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NL 00730.136: “R” Paragraphs and Captions

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  • Effective Dates: 10/13/2016 - Present
  • Effective Dates: 03/30/2018 - Present
  • TN 25 (10-16)
  • TN 28 (03-18)
  • NL 00730.136 R Paragraphs and Captions
  • NL 00730.136 “R” Paragraphs and Captions
  • List of “R” Paragraphs and Captions
  • A. RCY Universal Text Identifiers - Recovery
  • RCYC01 – CAPTION
  • How to Pay Us Back
  • RCYC04 – CAPTION
  • Do You Think That You Do Not Owe This Money?
  • RCYC05 – CAPTION
  • Reduction To Collect Your SSI Overpayment
  • RCY002 – CROSS PROGRAM RECOVERY FOR SUPPLEMENTAL SECURITY INCOME (SSI) OVERPAYMENT
  • We paid (1) more in Supplemental Security Income (SSI) payments in the past than (2) due. Our records show that (3) us (4) in SSI payments. By law, we can collect SSI overpayments from the Social Security benefits that (5). We withheld (6) from (7) Social Security benefits to collect (8) of the SSI payments that (9).
  • 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
  • he was
  • Choice 2
  • Choice 2
  • she was
  • Choice 3
  • Choice 3
  • you were
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • he still owes
  • Choice 2
  • Choice 2
  • she still owes
  • Choice 3
  • Choice 3
  • you still owe
  • Fill-in (4)
  • Fill-in (4)
  • Cross Program Recovery Overpayment Amount (CPR-OPAMT) in the format $$$$$$.¢¢
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • he receives
  • Choice 2
  • Choice 2
  • she receives
  • Choice 3
  • Choice 3
  • you receive
  • Fill-in (6)
  • Fill-in (6)
  • Cross Program Recovery Underpayment Amount (CPR-UPAMT) in the format $$$$$$.¢¢
  • 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
  • some of
  • Choice 2
  • Choice 2
  • Null
  • Fill-in (9)
  • Fill-in (9)
  •  
  • Choice 1
  • Choice 1
  • he owes
  • Choice 2
  • Choice 2
  • she owes
  • Choice 3
  • Choice 3
  • you owe
  • RCY003 – CROSS PROGRAM RECOVERY FOR SUPPLEMENTAL SECURITY INCOME (SSI) OVERPAYMENT - USED WITH RCY002
  • RCY003 – CROSS PROGRAM RECOVERY FOR SUPPLEMENTAL SECURITY INCOME (SSI) OVERPAYMENT - USED WITH RCY002
  • You may ask us to review our finding that you still owe the money. You may have evidence to show that you already paid some or all of the money or that we previously waived collection of it. If so, give us this evidence when you ask for review. We will review the evidence you give us and the information we have. We will send you a letter with our decision. If we find that you do not owe us this amount, then we will correct our records.
  • For more information on requesting review, see "If You Disagree With The Decision" below.
  • RCY006 – BENEFITS RAISED - PARTIAL RECOVERY ENDS
  • We have raised (1) benefits back to (2) regular monthly payment amount. This is because (3) repaid the overpayment money (4) owed us.
  • 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
  • Beneficiary Given Name (BGN) (possessive)
  • Choice 3
  • Choice 3
  • your
  • 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
  • he
  • Choice 2
  • Choice 2
  • she
  • Choice 3
  • Choice 3
  • you
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • he
  • Choice 2
  • Choice 2
  • she
  • Choice 3
  • Choice 3
  • you
  • RCY007 – PARTIAL RECOVERY ENDS - NO REMAINING OVERPAYMENT
  • RCY007 – PARTIAL RECOVERY ENDS - NO REMAINING OVERPAYMENT
  • We are withholding (1) from (2) benefits. This is the remaining balance (3) owed on (4) overpayment.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Monthly Recovery Amount (MRA) on the pre-MBR 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
  • he
  • Choice 2
  • Choice 2
  • she
  • Choice 3
  • Choice 3
  • you
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • B. “REF” Universal Text Identifiers – Referral
  • REFC01 – CAPTION
  • Suspect Social Security Fraud?
  • Please visit http://oig.ssa.gov/r or call the Inspector General’s Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).
  • If You Have Questions
  • REF001 – REFERRAL FOR DOMESTIC ADDRESS
  • We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. However, if you have any specific (1) questions, you can call us at 1-800-772-1213. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call out TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:
  • (2)
  • If you do call or visit an office, please have this letter with you. It will help us answer your questions.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Null
  • Fill-in (2)
  • Fill-in (2)
  • field office address
  • REF002 – REFERRAL FOR FOREIGN ADDRESS
  • REF002 – REFERRAL FOR FOREIGN ADDRESS
  • We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you should contact any Social Security office or the nearest United States Embassy or Consulate. You may also write the Social Security Administration, P.O. Box 17769, Baltimore, Maryland, 21235-7769, USA. Please be sure to include your claim number if you do write. However, if you visit an office, please have this letter with you. It will help the people there answer your questions. Medicare information is available on the Internet at www.medicare.gov.
  • We invite you to visit our website at www.socialsecurity.gov to find general information about Social Security. If you have questions, please contact any Social Security office or your Federal Benefits Unit. Visit *F1 for a list of Federal Benefits Units. You may also write to the Social Security Administration, P.O. Box 17769, Baltimore, Maryland 21235, U.S.A. Please be sure to include your Social Security claim number if you do write. If you visit an office, please take this letter with you. It will help us answer your questions. 
  • If you have questions about Medicare, please visit www.medicare.gov for information. 
  • Fill-in values:
  •  
  • Fill-in (1)
  • www.socialsecurity.gov/foreign/foreign.htm
  • REF003 – REFERRAL FOR DOMESTIC ADDRESS
  • We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (1). We can answer most questions over the phone. If you are deaf or hard of hearing, you may call out TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:
  • We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (1). We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:
  • (2)
  • If you do call or visit an office, please have this letter with you. It will help us answer questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Null
  • Fill-in (1)
  • Fill-in (2)
  • local field office telephone number in format 1-XXX-XXX-XXXX
  • local field office telephone number in format 1-XXX-XXX-XXXX
  •  
  • Fill-in (2)
  • field office address
  • REF008 – FIELD OFFICE REFERRAL - DEFAULT
  • REF008 – FIELD OFFICE REFERRAL - DEFAULT
  • We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific (1) questions, call us toll-free at 1-800-772-1213. We can answer most questions over the phone. If you prefer to visit one of our offices, please check the local telephone directory for the office nearest you. Or call us and we can give you the office address. Please have this letter with you if you call or visit an office. It will help us answer your questions.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Null
  • REF018 – STATE BUY-IN/BUY-OUT REFERRAL FOR DOMESTIC ADDRESS
  • REF018 – STATE BUY-IN/BUY-OUT REFERRAL FOR DOMESTIC ADDRESS
  • (1)
  • If you have any questions (2) you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (3). We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:
  • (4)
  • If you do call or visit an office, please have this letter with you. It will help us answer questions. Also if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • If you have any questions about the State Medicaid Program, please contact your State public assistance office.
  • Choice 2
  • Choice 2
  • If you have any questions about the State retirement system, please contact that office
  • Choice 3
  • Choice 3
  • Null
  • Fill-in (2)
  • Fill-in (2)
  • about Medicare
  • Fill-in (3)
  • Fill-in (3)
  • local Social Security office telephone number, in format, 1-XXX-XXX-XXXX
  • Fill-in (4)
  • Fill-in (4)
  • use the street address, City, State and zip code corresponding to the MBR District Office Code (DOC)
  • REF020 – DEFERRAL - ADVANCE FILE MATURING
  • REF020 – DEFERRAL - ADVANCE FILE MATURING
  • To make sure you get the correct amount of benefits, you need to report promptly any changes in the amount you earn or expect to earn. You should also report any other changes that may affect your payment.
  • The pamphlet (1) describes the events you need to report. If you no longer have the pamphlet, you can get one from any Social Security office, or the nearest United States Embassy or Consulate.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • “Your Social Security Checks...While You Are Outside the United States”
  • Choice 2
  • Choice 2
  • “When You Get Social Security Disability Benefits...What You Need to Know”
  • Choice 3
  • Choice 3
  • “When You Get Social Security Retirement or Survivors Benefits...What You Need to Know”
  • REF056 – REFERRAL - RAILROAD RETIREMENT
  • REF056 – REFERRAL - RAILROAD RETIREMENT
  • If you have any questions, please contact your local Railroad District Office or the Railroad Retirement Board. The address is U.S. Railroad Retirement Board, 844 Rush Street, Chicago, Illinois 60611-2092.
  • C. REP Universal Text Identifiers – Claimant Representation
  • REPC01 – CAPTION
  • If You Want Help With Your Appeal
  • REP002 – APPEALS INFORMATION - NOT USED ON END-STAGE RENAL DISEASE (ESRD) TERMINATION NOTICE
  • You may choose to have a representative help you. We will work with this person just as we would work with you. If you decide to have a representative, you should find one quickly so that person can start preparing your case.
  • Many representatives charge a fee only if you receive benefits. Others may represent you for free. Usually, your representative may not charge a fee unless we approve it. Your local Social Security office can give you a list of groups that can help you find a representative.
  • If you get a representative, you or that person must notify us in writing. You may use our Form SSA-1696 “Appointment of Representative.” Any local Social Security office can give you this form.
  • REP005 – APPEALS INFORMATION FOR AN END-STAGE RENAL DISEASE (ESRD) TERMINATION NOTICE
  • You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your Social Security office has a list of groups that can help you with your appeal. If you get someone to help you, you should let us know.
  • D. RFU Universal Text Identifiers - Refund
  • You should refund this overpaymRFU001 – OVERPAYMENT REQUESTED FROM TERMINATED BENEFICIARY ent within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Include (1) claim number (as shown above) on your check or money order.
  • RFU001 – OVERPAYMENT REQUESTED FROM TERMINATED BENEFICIARY
  • You should refund this overpayment of (*F1) within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope.
  • Always include (*F2) Social Security claim number on your check or money order.
  • If you cannot refund the full (*F3) now, please send:
  • • A partial payment
  • • An explanation of why you cannot pay the full amount now, and
  • If you cannot refund the full (2) now, please send:
  • * A partial payment,
  • * An explanation of why you cannot pay the full amount now, and
  • * A plan to repay the money.
  • • A plan to repay the money
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Overpayment amount in the format $$$$$$.¢¢
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (2)
  • Fill-in (3)
  • Overpayment amount in the format $$$$$$.¢¢
  • RFU002 – OVERPAYMENT REQUESTED - FOREIGN ADDRESS
  • RFU002 – OVERPAYMENT REQUESTED - FOREIGN ADDRESS
  • If you pay us by check or money order, make sure that the check or money order is in United States (U.S.) dollars or in local currency equal to U.S. dollars. When you pay us in local currency, we use the exchange rates in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment to us, please go to the nearest U.S. Embassy or consulate. They will help you make the refund.
  • RFU004 – SUPPLEMENTAL SECURITY INCOME (SSI) IS DETERMINED AND SOCIAL SECURITY RETROACTIVE BENEFITS ARE GREATER THAN THE SSI WINDFALL OFFSET AMOUNT
  • We compared (1) Social Security and SSI benefits. We found we should have paid (2) (3) less in SSI benefits. We will withhold this amount from (4) Social Security benefits.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Choice 4
  • Choice 4
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • Fill-in (3)
  • Fill-in (3)
  • Deductions Additions History Amount (DAH-AMOUNT) that corresponds to the Deductions Additions History Type of Payment (DAH-TOP) = PMA (P) and Deductions Additions History Item (DAH-ITEM) = 345 (DIB SSI offset) or the DAH ITEM = 346 (RIB SSI offset) in the format $$$$$$.¢¢
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • RFU006 – SUPPLEMENTAL SECURITY INCOME (SSI) IS DETERMINED AND THE SOCIAL SECURITY RETROACTIVE BENEFITS ARE LESS OR EQUAL TO THE WINDFALL OFFSET AMOUNT
  • RFU006 – SUPPLEMENTAL SECURITY INCOME (SSI) IS DETERMINED AND THE SOCIAL SECURITY RETROACTIVE BENEFITS ARE LESS OR EQUAL TO THE WINDFALL OFFSET AMOUNT
  • We compared (1) Social Security and SSI benefits. We found that we should have paid (2) (3) less SSI benefits. As a result, we cannot pay (4) any of the Social Security benefits we withheld.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Choice 4
  • Choice 4
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • Fill-in (3)
  • Fill-in (3)
  • Deductions Additions History Amount (DAH-AMOUNT) that corresponds to the Deductions Additions History Type of Payment Code (DAH-TOP) = PMA (P) and [Deductions Additions History Item Code (DAH-ITEM) = 345 (DIB SSI offset or DAH-ITEM=346 (RIB SSI offset)] in the format $$$$$$.¢¢.
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Choice 4
  • Choice 4
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • RFU007 – SUPPLEMENTAL SECURITY INCOME (SSI) WINDFALL OFFSET IS DETERMINED AND THERE IS NO SSI OFFSET APPLIED TO SECURITY BENEFITS THEREFORE RETRO BENEFITS ARE PAYABLE TO THE BENEFICIARY
  • RFU007 – SUPPLEMENTAL SECURITY INCOME (SSI) WINDFALL OFFSET IS DETERMINED AND THERE IS NO SSI OFFSET APPLIED TO SECURITY BENEFITS THEREFORE RETRO BENEFITS ARE PAYABLE TO THE BENEFICIARY
  • Our records show that (1) did not get SSI money for (2). We can refund all of the Social Security money withheld.
  • 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
  • History Start date of the first month where Reason for Suspension = WINFAL in the format Month CCYY
  • Choice 2
  • Choice 2
  • Start date that corresponds to the Reason for Suspension = WINFAL plus ”through” plus the stop date of the last WINFAL Suspension month
  • RFU012 – TITLE II OVERPAYMENT ADJUSTMENT FROM BENEFITS WHEN OVERPAYMENT AMOUNT IS GREATER THAN MONTHLY BENEFIT AMOUNT (MBA)
  • RFU012 – TITLE II OVERPAYMENT ADJUSTMENT FROM BENEFITS WHEN OVERPAYMENT AMOUNT IS GREATER THAN MONTHLY BENEFIT AMOUNT (MBA)
  • You should refund this overpayment of (1) within 30 days. Please make your check or money order payable to "Social Security Administration," and send it to us in the enclosed envelope.
  • You should refund this overpayment of (1) within 30 days. Please make your check or money order payable to "Social Security Administration," and send it to us in the enclosed envelope. Include (2) claim number (as shown above) on your check or money order.
  • Always include (2) Social Security claim number on your check or money order.
  • If we do not receive your refund within 30 days, we will hold back (3) full benefit starting with the payment you would normally receive (4) about (5). We will continue holding back (6) benefits until we recover the overpayment.
  • If you cannot refund the full overpayment now or cannot afford to have us hold back (7) full benefit, you may ask us to hold back a smaller amount each month. Contact us to discuss your plan for repaying the balance. You may need to show us proof of (8) assets, monthly income, and expenses.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Overpayment amount in format $$$$$$.¢¢
  • 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)
  •  
  • Choice 1
  • Choice 1
  • Null
  • Choice 2
  • Choice 2
  • for him
  • Choice 3
  • Choice 3
  • for her
  • Fill-in (5)
  • Fill-in (5)
  • Date of payment in the format Month DD, 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)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (8)
  • Fill-in (8)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • E. RIN Universal Text Identifiers – Rate Information
  • RIN006 – EXPLAINS ADJUSTMENT REDUCTION FACTOR INCREASE
  • Because (1) retired early, we reduced (2) monthly Social Security benefit. The amount that we reduced it was based on the number of months (3) would receive benefits before (4). However, (5) didn't receive benefits some of these months because (6) worked and earned over certain limits. So, we must increase (7) benefit amount to give credit for these months.
  • 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
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Choice 4
  • Choice 4
  • your
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • BGN
  • Choice 2
  • Choice 2
  • he
  • Choice 3
  • Choice 3
  • she
  • Choice 4
  • Choice 4
  • you
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • full retirement age
  • Choice 2
  • Choice 2
  • age 62
  • Choice 3
  • Choice 3
  • age 60
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary Given Name (BGN)
  • Choice 2
  • Choice 2
  • he
  • Choice 3
  • Choice 3
  • she
  • Choice 4
  • Choice 4
  • you
  • Fill-in (6)
  • Fill-in (6)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary Given Name (BGN)
  • Choice 2
  • Choice 2
  • BIC A’s Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • Choice 3
  • Choice 3
  • he
  • Choice 4
  • Choice 4
  • she
  • Choice 5
  • Choice 5
  • you
  • Choice 6
  • Choice 6
  • he and his spouse
  • Choice 7
  • Choice 7
  • she and her spouse
  • Choice 8
  • Choice 8
  • you and your spouse
  • Choice 9
  • Choice 9
  • his spouse
  • Choice 10
  • Choice 10
  • her spouse
  • Fill-in (7)
  • Fill-in (7)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Choice 4
  • Choice 4
  • your
  • RIN007 – EXPLAINS DELAYED RETIREMENT CREDIT INCREASE
  • RIN007 – EXPLAINS DELAYED RETIREMENT CREDIT INCREASE
  • When (1) filed for Social Security benefits, we figured the benefit amount based on (2) earnings history at that time. If after becoming entitled to benefits, (3) to work, (4) may earn credit for this additional work. So, we must increase (5) benefit amount to give credit for these months.
  • We apply the increase sometime after it is due. This is because earnings information is not available until after each tax year.
  • 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 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Choice 4
  • Choice 4
  • your
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • he continues to work or later returns
  • Choice 2
  • Choice 2
  • she continues to work or later returns
  • Choice 3
  • Choice 3
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) plus “continues to work or later returns”
  • Choice 4
  • Choice 4
  • you continue to work or later return
  • 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)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • RIN008 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY IS TERMINATED OR BECOMES ENTITLED ON THE RECORD
  • RIN008 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY IS TERMINATED OR BECOMES ENTITLED ON THE RECORD
  • We changed (1) monthly benefit to (2) starting (3). We made this change because we (4) paying benefits to another person on this record.
  • 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
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA increase
  • Choice 2
  • Choice 2
  • NA-HIST-POST-MBA in the format $$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) increase
  • Choice 2
  • Choice 2
  • NA-HIST-START month in the format Month CCYY
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • started
  • Choice 2
  • Choice 2
  • stopped
  • RIN012 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - COST OF LIVING INCREASE
  • RIN012 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - COST OF LIVING INCREASE
  • We raised (1) monthly benefit to (2) beginning (3) because the cost of living increased.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA decrease
  • Choice 2
  • Choice 2
  • NA-HIST-POST-MBA in the format $$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) increase
  • Choice 2
  • Choice 2
  • NA-HIST-START month in the format Month CCYY
  • RIN013 – AUXILIARY'S MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO ANOTHER BENEFICIARY'S DEATH
  • RIN013 – AUXILIARY'S MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO ANOTHER BENEFICIARY'S DEATH
  • We changed (1) monthly benefit to (2) starting (3). We changed (4) benefit because of the death of (5).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA increase
  • Choice 2
  • Choie 2
  • NA-HIST-POST-MBA in the format $$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) increase due to death
  • Choice 2
  • Choice 2
  • NA-HIST-START month in the format Month CCYY
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Choice 3
  • Choice 3
  • your
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • Deceased Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • Choice 2
  • Choice 2
  • another person entitled on this record
  • RIN044 – AUXILIARY MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY ENTITLED AND COST-OF-LIVING ADJUSTMENT (COLA)
  • RIN044 – AUXILIARY MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY ENTITLED AND COST-OF-LIVING ADJUSTMENT (COLA)
  • We changed (1) monthly benefit to (2) beginning (3) because we started paying another person(s) on this record. This change also includes the cost of living increase.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢
  • Choice 2
  • Choice 2
  • NA-HIST-POST-MBA in the format $$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY
  • Choice 2
  • Choice 2
  • NA-HIST-START month in the format Month CCYY
  • RIN045 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY TERMINATES AND COST-OF-LIVING ADJUSTMENT (COST-OF-LIVING ADJUSTMENT (COLA))
  • RIN045 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - ANOTHER BENEFICIARY TERMINATES AND COST-OF-LIVING ADJUSTMENT (COST-OF-LIVING ADJUSTMENT (COLA))
  • We changed (1) monthly benefit to (2) beginning (3) because benefits to another entitled person(s) stopped. This change also includes the cost of living increase.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢
  • Choice 2
  • Choice 2
  • NA-HIST-POST-MBA in the format $$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY
  • Choice 2
  • Choice 2
  • NA-HIST-START month in the format Month CCYY
  • RIN046 – NUMBER HOLDER NOTICE WORKERS’ COMPENSATION (WC)/PUBLIC DISABILITY BENEFIT (PDB) INVERSE OFFSET POSTPONED MONTHLY BENEFIT AMOUNT (MBA) CHANGE
  • RIN046 – NUMBER HOLDER NOTICE WORKERS’ COMPENSATION (WC)/PUBLIC DISABILITY BENEFIT (PDB) INVERSE OFFSET POSTPONED MONTHLY BENEFIT AMOUNT (MBA) CHANGE
  • We changed (1) monthly benefit to (2) beginning (3).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (2)
  • Fill-in (2)
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY
  • RIN047 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - AGE REDUCTION FACTOR (ARF)
  • RIN047 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - AGE REDUCTION FACTOR (ARF)
  • We changed (1) monthly benefit to (2) starting (3). We gave (4) credit for benefits that we did not pay at the full rate before (5) reached (6).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢
  • Choice 2
  • Choice 2
  • Show the NA-HIST-POST-MBA in the format $$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY
  • Choice 2
  • Choice 2
  • NA-HIST-START month in the format Month CCYY
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • he
  • Choice 3
  • Choice 3
  • she
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • he
  • Choice 3
  • Choice 3
  • she
  • Fill-in (6)
  • Fill-in (6)
  •  
  • Choice 1
  • Choice 1
  • age 60
  • Choice 2
  • Choice 2
  • age 62
  • Choice 3
  • Choice 3
  • full retirement age
  • RIN048 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - DELAYED RETIREMENT CREDIT (DRC)
  • RIN048 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE - DELAYED RETIREMENT CREDIT (DRC)
  • We raised (1) monthly benefit amount beginning (2) to (3). We changed (4) benefit amount to give (5) credit for the past months that (6) delayed receiving retirement benefits.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY
  • Choice 2
  • Choice 2
  • TDA-RETAP-EVENT-DATE that corresponds to the TDA-EVENT-INDICATOR = A602 in the format Month CCYY
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢
  • Choice 2
  • Choice 2
  • TDA-RETAP-EVENT-DATE that corresponds with TDA-EVENT-INDICATOR = A602 in the format $$$$$.¢¢
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Fill-in (6)
  • Fill-in (6)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • he
  • Choice 3
  • Choice 3
  • she
  • RIN049 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO INCORRECT MBA
  • RIN049 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO INCORRECT MBA
  • We changed (1) monthly benefit to (2) as of (3). We found that (4) prior amount was incorrect.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) of the MBA change in the format $$$$$.¢¢
  • Choice 2
  • Choice 2
  • NA-HIST-POST-MBA in the format $$$$$.¢¢
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY
  • Choice 2
  • Choice 2
  • NA-HIST-START month in the format Month CCYY
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • RIN053 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO DUAL ENTITLEMENT (BENEFITS COMBINED OR DECOMBINED)
  • RIN053 – MONTHLY BENEFIT AMOUNT (MBA) CHANGE DUE TO DUAL ENTITLEMENT (BENEFITS COMBINED OR DECOMBINED)
  • We changed (1) monthly benefit amount to (2) starting (3). We changed the amount because (4) also entitled on another record.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Choice 2
  • Choice 2
  • your
  • Fill-in (2)
  • Fill-in (2)
  • Post-MBR Monthly Benefit Amount (MBA) associated with the Effective Date (EFD) on the MBA change in the format $$$$$$¢¢
  • Fill-in (3)
  • Fill-in (3)
  • Effective Date (EFD) on the post-MBR associated with the Monthly Benefit Amount (MBA) change in the format Month CCYY
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • you are
  • Choice 2
  • Choice 2
  • he is
  • Choice 3
  • Choice 3
  • she is
  • RIN059 – PRIMARY INSURANCE AMOUNT (PIA) CHANGE DUE TO CREDITABLE MILITARY SERVICE
  • RIN059 – PRIMARY INSURANCE AMOUNT (PIA) CHANGE DUE TO CREDITABLE MILITARY SERVICE
  • We are changing (1) benefits to give (2) credit for time (3) spent in military service. This time was not included when we figured (4) benefit before.
  • 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)
  • Choice 3
  • Choice 3
  • his
  • Choice 4
  • Choice 4
  • her
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • he
  • Choice 3
  • Choice 3
  • she
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • RIN060 – IDENTIFIES SPECIFIC YEAR(S) OF EARNINGS CREDITED TO THE NUMBER HOLDER, RESULTING IN A PRIMARY INSURANCE AMOUNT (PIA) INCREASE
  • RIN060 – IDENTIFIES SPECIFIC YEAR(S) OF EARNINGS CREDITED TO THE NUMBER HOLDER, RESULTING IN A PRIMARY INSURANCE AMOUNT (PIA) INCREASE
  • We changed (1) benefit amount to give (2) credit for (3) (4) earnings. We did not include these earnings when we figured (5) benefit amount before.
  • 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)
  • Choice 3
  • Choice 3
  • his
  • Choice 4
  • Choice 4
  • her
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • him
  • 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)
  •  
  • Choice 1
  • Choice 1
  • Year of earnings in format CCYY
  • Choice 2
  • Choice 2
  • Year of earnings and year of earnings in format CCYY and CCYY
  • Choice 3
  • Choice 3
  • Year of earnings, year of earnings and year of earnings in format CCYY, CCYY and CCYY
  • Choice 4
  • Choice 4
  • Year of earnings, year of earnings, year of earnings and year of earnings in format CCYY, CCYY, CCYY and CCYY
  • Choice 5
  • Choice 5
  • Null
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • RIN061 – DUALLY ENTITLED BENEFICIARY RECEIVING PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON THE OTHER RECORD – NO INCREASE DUE ON OWN PIA
  • RIN061 – DUALLY ENTITLED BENEFICIARY RECEIVING PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON THE OTHER RECORD – NO INCREASE DUE ON OWN PIA
  • We reviewed our records to see if (1) due more money. We increased (2) benefits to give (3) credit for the earnings of (4) spouse that we did not count before.
  • 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”
  • Choice 3
  • Choice 3
  • he is
  • Choice 4
  • Choice 4
  • she 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)
  •  
  • Choice 1
  • Choice 1
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • RIN062 – DUALLY ENTITLED BENEFICIARY RECEIVING PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN ACCOUNT – BENEFITS ON OTHER RECORD ARE ENDING BECAUSE BENEFICIARY’S OWN BENEFIT IS LARGER
  • RIN062 – DUALLY ENTITLED BENEFICIARY RECEIVING PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN ACCOUNT – BENEFITS ON OTHER RECORD ARE ENDING BECAUSE BENEFICIARY’S OWN BENEFIT IS LARGER
  • We reviewed our records and found that we can increase (1) benefits. We increased (2) benefits because we gave (3) credit for earnings that we did not count before.
  • (4) benefits on (5) own record and as a (6) on another record. Since (7) benefits are now higher on (8) own record, we stopped the benefits (9) on the other record.
  • 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)
  • Choice 3
  • Choice 3
  • his
  • Choice 4
  • Choice 4
  • her
  • 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
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • You receive
  • Choice 2
  • Choice 2
  • He receives
  • Choice 3
  • Choice 3
  • She receives
  • Fill-in (5)
  • Fill-in (5)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (6)
  • Fill-in (6)
  •  
  • Choice 1
  • Choice 1
  • spouse
  • Choice 2
  • Choice 2
  • parent
  • Choice 3
  • Choice 3
  • surviving spouse
  • Choice 4
  • Choice 4
  • divorced spouse
  • Choice 5
  • Choice 5
  • surviving former spouse
  • Fill-in (7)
  • Fill-in (7)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (8)
  • Fill-in (8)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • Fill-in (9)
  • Fill-in (9)
  •  
  • Choice 1
  • Choice 1
  • you receive
  • Choice 2
  • Choice 2
  • he receives
  • Choice 3
  • Choice 3
  • she receives
  • RIN063 – DUALLY ENTITLED BENEFICIARY’S ONGOING MONTHLY PAYMENT AMOUNT REMAINS THE SAME OR IS SLIGHTLY DIFFERENT DUE TO ROUNDING – SMALLER PRIMARY INSURANCE AMOUNT (PIA) AND BENEFIT INCREASE ON OWN RECORD WHILE LARGER PIA ON OTHER RECORD REMAINS THE SAME BUT THE AMOUNT PAYABLE DECREASES
  • RIN063 – DUALLY ENTITLED BENEFICIARY’S ONGOING MONTHLY PAYMENT AMOUNT REMAINS THE SAME OR IS SLIGHTLY DIFFERENT DUE TO ROUNDING – SMALLER PRIMARY INSURANCE AMOUNT (PIA) AND BENEFIT INCREASE ON OWN RECORD WHILE LARGER PIA ON OTHER RECORD REMAINS THE SAME BUT THE AMOUNT PAYABLE DECREASES
  • Since we increased the amount we pay (1) on (2) own record, we decreased the amount we pay (3) on another record.
  • 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)
  • Choice 3
  • Choice 3
  • him
  • Choice 4
  • Choice 4
  • her
  • 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
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • RIN064 – DUALLY ENTITLED BENEFICIARY RECEIVES PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN RECORD AND ON THE OTHER RECORD
  • RIN064 – DUALLY ENTITLED BENEFICIARY RECEIVES PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN RECORD AND ON THE OTHER RECORD
  • We increased the benefits on both Social Security records. To get the amount we can pay (1), we subtract the new benefit on (2) own record from the new benefit on the other record.
  • 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)
  • Choice 3
  • Choice 3
  • him
  • Choice 4
  • Choice 4
  • her
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • RIN065 – DUALLY ENTITLED BENEFICIARY RECEIVES PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN ACCOUNT – ONGOING MONTHLY PAYMENT AMOUNT REMAINS THE SAME OR IS SLIGHTLY DIFFERENT DUE TO ROUNDING – SMALLER PIA AND BENEFIT INCREASE ON OWN ACCOUNT WHILE LARGER PIA ON OTHER RECORD REMAINS THE SAME BUT AMOUNT PAYABLE DECREASES
  • RIN065 – DUALLY ENTITLED BENEFICIARY RECEIVES PRIMARY INSURANCE AMOUNT (PIA) INCREASE ON OWN ACCOUNT – ONGOING MONTHLY PAYMENT AMOUNT REMAINS THE SAME OR IS SLIGHTLY DIFFERENT DUE TO ROUNDING – SMALLER PIA AND BENEFIT INCREASE ON OWN ACCOUNT WHILE LARGER PIA ON OTHER RECORD REMAINS THE SAME BUT AMOUNT PAYABLE DECREASES
  • Since we increased the amount we pay (1) on (2) own record, we decreased the amount we pay (3) on (4) spouse’s record.
  • 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)
  • Choice 3
  • Choice 3
  • him
  • Choice 4
  • Choice 4
  • her
  • 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
  • you
  • Choice 2
  • Choice 2
  • him
  • Choice 3
  • Choice 3
  • her
  • Fill-in (4)
  • Fill-in (4)
  •  
  • Choice 1
  • Choice 1
  • your
  • Choice 2
  • Choice 2
  • his
  • Choice 3
  • Choice 3
  • her
  • RIN066 – MONTHLY BENEFIT AMOUNT (MBA) DECREASED BECAUSE ACTUAL EARNINGS WERE LESS THAN THE EXPECTED EARNINGS ORIGINALLY USED TO CALCULATE THE PRIMARY INSURANCE AMOUNT (PIA)
  • RIN066 – MONTHLY BENEFIT AMOUNT (MBA) DECREASED BECAUSE ACTUAL EARNINGS WERE LESS THAN THE EXPECTED EARNINGS ORIGINALLY USED TO CALCULATE THE PRIMARY INSURANCE AMOUNT (PIA)
  • We reviewed (1) record and found that (2) earnings changed. These changes caused (3) monthly benefit amount to decrease effective (4).
  • 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)
  •  
  • Choice 1
  • Choice 1
  • Post-MBR History Effective Date (EFD) associated with the first Primary Insurance Amount Effective Date (PIED) occurrence of Primary Insurance Amount (PIA) decrease in the format Month CCYY
  • F. RPA Universal Text Identifier – Representative Payee Annual Accounting
  • RPAC01 – CAPTION
  • It Is Important To Keep Track Of This Money
  • G. RPY Universal Text Identifiers – Representative Payee
  • RPY002 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF PAYEE DEVELOPMENT (DEVPYE) OR DEATH OF PAYEE (DTHPYE)
  • If you know someone who can be your payee, please call us at either of the telephone numbers shown at the end of this letter. We will consider this person for your new payee. Also, if you believe you are able to manage your own money, please let us know. Call us within the next 30 days if you do not hear from us. You may be able to get some payments directly while we make our decision.
  • RPY003 – SUSPENSION - HISTORY REASON FOR SUSPENSION OR TERMINATION (HRFST) OF PAYEE DEVELOPMENT (DEVPYE) OR DEATH OF PAYEE (DTHPYE)
  • If you know someone who can be your payee, please call us at either of the telephone numbers shown at the end of this letter. We will consider this person for your payee. Also, call us within the next 30 days if you do not hear from us. You may be able to keep getting some payments directly while we make our decision.
  • RPY015 – FORMER PAYEE NOTICE
  • Thank you for your willingness to serve as a representative payee. We have decided that it would be best for (1) to have (2) checks sent to another payee.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • RPY016 – FORMER PAYEE NOTICE
  • RPY016 – FORMER PAYEE NOTICE
  • We have decided that it would be best for (1) to have (2) checks sent to (3).
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • him
  • Choice 2
  • Choice 2
  • her
  • RPY038 – PAYEE CHANGE TO SELF
  • RPY038 – PAYEE CHANGE TO SELF
  • We will begin to send your checks directly to you. The rest of this letter will give you more information about your benefits.
  • RPY039 – NEW PAYEE SELECTED
  • We have chosen you to be (1) representative payee. The rest of this letter will give you information about the checks you will receive while you are the payee.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • RPY041 – NEW PAYEE SELECTED
  • RPY041 – NEW PAYEE SELECTED
  • Please read the enclosed pamphlet, “A Guide for Representative Payees.” It lists the things you will need to know because you have been chosen as payee.
  • RPY042 – NEW PAYEE SELECTED
  • You will need to keep track of how you use all of the money we send you for (1). Each year we will ask you to report on how you used the money. We call this a representative payee accounting.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
  • RPY048 – NEW PAYEE SELECTED - NO BENEFITS PAYABLE
  • RPY048 – NEW PAYEE SELECTED - NO BENEFITS PAYABLE
  • We have chosen you to be (1) representative payee. However, we cannot pay benefits at this time.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
  • RPY073 – PAYEE CHANGE - BENEFICIARY'S NOTICE
  • RPY073 – PAYEE CHANGE - BENEFICIARY'S NOTICE
  • We have chosen (1) to be your representative payee. Your payee will receive your checks each month and will use this money for your needs.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • New Payee Name
  • RPY086 – BENEFICIARY DIES - PAYEE TOLD ABOUT CONSERVED FUNDS
  • RPY086 – BENEFICIARY DIES - PAYEE TOLD ABOUT CONSERVED FUNDS
  • You may have saved some Social Security money for (1). Any money that you have saved, plus any interest on that money, belongs to (2) estate.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  • BGN plus BKN
  • BGN plus BLN
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • his
  • Choice 2
  • Choice 2
  • her
  • RPY087 – BENEFICIARY DIES - PAYEE TOLD OF DISPOSITION OF FUNDS
  • RPY087 – BENEFICIARY DIES - PAYEE TOLD OF DISPOSITION OF FUNDS
  • You need to do one of these things:
  • * Give this money to the legal representative of the estate, or
  • * If there is no legal representative, contact the state probate court. They will be able to tell you what to do with the money, or
  • * If there is no legal representative, and you live outside the United States, contact the authorities who control the estate's money. They will be able to tell you what to do with the money.
  • H. RRB Universal Text Identifier – Railroad Board
  • RRBC01 – CAPTION
  • What The Railroad Retirement Board Will Do
  • I. RSD Universal Text Identifier – Not Qualified For Medicare
  • RSD003 – MEDICARE DISALLOWANCE - RESIDENCY
  • (1) cannot qualify for Medicare because (2) did not live in any of the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa or the Northern Mariana Islands at the time (3) applied for Medicare.
  • Fill-in values:
  •  
  • Fill-in (1)
  • Fill-in (1)
  •  
  • Choice 1
  • Choice 1
  • He
  • Choice 2
  • Choice 2
  • She
  • Choice 3
  • Choice 3
  • You
  • Fill-in (2)
  • Fill-in (2)
  •  
  • Choice 1
  • Choice 1
  • he
  • Choice 2
  • Choice 2
  • she
  • Choice 3
  • Choice 3
  • you
  • Fill-in (3)
  • Fill-in (3)
  •  
  • Choice 1
  • Choice 1
  • he
  • Choice 2
  • Choice 2
  • she
  • Choice 3
  • Choice 3
  • you
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.