  • Information About Past-Due Benefits Withheld
  • ATY067 – SUPPLEMENTAL SECURITY INCOME OFFSET HAS BEEN DETERMINED – PAST DUE BENEFITS BEING RELEASED TO BENEFICIARY AND REPRESENTATIVE HAS NOT REGISTERED FOR DIRECT PAYMENT
  • If a representative, who is a (1), registers with us to receive direct fee payment, because of the law we usually withhold part of the past-due benefits to pay the fee we approve. Although (2) representative is a (3), he or she did not register for direct payment before we completed our work on (4) claim. For that reason, we did not withhold from (5) past-due benefits to pay the fee we approve. Therefore, the Social Security Administration is not involved in paying the fee. This is a matter between (6) and (7) (8).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • lawyer
  • Choice 2
  • Choice 2
  • participant in the non-attorney direct payment demonstration project
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • lawyer
  • Choice 2
  • Choice 2
  • participant in the demonstration project
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “has”
  • Choice 2
  • Choice 2
  • your
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • Fill-in (6)
  • Fill-in (6)
  •  
  • Choice 1
  • Choice 1
  • him
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • you
  • Fill-in (7)
  • Fill-in (7)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • Fill-in (8)
  • Fill-in (8)
  •  
  • Choice 1
  • Choice 1
  • lawyer
  • Choice 2
  • Choice 2
  • representative
  • ATY836 – EXPLANATION TO THE BENEFICIARY ABOUT THE WITHHOLDING OF REPRESENTATIVE FEES FROM PAST-DUE BENEFITS IN SUPPLEMENTAL SECURITY INCOME (SSI) OFFSET CASES
  • ATY836 – EXPLANATION TO THE BENEFICIARY ABOUT THE WITHHOLDING OF REPRESENTATIVE FEES FROM PAST-DUE BENEFITS
  • Based on the law, we must withhold part of past-due benefits to pay an appointed representative. We cannot withhold more than 25 percent of past-due benefits to pay an authorized fee. We withheld (1) from (2) past-due benefits to pay (3) representative.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Attorney fee amount in the format $$$$$$.¢¢
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
The materials available at this web site are provided free of charge, for informational purposes only, and without warrant by True Link Financial, Inc., and are not legal advice or Social Security benefits advice. You should contact your attorney to obtain advice with respect to any particular issue or problem, or the Social Security Administration with any general inquiries. Click here to view this section of the POMS on the Social Security Administration website.