NL: Notices, Letters and Paragraphs

Effective Dates: 11/20/2006 - Present

TN 29 (07-02)

1481. Situation Where Used:

IC and PE: Eligibility or payment terminated because of cessation of disability or blindness or voluntary withdrawal; or, eligibility for payment terminated more than 1 year retroactively, and no current eligibility.

Text:

If at any time in the future you think (1) , please contact us immediately about filing a new application. We cannot make payment for any month before the month in which (2) .

Fill-ins:

Choice 1 - you qualify for payment

Choice 2 - she qualifies for payment

Choice 3 - he qualifies for payment

Choice 4 - you qualify for the Supplemental Security Income program

Choice 5 - she qualifies for the Supplemental Security Income program

Choice 6 - he qualifies for the Supplemental Security Income program
Choice 1 - you apply

Choice 2 - she or someone on her behalf applies

Choice 3 - he or someone on his behalf applies

1482. Situation Where Used:

IC and PE: Notice to newly selected representative payee, or notice to aged recipient about reporting responsibilities.

Text:

Payments may change if (1) circumstances change. Therefore, you are required to report any change in (2) situation that may affect (3) Supplemental Security Income payment. For example, you should tell us if (4) , if anyone else moves from or into (5) household, if (6) marital status changes, if income or resources for (7) or members of (8) household change (9) (10) or if (11) to work. Read the booklet—What You Have to Know About SSI—carefully for additional information about this requirement.

Fill-ins:

Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - you move

Choice 2 - she moves

Choice 3 - he moves
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - you

Choice 2 - her

Choice 3 - him
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - if you stop or start attending school regularly

Choice 2 - if she stops or starts attending school regularly

Choice 3 - if he stops or starts attending school regularly

Choice 4 - Null
Choice 1 - if your medical condition improves

Choice 2 - if her medical condition improves

Choice 3 - if his medical condition improves

Choice 4 - Null
Choice 1 - you go

Choice 2 - he goes

Choice 3 - he goes

1487. Situation Where Used:

IC and PE: Claimant/recipient applied for or receiving benefits from other Social Security program. Separate notices required.

Text:

This decision refers only to (1) claim for Supplemental Security Income payments. (2)

Fill-ins:

Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - Any decision about your benefits under other Social Security programs will be sent to you in a separate notice.

Choice 2 - Any decision about her benefits under other Social Security programs will be sent to you in a separate notice.

Choice 3 - Any decision about his benefit under other Social Security programs will be sent to you in a separate notice.

Choice 4 - Any decision about your benefits under the Social Security Disability Insurance program will be sent to you in a separate notice.

Choice 5 - Any decision about her benefits under the Social Security Disability Insurance program will be sent to you in a separate notice.

Choice 6 - Any decision about his benefits under the Social Security Disability Insurance program will be sent to you in a separate notice.

Choice 7 - Null

1488. Situation Where Used:

IC: Standard reporting instructions. See paragraph 2453 for language used in PE situations.

Text:

(1) (2) SSI (3) may change if (4) circumstances change. Therefore, you are required to report any change in (5) situation that may affect (6) SSI. For example, you should tell us if:

(7)
anyone else moves from or into (8) household
(9) marital status changes
income or resources for (10) or members of (11) household change (12)
(14) to work (15)

This will help us (16) (17) correctly.

Please read the booklet "What You Need to Know When You Get SSI" carefully for additional information about this requirement.

Fill-ins:

(Fill-in 1 only exists for Spanish translation.)
Choice 1 – Your
Choice 2 – Name possessive ('s)
Choice 3 – Name ending in s possessive (')
Choice 1 – payments
Choice 2 – eligibility
Choice 1 – your
Choice 2 – her
Choice 3 – his
Choice 1 – your
Choice 2 – her
Choice 3 – his
Choice 1 – your
Choice 2 – her
Choice 3 – his
Choice 1 – you move
Choice 2 – she moves
Choice 3 – he moves
Choice 1 – your
Choice 2 – her
Choice 3 – his
Choice 1 – your
Choice 2 – her
Choice 3 – his
Choice 1 – you
Choice 2 – her
Choice 3 – him
Choice 1 – your
Choice 2 – her
Choice 3 – his
Choice 1 – you stop or start attending school regularly
Choice 2 – she stops or starts attending school regularly
Choice 3 – he stops or starts attending school regularly
Choice 4 – NULL
Choice 1 – your medical condition improves
Choice 2 – her medical condition improves
Choice 3 – his medical condition improves
Choice 4 – NULL
Choice 1 – you go
Choice 2 – she goes
Choice 3 – he goes
Choice 1 – you become a US citizen or if any facts that affect your eligibility as an alien change.
Choice 2 – you become a US citizen or if any facts that affect your eligibility as an alien change.
Choice 3 – she becomes a US citizen or if any facts that affect her eligibility as an alien change.
Choice 4 – he becomes a US citizen or if any facts that affect his eligibility as an alien change.

Choice 5 – period (.) used when choices 1-4 aren't used.
Choice 1 – pay you
Choice 2 – pay her
Choice 3 – pay him
Choice 4 – provide benefits
(Fill-in 17 only exists for Spanish translation.)

1489. Situation Where Used:

IC and PE: Copy of notice is being sent to another person.

Text:

This information is also being sent to (1) .

Fill-ins:

Choice 1 - the representative payee

Choice 2 - (Name of other person)

1599. Situation Where Used:

The FO has determined that no title II benefits are payable or if the individual is receiving title II, that no additional title II benefits are payable. The FO inputs CLST in the CG field per SI 00601.030 to generate this paragraph on automated notices.

Text:

The application (1) filed for SSI was also a claim for Social Security benefits. We looked into this, and decided (2) can't get any Social Security benefits (3) . If you think we're wrong about this, you have the right to appeal. A case review, described later in this letter, is the only kind of appeal (4) can have regarding Social Security benefits.

Fill-ins:

Choice 1 - you

Choice 2 - she

Choice 3 - he
Choice 1 - you

Choice 2 - she

Choice 3 - he
Choice 1 - except the benefit you are already getting.

Choice 2 - except the benefit she is already getting.

Choice 3 - except the benefit he is already getting.

Choice 4 - Null
Choice 1 - you

Choice 2 - she

Choice 3 - he

1615. Situation Where Used:

Award: Recipient in E01 status—Reminder on reporting responsibilities.

Text:

You are required to report any change in (1) situation that may affect (2) Supplemental Security Income eligibility. For example, you should tell us if (3) , if anyone else moves from or into (4) household, if marital status changes, if income or resources for (5) or members of (6) household change (7) (8) or if (9) to work. Read the booklet—What You Have To Know About SSI—carefully for additional information about this requirement.

Fill-ins:

Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - you move

Choice 2 - she moves

Choice 3 - he moves
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - you

Choice 2 - her

Choice 3 - him
Choice 1 - your

Choice 2 - her

Choice 3 – his
Choice 1 - if you stop or start attending school regularly

Choice 2 - if she stops or starts attending school regularly

Choice 3 - if he stops or starts attending school regularly

Choice 4 - Null
Choice 1 - if your medical condition improves

Choice 2 - if her medical condition improves

Choice 3 - if his medical condition improves

Choice 4 - Null
Choice 1 - you go

Choice 2 - she goes

Choice 3 - he goes

1620. Situation Where Used:

IC and PE: Recipient is eligible but no payment is due.

Text:

Even though (1) not due payments, (2) still considered to be eligible under the Supplemental Security Income program. (3) should report any event that might affect (4) eligibility or allow (5) to receive payments again.

Fill-ins:

Choice 1 - you are

Choice 2 - she is

Choice 3 - he is
Choice 1 - you are

Choice 2 - she is

Choice 3 - he is
Choice 1 - You

Choice 2 - She

Choice 3 - He
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - you

Choice 2 - her

Choice 3 - him

XVI295 Situation Where Used:

This referral paragraph emphasizes the availability of information on the Internet. It can be used on any SSI notice, but it must be used on all automated SSI financial eligibility notices (SSA-L8025; SSA-L8030; SSA-L8151 and SSA-L8100; SSA-L8155; SSA-L8165 and SSA-L8166).

Text:

If You Have Any Questions

For general information about SSI, visit our website at www.ssa.gov on the Internet. There you will also find the law and regulations about SSI eligibility and SSI payment amounts.

For general questions about SSI or specific questions about (1) case, you may call us toll-free at (2) (3) (4) (5). We can answer most questions over the phone. You can also write or visit any Social Security office. (6) (7)

If you do call or visit an office, please have this letter with you. It will help us answer your 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-ins:

Choice -1 your
Choice -2 (Name possessive)
Choice -1 1-800-772-1213
Choice -2 NULL
Choice -1 , or call your local Social Security office
Choice -2 NULL
Choice -1 toll free at
Choice -2 at
Choice -3 NULL
Choice -1 (Title XVI Telephone # on DOORS, formerly TRIDE)
Choice -2 NULL
Choice -1 The office that serves your area is located at:
Choice -2 NULL
Choice -1 (Servicing FO's address on DOORS, formerly TRIDE)
Choice -2 NULL

2453. Situation Where Used:

PE: Standard reporting instructions. See paragraph 1488 for language used in IC situations.

Text:

(1) (2) may change if (3) circumstances change. Therefore, you are required to report any change in (4) situation that may affect (5) Supplemental Security Income payment. For example, you should tell us if (6) , if anyone else moves from or into (7) household, if (8) marital status changes, if income or resources for (9) or members of (10) household change (11) (12) or if (13) to work.

Fill-ins:

Choice 1 - Your

Choice 2 - Her

Choice 3 - His
Choice 1 - payments

Choice 2 - eligibility
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - your

Choice 2 - her

Choice 3 – his
Choice 1 - your

Choice 2 - her

Choice 3 – his
Choice 1 - you move

Choice 2 - she moves

Choice 3 - he moves
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - your

Choice 2 - her

Choice 3 – his
Choice 1 - you

Choice 2 - her

Choice 3 – him
Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - , if you start or stop attending school regularly

Choice 2 - , if she starts or stops attending school regularly

Choice 3 - , if he starts or stops attending school regularly

Choice 4 – Null
Choice 1 - , if your medical condition improves

Choice 2 - , if her medical condition improves

Choice 3 - , if his medical condition improves
Choice 1 - you go

Choice 2 - she goes

Choice 3 - he goes

2507. Situation Where Used:

Record has been in suspense due to returned checks and recipient remains ineligible due to excess income.

Text:

If you think payment may be due (1) for earlier months or at any time in the future, please contact us immediately. If (2) not eligible to receive payment during a month before (3) , you will have to file a new application to receive payment. Since we cannot make payment for a month before the month in which application is filed, a delay in applying will result in a loss of payment for any months in which (4) otherwise eligible.

Fill-ins:

Choice 1 - you

Choice 2 - her

Choice 3 - him
Choice 1 - you are

Choice 2 - she is

Choice 3 - he is
Month/Year
Choice 1 - you are

Choice 2 - she is

Choice 3 - he is

2508. Situation Where Used:

Use when we are suspending payment or eligibility, except for reasons of disability cessation, voluntary withdrawal, administrative inability to pay, or death. Use on a SSA-L8155-U2, Notice of Planned Action, under the caption, "Things to Remember."

NOTE: See paragraph SUSM52, which follows, to use in N20 manual notices.

Text:

If at any time in the future you think (1) for the Supplemental Income program, please contact us immediately. If (2) not eligible (3) during a month before (4) , you will have to file a new application (5) . Since we cannot make payment for a month before the month in which an application is filed, a delay in applying will result in a loss of payment for any months in which (6) otherwise eligible.

Fill-ins:

Choice 1 - you qualify

Choice 2 - she qualifies

Choice 3 - he qualifies
Choice 1 - you are

Choice 2 - she is

Choice 3 - he is
Choice 1 - to receive payment

Choice 2 - Null
(Month/Year)
Choice 1 - to receive payment

Choice 2 - Null
Choice 1 - you are

Choice 2 - she is

Choice 3 - he is

SUSM52. Situation Where Used:

Use this language for N20 manual notices. Use it in the same situation as for paragraph 2508 above.

Text:

If we (1) and (2) not become eligible again before (3) , (4) will have to file a new application to get SSI.

Fill-ins:

NOTE: When E01 or 1619(b) eligibility changes to N20, select from fill-in (1), choices 4-6.

Choice 1 - stop your SSI

Choice 2 - stop her SSI

Choice 3 - stop his SSI

Choice 4 - close your SSI case

Choice 5 - close her SSI case

Choice 6 - close his SSI case
Choice 1 - you do

Choice 2 - she does

Choice 3 - he does
Month/Year (one year from last month of eligibility)
Choice 1 - you

Choice 2 - she

Choice 3 - he

2514. Situation Where Used:

Check returned from Treasury. Suspension.

Text:

Our records show that the (1) we sent (2) (3) (4) returned to the (5) . We will not send (6) any more checks until you get in touch with (7) local Social Security office.

Fill-ins:

Choice 1 - check

Choice 2 - checks
Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 4 - your representative payee
Choice 1 - for (Month/Year)

Choice 2 - for (Month/Year) through (Month/Year)
Choice 1 - was

Choice 2 - were
Choice 1 - United States Treasury Department

Choice 2 - Social Security Administration
Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 4 - your representative payee
Choice 1 - your

Choice 2 - her

Choice 3 - his

2525. Situation Where Used:

Change is retroactive and does not affect ongoing payment.

Text:

This action does not change (1) current payment amount.

Fill-ins:

Choice 1 - your

Choice 2 - her

Choice 3 – his

2527. Situation Where Used:

Suspension due to returned check.

Text:

The (1) we sent (2) (3) (4) returned to the (5) . We will not sent (6) any more checks until you get in touch with (7) local Social Security office.

Fill-ins:

Choice 1 - check

Choice 2 - checks
Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 4 - your representative payee
Choice 1 - for (Month/Year)

Choice 2 - for (Month/Year) through (Month/Year)
Choice 1 - was

Choice 2 - were
Choice 1 - U.S. Treasury Department

Choice 2 - Social Security Administration
Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 4 - your representative payee
Choice 1 - your

Choice 2 - her

Choice 3 - his

2530. Situation Where Used:

PE: The recipient was erroneously terminated (T01). Payment is being reinstated.

Text:

We stopped (1) (2) by mistake. We regret this mistake and have corrected it.

Fill-ins:

Choice 1 - your

Choice 2 - her

Choice 3 - his
Choice 1 - check

Choice 2 - eligibility under the Supplemental Security Income program

2531. Situation Where Used:

PE: The recipient was erroneously terminated (T01). Notice to eligible spouse that his/her husband/wife has been reinstated.

Text:

We stopped the (1) for (2) spouse by mistake. We regret this mistake and have corrected it.

Fill-ins:

Choice 1 - checks

Choice 2 - eligibility under the Supplemental Security Income program
Choice 1 - your

Choice 2 - her

Choice 3 - his

2532. Situation Where Used:

PE: Incorrect date of death input. The input of the correct date of death results in a change in payment amount or eligibility.

Text:

We took (1) off (2) record by mistake. We regret this mistake and have corrected it.

Fill-ins:

(Name of ineligible spouse or parent)
Choice 1 - your

Choice 2 - her

Choice 3 - his

2533. Situation Where Used:

PE: Incorrect date of death input. The input of the correct date of death results in a change in payment amount or eligibility.

Text:

(1) changed because we corrected, on our records, the date of death of (2) from (3) to (4).

Fill-ins:

Choice 1 - Your Supplemental Security Income checks

Choice 2 - Supplemental Security Income checks for (Name of recipient)
(Name of deceased)
(Month/Year)
(Month/Year)

2534. Situation Where Used:

Death of one member of an eligible couple, or an ineligible spouse, parent(s), or essential person(s). Do not use this paragraph if the survivor is not in continuing payment status code C01 effective with the month after the month of the death.

Text:

(1) Because of the death of (2) in (3) , (4) .

Fill-ins:

Choice 1 - Before (Month/Year), we used the money received and things owned by (Name of deceased) in figuring the amount of SSI payments for you.

Choice 2 - Before (Month/Year), we used the money received and things owned by (Name of deceased) in figuring the amount of SSI payments for (Name of recipient).

Choice 3 - Null
(Name of deceased)
(Month/Year of death)
Choice 1 - your payments have been refigured

Choice 2 - SSI payments for (Name of recipient) have been refigured

Choice 3 - you cannot get SSI payments

Choice 4 - (Name of recipient) cannot get SSI payments

NOTE: In fill-in 1 above, Month/Year = the month after the month of death. Choice 3 is used in fill-in 1 when the deceased was the ineligible spouse of a parent.

2750. Situation Where Used:

A determination is made which revises a previous determination.

Text:

This determination replaces all previous determinations for the above (1) .

Fill-ins:

Choice 1 - period

Choice 2 - periods

MISM50. Situation Where Used:

Duplicate claim filed by claimant on own behalf.Text:

The application (1) recently filed is a duplicate of the one that was previously filed. Therefore, the initial decision is still in effect and no change is being made on (2) record.

Fill-ins:

Choice 1 - (Name of Applicant)

Choice 2 - you
Choice 1 - Your

Choice 2 - (Name of Claimant's)

MISM51. Situation Where Used:

Duplicate claim filed on behalf of claimant.

Text:

The application (1) recently filed is a duplicate of the one already filed on behalf of
(2) . Therefore, the decision made on the previous claim is still in effect, and no change is being made on the record.

Fill-ins:

(Name of Applicant)
(Name of Claimant)

MISM52. Situation Where Used:

Claimant has appointed representative who is not the representative payee.

Text:

Enclosed is a copy of our decision concerning the SSI application of (1) .

Fill-ins:

(Name of Claimant)

Closing Paragraph

MISM53. Situation Where Used:

Closing paragraph. Use on all manual notices if not already preprinted on the notice; e.g. SSA-L8030-U2. If preprinted, be sure to fill in Claims Representative's Name and telephone number.

Text:

If you have any questions, you may call, write, or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (Claims Representative's Name). (His/Her) telephone number is (XXX) XXX-XXXX.

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.

PENM50. Situation Where Used:

We are notifying a recipient or a representative payee that we plan to withhold a penalty from a SSI payment. In most cases, this language will be used after a discussion with the recipient about his/her reason for failing to report on time. The field office will assess a penalty if it cannot find good cause for the recipient's failure to report. Use on a SSA-L8166-U2, Important Information, with paragraph PENM52.

Text:

Information About (1) Payments

We plan to collect a penalty of (2) from (3) SSI for the following reasons:

· (4) did not report on time that (5) .

· (6) did not have a good reason for reporting this change late.

· We paid (7) too much SSI because (8) did not report the change to us on time.

Fill-ins:

Choice 1 - Recipient's Name (possessive)
Choice 2 - Your
Choice 1 - $25 (if first time penalty assessed)
Choice 2 - $50 (if second time penalty assessed)
Choice 3 - $100 (if third or subsequent time penalty assessed)
Choice 1 - your
Choice 2 - her
Choice 3 - his
Choice 1 - You
Choice 2 - She
Choice 3 - He
(Description of the change the recipient did not report or did not report timely.)
Choice 1 - You
Choice 2 - She
Choice 3 - He
Choice 1 - you
Choice 2 - her
Choice 3 - him
Choice 1 - you
Choice 2 - she
Choice 3 - he

PENM51. Situation Where Used:

We are notifying a recipient or a representative payee that no penalty applies for the recipient's failure to report information that affected his/her SSI payment. This language will be used on a SSA-8165-U2, Important Information, along with paragraph PENM52.

Text:

We paid (1) too much Supplemental Security Income (SSI) because (2) did not report a change to us on time. We did not know (3) .

We have found that (4) had a good reason for not reporting the change (5) . Because of this, we will not collect a penalty from (6) SSI.

Fill-ins:

Choice 1 - you
Choice 2 - Recipient's name
Choice 1 - you
Choice 2 - she
Choice 3 - he
(Description of change)
Choice 1 - you
Choice 2 - she
Choice 3 - he
Choice 1 - on time (Use if change reported late.)
Choice 2 - Null (Use if change not reported.)
Choice 1 - your
Choice 2 - her
Choice 3 - his

PENM52. Situation Where Used:

Use under the caption, "Things To Remember" with paragraph PENM50 or PENM51.

Text:

It is important that (1) tell us right away about changes that could affect (2) SSI payments. (3) must report a change within 10 days after the month it happens. However, (4) should still report the change even if the 10 days have passed.

If (5) not report changes on time in the future, and (6) money from us (7) shouldn't have, we may have to collect a penalty of (8) , unless (9) a good reason for reporting late.

Please read the enclosed pamphlet "When You Get SSI...What You Need To Know." It tells you what changes to report and when to report.

(10)

Fill-ins:

Choice 1 - you
Choice 2 - she
Choice 3 - he
Choice 1 - your
Choice 2 - her
Choice 3 - his
Choice 1 - You
Choice 2 - She
Choice 3 - He
Choice 1 - you
Choice 2 - she
Choice 3 - he
Choice 1 - you do
Choice 2 - she does
Choice 3 - he does
Choice 1 - you get
Choice 2 - she gets
Choice 3 - he gets
Choice 1 - you
Choice 2 - she
Choice 3 - he
Choice 1 - $25 (if first time penalty assessed)
Choice 2 - $50 (if second time penalty assessed
Choice 3 - $100 (if third or subsequent time penalty assessed)
Choice 1 - you have
Choice 2 - she has
Choice 3 - he has
Choice 1 - It is also your duty as a representative payee to report changes on time that could affect (recipient title and surname, possessive) SSI. Please read the enclosed pamphlet, "A Guide For Representative Payees."

Choice 2 - Null

REFERENCES:

Unconfirmed Eligibility (N05)—manual notice instructions, SI 02301.220C.

Penalty Notices and Collection Actions—manual notice instructions, SI 02301.110B.2.

RVW001 Situation Where Used:

This paragraph will be used in SSI notices that communicate decisions.

You Can Review The Information in (1)

The decisions in this letter are based on the law. You have a right to review and get copies of the information in our records that we used to make the decisions explained in this letter. You also have a right to review and copy the laws, regulations and policy statements used in deciding (2) case. To do so, please contact us. Our telephone number and address are shown under the heading "If You Have Any Questions."

Fill-ins:

Choice 1 - Your Case
Choice 2 - (Recipient's Full Name)'s Case
Choice 3 - (Recipient's Full Name)' Case
Choice 1 - your
Choice 2 - her
Choice 3 - his

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