NL: Notices, Letters and Paragraphs

Effective Dates: 09/19/2012 - Present

TN 4 (02-95)

A. Procedure

The following chart lists the captions and paragraphs to consider when you complete the body of the notice.

NOTE: We labeled the captions with capital letters in alphabetic order as a place-keeping device due to the length of the chart.

Apply the instructions in NL 00802.001B when using this chart.

B. Your payments will be changed as follows

(Mandatory for all SSA-L8155-U2's.)

NL Reference	Paragraph	Use
NL 00804.115	2019	Tells recipient SSI check will stop or be reduced - Mandatory paragraph for caption.

C. Our decision about how we'll pay you

(Use this caption and the following paragraphs only if the notice addresses a representative payee issue.)

NL Reference	Paragraph	Use
NL 00804.185	1291	Notices to recipient and representative payee -SSI payments will go to a representative payee.
	2290	Notice to recipient - Direct payment to recipient.
	2292	Notice to representative payee - New payee selected or direct payment to recipient.
	2301	Reporting responsibilities for new representative payee.
	2302	Notice to new representative payee - Use of SSI payments.
	2294	No SSI payments due now.
NL 00804.200	2600	Drug addiction/alcoholism contributes to recipient's disability- Treatment and representative payee requirements.
NL 00804.200	2602	Recipient continues to need representative payee.

D. Why your payments changed

(Mandatory caption for all three notices.)

NL Reference	Paragraph	Use
		WITHDRAWAL OR TERMINATION - Use the following paragraphs on the SSA-L8155-U2 to notify a recipient about his/her request for withdrawal or termination of SSI payments:
NL 00804.215	2470	N19 - Request for termination approved.
	1503	Provides 60-day notice to recipient to change decision about withdrawal or termination. Use with paragraph 2470 above.
	2471	Recipient received SSI payments for termination (N19) month-request for refund. SUSPENSION ACTIONS - Use the following paragraphs to notify a recipient about a suspension action:
NL 00804.175	2523	N01 - Suspension due to excess income.
NL 00804.165	2200	N02 suspension - Recipient is resident of a public institution.
NL 00804.170	2216	N03 suspension - Recipient is outside the U.S.
NL 00804.170	2219	N13 suspension - Recipient not a U.S. citizen, resident or eligible alien.
NL 00804.180	1272 1274	N04 - Suspension due to excess resources. Use both paragraphs if the recipient does not have a conditional payment agreement.
NL 00804.180	2285	N04 suspension - Sponsor-to-alien deeming involved.
NL 00804.130	2082	N06 suspension - Failure to file for other benefits.
NL 00804.200	2603	N10/N11 suspension - Recipient not receiving required treatment for drug addiction/alcoholism.
NL 00804.140	2118	N14 suspension - Recipient not age 65 or older.
NL 00804.135	2100	N20 suspension - Recipient failed to furnish a required report or evidence.
NL 00804.190	2325	N52/N53 - Deleted from State rolls for December 1973.
NL 00804.240	2527	S07 suspension - Recipient's SSI check returned for miscellaneous reasons.
NL 00804.185	2291	S08 suspension - Representative payee development pending.
NL 00804.185	2300	S08 suspension - Recipient newly determined to be a drug addict or alcoholic and payee development is pending. REINSTATEMENTS - Use these paragraphs to notify a recipient after a period of suspension that payments will resume:
NL 00804.170	2217	N03 to C01 - Recipient resumes residence in U.S.
NL 00804.180	2284	N04 to C01 - Recipient within resource limits.
NL 00804.180	2286	N04 to C01 - Sponsor-to-alien deeming involved.
NL 00804.130	2080	N06 to C01 - Recipient has taken steps to file for other benefits.
NL 00804.200	2617	N09 to C01 - Recipient willing to cooperate with vocational rehabilitation agency.
NL 00804.200	2618	N10/N11 to C01 - Recipient receiving required treatment for drug addiction/alcoholism.
NL 00804.135	2101	N20 to C01 - Recipient provided required report or evidence. OPTIONAL STATE SUPPLEMENT (OSS) - Consider the following paragraphs if an OSS is an issue:
NL 00804.190	2338	Recipient is not eligible for an OSS payment.
	2333	Recipient waived OSS payments.
	2310	Recipient moves from State that pays OSS to another OSS State.
	2311	Tells recipient effective date of new OSS payments.
	2312	Tells recipient effective date former State of residence stops paying OSS.
	2317	Tells recipient about change in OSS amount due to State rate change. MULTICATEGORY ELIGIBILITY (SI 00501.300) - Consider the following paragraphs when multicategory eligibility is an issue:
NL 00804.195	2638	Aged recipient also eligible on basis of disability and/or blindness.
	2347	Multicategory eligibility results in increase in OSS payments.
	2351	Multicategory eligibility for spouse results in SSI increase.
	2346	Recipient or spouse loses eligibility in one or more categories resulting in reduced SSI payment.
	2640	Sponsor-to-alien deeming no longer applies - Recipient's date of onset is after date of admission to U.S. for permanent residence. MISCELLANEOUS - The following paragraphs cover a variety of topics:
NL 00804.155	2161	Living arrangement change - Household of another to own household.
NL 00804.225	2371	Appeal pending - Interim change results in change in amount of SSI.
NL 00804.160	2180	Spouse becomes eligible for SSI - Payment decrease for other member of couple.
NL 00804.160	2181	Spouse's presumptive disability/blindness payments stop - Refigured payment for other member of couple results in increase.
NL 00804.240	2534	Death of eligible spouse, deemor, or sponsor.

E. Information about your payments

(Consider this caption if the notice will include check payment information or if an overpayment, Goldberg-Kelly, or an interim assistance reimbursement (IAR) issue exists.)

NL Reference	Paragraph	Use
		CHECK PAYMENT INFORMATION - Consider the following paragraphs if the notice will have check payment information:
NL 00804.115	1012	Notifies recipient about the retroactive check.
	1479	Tells the retroactive check delivery date.
	2509	Tells recipient balance due after check adjustment is for a past period.
	2510	Tells recipient no additional payment is due for a past period.
	2524	Gives check delivery information for the regular monthly check.
	2511	Explains underpayment is being withheld to recover an overpayment - states balance of underpayment due to the recipient.
NL 00804.120	2043	Explains that advance payments were recovered. Specifies the ongoing amount due.
NL 00804.120	2040	Explains that advance payments were made and no additional payments are due now.
NL 00804.235	1014	Explains that proration applies and tells recipient the first day of eligibility.
NL 00804.240	2525	Retroactive change does not affect current payments.
NL 00804.210	2520	First-of-month payment paid in two checks. OVERPAYMENT - Consider the following paragraphs if there is an overpayment issue:
NL 00804.210	2526	U1 or U2 diary - Notifies recipient about possible underpayment.
	2444	Last month of overpayment collection - Regular monthly checks will resume.
	2434	Overpayment recovery complete - Regular monthly checks will resume.
	2437	Overpayment partially recovered from underpayment - Regular monthly check also reduced.
	1015 1016	Overpayment recovery will begin. 10 percent overpayment recovery rate - Ongoing checks due.
	1017	10 percent overpayment recovery rate results in withholding of entire check.
	1018	Amount of check changes and 10 percent recovery changes.
	2042	Overpayment recovery in progress - Subsequent reduction in SSI payments results in withholding of entire SSI payment.
	2450	SSI payment change while overpayment recovery is in process.
	2455	Living arrangement of overpaid recipient changes to “D” - Overpayment withholding postponed. GOLDBERG-KELLY - Consider the following paragraphs if there is a Goldberg-Kelly issue:
NL 00804.225	2021	Next month's check not reduced to allow time to appeal. Use only on the SSA-L8155-U2 after the Goldberg-Kelly cutoff, when appropriate.
	2022	Similar to paragraph 2021 above - Overpayment involvement.
	2370	Payment continuation pending appeal decision.
	2381	Payment stopped - Payment resumed pending outcome of appeal.
	2372	Change in payment amount not implemented - Appeal pending.
	2375	Appeal pending - Recipient may have to repay incorrect payments.
	2373	New determination differs from issue under appeal - Change in SSI payment results.
	GBKM01	Appeal pending - Recipient requests payment maintenance - OTP or supplemental payment made. INTERIM ASSISTANCE REIMBURSEMENT (IAR) - Consider the following paragraphs if there is an IAR issue:
NL 00804.125	1046	Check sent to IAR agency per agreement.
NL 00804.125	1069	Balance of SSI payments that are not IAR excluded from resources for 6 months.

F. Information about medicaid

(Use this caption before the next caption, “Your SSI Is Based On These Facts,” only when a 1619(b) participant loses 1619(b) status due to excess income other than earned income.)

NL Reference	Paragraph	Use
NL 00804.250	2053	1619(b) participant will lose Medicaid based on SSI due to loss of 1619(b) status due to computer matching income (Mandatory paragraph)
NL 00804.250	2054	State Medicaid office will make final Medicaid decision - Always use this paragraph under paragraph 2053 above.

G. Your (payment/SSI) is based on these facts

(Use this caption when one or more of the paragraphs below is appropriate for explaining the reason for the payment change. When reinstating payments, use all the paragraphs that address facts that affect the payment computation. When the individual is a 1619(b) participant replace “Payment” with “SSI.” )

NL Reference	Paragraph	Use
NL 00804.215	2473	Recipient revoked request to terminate SSI payments.
NL 00804.145	1130	Correction in category of eligibility.
NL 00804.200	2641	Tells date of onset.
NL 00804.160	1161	Change in spouse's eligibility causes SSI payment to increase or stay the same.
NL 00804.135	PMTM01	Past period of N05 - Unable of confirm eligibility for past nonpay month(s).
NL 00804.170	2218	N13 to C01 - Tells effective date for “color of law” determination.
NL 00804.155	1165	Statement - living arrangement “C” or “D.”
	2162	Living arrangement change from “C” or “D” to “A.”
	DCMM06	A child can no longer receive SSI based on section 1614(f)(2) of the Act. Explains why he is ineligible.
NL 00804.165	2201	N02 to C01 - Recipient leaves public institution.
NL 00804.190	1312	Change in recipient's county or State of residence causes payment change.
NL 00804.190	1163 1164	Living arrangement for purpose of optional State supplement. Choose the appropriate paragraph. INCOME - The following paragraphs address income related issues:
NL 00804.175	1240	Recipient has no income or deemed income.
	1601	Change in recipient's or deemor's income does not affect SSI payments.
	1280 1281 1282	Choose the appropriate paragraph when windfall offset applies.
	1231	Lead-in preceding list of monthly income in paragraph 1232 below.
	1232	Describes type, period and amount of countable income.
	1253	Recipient received one-time income payment other than SSI. Also use paragraph 1261 (NL 00804.175) if one-time payment will result in N01 suspension for a future month.
	1258	Recipient subject to value of the one- third reduction (VTR).
	1260	Recipient receives in-kind support and maintenance.
	1603	Recipient had net loss from self- employment.
	1257	Special income disregards apply.
	1602	Student earned income exclusion applies. DEEMING - Consider the following paragraphs if the claimant is subject to deeming:
	1248	Describes type, period and amount of income deemed from spouse or parent(s).
	1234	Spouse, parent(s) or sponsor(s) have income deemed to recipient.
	1254	Spouse or parent(s) has one-time income payment other than SSI.
	2230	Spouse or parent(s) no longer receives public assistance - Deemed income results.
	1249	Spouse or parent(s) receive public assistance - No deemed income.
	1604	Spouse or parent(s) has net loss from self-employment. COMPUTER MATCHING - Consider the following paragraphs if computer matching is an issue:
NL 00804.250	2050	Tells recipient about payment reduction and to check computer matching data within 30 days. Use on the SSA-L8155-U2 only.
	2051	Tells recipient about payment increase and to check computer matching data within 30 days. Use only on the SSA-L8151-U2.
	2052	Payment due increases in the current calendar month of the interface or the supplemental month - FO must issue the additional amount due. GRANDFATHERED RECIPIENTS - The following paragraphs address changes that only apply to recipients grandfathered into the SSI program in December 1973. Choose any appropriate paragraphs as follow:
NL 00804.190		2326, 2327, 2328, 2329, 2330, 2318, 2335, 2336 and 2337.

H. Information about your back payments

(Mandatory caption when paragraph 1497 below applies.)

NL Reference	Paragraph	Use
NL 00804.180	1497	Mandatory paragraph when recipient will receive a retroactive SSI check and there is no IAR involvement, or will receive a retroactive title II check.

I. Our decision on your waiver request

(Use only when paragraph 2439 below applies.)

NL Reference	Paragraph	Use
NL 00804.210	2439	Waiver request approval. (Mandatory paragraph for this caption.)

J. About your request for direct deposit

(Use only when direct deposit is an issue.)

NL Reference	Paragraph	Use
NL 00804.230	2772	Recipient requests direct deposit.
	2773	Recipient cancels direct deposit.
	2774	Recipient changes direct deposit. Consider the following paragraphs if the recipient's payments are or will be in suspense: 2766, 2767, 2768, 2769, 2770, and 2771.

K. Information about medicaid and other benefits

(Use “AND OTHER BENEFITS” only if paragraph 1311 below will follow. Use this caption only if a change has occurred that may affect Medicaid eligibility.)

NL Reference	Paragraph	Use
NL 00804.190	1311	Recipient moves to a State that administers its own supplementation program.
NL 00804.110	1150	Recipient moves to a State (or the District of Columbia) for which SSA makes Medicaid determinations.
	1156	We are developing for recipient's eligibility under section 1619(b).
	1152 or 1170	Recipient resides in or moves to a State where SSA makes Medicaid determinations. Use on the SSA-L8155-U2 when you suspend or terminate SSI payments. Use 1170 instead of 1152 if the recipient resides in Texas.
	1154	Change in State of residence - New State of residence makes its own Medicaid determinations.
	1146	Recipient did not provide third-party liability (TPL) information.
	1149	Recipient did not assign rights to medical support payments to the State.
	1143	Notifies title II early widow(er) beneficiaries of possible special Medicaid eligibility. Use this paragraph only on the SSA-L8155-U2. Remember to include the caption labeled K. below and the mandatory paragraph under caption K. when you use this paragraph.
	1197	SSI checks have stopped - Recipient may qualify for Medicaid under section 1619(b).
	1198	Similar to paragraph 1197 except that State makes Medicaid eligibility determination.
	1199	Recipient not eligible for Medicaid based on SSI rules under section 1619(b). (Does not meet use and/or insufficiency tests.)
NL 00804.155	DCMM07	A child is ineligible for SSI because he does not meet the requirements of section 1614(f)(2) of the Act. Tells which State agency can tell him about Medicaid eligibility.

L. Where you can apply for medicaid

(Use only on an SSA-L8155-U2 when you use paragraph 1143 under the preceding caption.)

NL Reference	Paragraph	Use
NL 00804.110	1144	Notifies title II early widow(er) beneficiaries ineligible for SSI because of their title II income (N01) where to apply for special Medicaid coverage. (Mandatory paragraph for this caption.)

M. Please remember this

(Mandatory caption on SSA-L8155-U2 when a disabled/blind recipient is N01 due to earnings and eligibility under section 1619(b) is an issue or the recipient is ineligible under section 1619(b) because of the use and/or insufficiency of earnings test.)

NL Reference	Paragraph	Use
		The following paragraphs are mandatory when 1619(b) eligibility is an issue.
NL 00804.110	1157	Lead-in for reporting responsibilities when recipient is potentially eligible for Medicaid under section 1619(b).
	1191 1192 1193	Reporting responsibilities - use all three paragraphs. Use the following when the recipient is ineligible under section 1619(b).
	1195	Reminder - Recipient should report change(s) by deadline to avoid filing new application.
NL 00804.250	2055	Similar to paragraph 1195 above - Use when computer matching causes 1619(b) participant to lose eligibility.

N. we will review your case

(Use only for section 1619(b) eligibles when paragraph 1190 below applies.)

NL Reference	Paragraph	Use
NL 00804.110	1190	Information for section 1619(b) eligibles about continuing disability reviews. (Mandatory paragraph for this caption.)

O. Things to remember