TN 6 (12-93)

A. Policy

1. When award notice required

An award notice is required in the following situations:

1. Initial determination of entitlement to monthly benefits or the LSDP. (See NL 00601.120 for instructions on dual entitlement awards);

2. Amended, supplemental, or subsequent awards. (See GN 01061.005);

3. Conversion from E to D, W to D and HA to A at full retirement age;

4. RIB to DIB conversion;

5. An award that reverses an initial disallowance;

6. Change of representative payee;

7. Conversion from B2 to E, B to D at death of NH. (See RS 00207.005);

8. Change from child to student benefits when child becomes own payee at age 18. (The SSA-L3926-EP generated by TASTE serves as an award notice.)

9. Medicare Only (BIC T, TA, TB, M etc.) award.

2. When award notice not required

An award notice is not used in the following situations:

1. Technical entitlement awards, except for awards to HA auxiliaries where no benefits are payable because of the family maximum. (see NL 00601.010C.2. for proper notice);

2. Continuation of payment cases such as converting minor children to childhood disability benefits. (See NL 00703.566 - NL 00703.569.);

3. When month of entitlement is confirmed or changed based on what is most advantageous (use a postentitlement notice);

4. Recalculations back to the month of entitlement.

NOTE: A notice of award should not be confused with a notice of initial determination. An initial determination can also be included in a postentitlement notice. (GN 03101.070 and
NL 00601.040).

3. To whom an award notice is sent

An award notice is usually sent to each beneficiary and his or her representative payee. If the beneficiary is receiving a combined payment based on entitlement to multiple benefits, he or she will receive a single award notice with information about each benefit.

4. Copies of award notice

Send copies of the award notice to the following as appropriate:

• Claimant's Attorney

• Claimant's authorized or legal representative

• Private pension plan, employer and/or union, at claimant's request.

• Legally competent beneficiary with a payee.

B. Procedure required content and preferred sequence

1. Date of the notice

1. Why important:

   • May be used in appeals process to determine if a person was notified timely; and

   • To determine if reconsideration was requested within the allowed time frame.

2. What date to use:

   • On systems-generated notices The computer generates the estimated date that a non-review notice produced by the system will actually be mailed; or

   • On manual or word processor notices Show the date the notice is expected to leave the mailroom. If for any reason the mailing of a notice is delayed more than 5 days after the date shown, the notice must be retyped and the date adjusted.

2. Claim number

Show the NH's SSN followed by the appropriate claims symbol of the beneficiary. See GN 01050.005 - GN 01050.021 for claims symbols currently in use.

3. Beneficiary's name and address

Show the beneficiary's name and address if he/she is in direct payment. If beneficiary has a representative payee, show the representative's name and address, as well as the beneficiary's name.

Sample formats

• Michael A. Smith
  24 Main Street
  Boston, MA 02145
• Sarah Goodman
  for John Smith
  42 South Street
  Abbot, CT 11245

4. Opening statement

Show the type of benefit being awarded and the date of entitlement.

Do not show the MBA since this is usually discrepant from the ongoing MBP, which is shown in the check paragraph.

EXCEPTIONS:

• Award where no check is being paid, e.g., full work deductions. Show the MBA at date of entitlement.

• PIC “O” cases, e.g., “A” and “B” paid in a combined check. If LAF S, show the MBA for each beneficiary at date of entitlement. If LAF C, show the MBP for each beneficiary at current rate.

5. Payment information

Show:

1. The amount of the first check.

2. The month through which past-due benefits or the first check are due;

3. The amount of the ongoing monthly benefit payment;

4. Direct deposit information;

5. Whether the first check includes the LSDP

6. Whether an underpayment is included.

7. Whether we are paying in installments.

8. Whether husband's and wife's or children's benefits are combined in one check; and

9. Proportionate share of the LSDP or underpayment.

6. Benefit information

Show:

1. All the factors affecting the amount of monthly or past-due benefits such as work deductions, withholding for attorney fees, partial award, exclusion or inclusion of lag earnings, SMI premiums, WC offset, SSI offset, Government pension offset (GPO), or inclusion or exclusion of military service credits.

2. All benefit changes such as cost-of-living increase, DRC's, automatic reduction factor (ARF), termination or entitlement of another beneficiary, or any other cause for an increase or decrease in the benefit payment. (However, do not show the different benefit money amounts in RSI awards.)

3. In disability awards, to HA and auxiliaries, paragraph AWD014 and/or AWD016 (MADCAP) will generate or can be requested by the technician. These paragraphs list the MBA's from the date of entitlement through the current month, the dates, and the reasons for the changes in MBA. In auxiliary awards where no benefits are payable because the family maximum equals the PIA (DIB max cases) the new paragraph will not appear.

NOTE: Earnings or military service paragraphs go to the NH, only, in life cases and principal or co-equal claimant(s) in survivor cases (e.g., adult children receiving underpayment). Do not include earnings or military service paragraphs in notices for survivor's claims if the NH was already notified in a retirement award and nothing has changed since the retirement award was made.

7. Initial determination affecting entitlement

Include determinations made to establish entitlement, such as date of birth (DOB).

NOTE: In the Modernized Claims System (MCS) the DOB paragraph is only included when the DOB established is different from that alleged or no DOB was alleged. However, claims not processed under MCS will continue to show the DOB paragraph when DOB is a factor of entitlement.

8. Other important information

The last section of the award notice must include a statement of the conditions under which payments are made and:

1. A closeout paragraph (see NL 00601.160).

2. Reporting responsibilities regarding:

   • work

   • representative payee (include a paragraph referring payee to the enclosed pamphlet)

   • pending WC claim or appeal

   • medical improvement

   • any other event affecting entitlement or the amount of payment

3. Things to remember, such as:

   • Medical reexamination

   • Eligibility for retirement benefits at age 62

4. Reconsideration or other appeal paragraph. (See NL 00601.150.)

   When benefits are awarded on reconsideration, state this and explain that this determination replaces our previous determination.

5. Referral paragraph

   Conclude with a paragraph telling the person what to do if he/she has any questions. The paragraph will vary depending on whether the notice is systems generated or manually prepared, or whether it is a domestic or foreign case.

   • MADCAP has an automatically generated referral paragraph (REF001) showing the title II/TSC public contact telephone number and the address of the recipient's servicing FO.

   • For manually prepared letters and in MADCAP cases where the system does not have a valid telephone number or FO address, use the general referral paragraph REF008 (MADCAP).

   • In foreign cases, MADCAP generates foreign referral paragraph REF002. For manually prepared letters, see NL 00703.005.

6. “Enclosure” remark

   • MADCAP

     The systems has been programmed to automatically generate the appropriate remark.

   • Manual Notices

     The SSA Notice Standards Handbook illustrates where this is placed.

C. Procedure special award situations

1. Lump sum only

1. Types of Notices

   • MADCAP - Category M

     All paragraphs are automatically generated on simple LSDP awards with only one recipient. When a proportionate share is involved, request LSP013. When widow /widower under age 60 and not disabled, request FOB005.

2. For manually prepared LS only awards include the following information:

   • Claim number of deceased NH followed by the BIC, G, with a subscript, if any;

   • The name of the deceased;

   • The amount of the LSDP and that the payment will be sent soon;

   • An explanation if only a proportionate share of the LSDP is paid;

   • If LS paid to widow/widower under age 60 and not disabled, paragraph FOB005; and

   • Closeout, reconsideration, and referral paragraphs.

2. Technical entitlement awards

1. Definition

   There are three types. For notice purposes we can group these into two categories.

   • Auxiliaries entitled on a disability record, but because the family maximum equals the PIA, the MBA for the auxiliaries equals zero. This is commonly called a DIB max case.

   • Claimant becomes entitled to a benefit he or she will not actually receive because of entitlement to another benefit on another account. (This should not be confused with “true” dual or triple entitlement cases where the beneficiary does receive benefits on more than one account.

2. Type of notice

   • For DIB max cases the MADCAP system will automatically generate a “Notice of Award.”

   • When the two awards are adjudicated simultaneously, include a dictated paragraph regarding the technical entitlement in the “Notice of Award” for the primary (payable) benefit.

   • When the technical entitlement award is adjudicated after a “Notice of Award” has been sent for the primary (payable) benefit, send a letter on an SSA-L2000-C2 that includes essentially the same information that would appear on an award. However, details such as LMETY or date of birth need not be included since this information was in the “Notice of Award.” It will include information on the technical entitlement and why the benefit will not be paid, a closeout, reconsideration, and referral paragraph. If necessary, modify the closeout paragraph to fit the case.

3. No payment awards

1. Definition

   Claimant entitled to a benefit for a limited time and then terminates. However, due to a deduction event applicable for all months, no benefits are payable.

2. Type of notice

   Send an award notice with appropriate paragraphs or dictated language to explain the situation.

4. Underpayment awards after death

1. When a beneficiary dies before receiving an award notice, send an award notice to the individual entitled to the underpayment. (See GN 02301.075B. for payee legends.)

2. Notice Content

   • When no survivor benefits are due, show essentially the same information that would have gone to the deceased. Do not include paragraphs regarding reporting responsibilities or medical reexams.

   • When survivor benefits are being awarded (including LSDP) specify which part of the payment is the underpayment due the deceased. If no award letter was ever sent to the deceased, include whatever information that would have gone to the deceased in the award notice to the survivor. If this would result in a very complex or confusing letter, you may prepare two notices.

   • If survivor benefits are awarded before disability development is complete, include a paragraph in the survivor award notice explaining that we will notify him/her when a decision is made about the deceased's disability claim.

   • Include the appropriate appeal paragraph, reconsideration, ALJ, AC, since the amount of the underpayment and findings that support the determination can be appealed by the person(s) entitled to the underpayment.

     For additional information about underpayment awards see GN 01061.020 - GN 01061.050 and GN 02301.030 - GN 02301.075.

5. DIB to RIB, W to D, conversion full retirement age

Notice is either systems produced (e.g., SSA-L3926-EP) or manually produced. When manually produced, send a MADCAP “Notice of Award” include ADJ023 (W-D) to explain change and new reporting responsibilities.

6. Change of payee awards

Most change of payee awards can be processed through MADCAP. Most of these awards consist entirely of automatically generated paragraphs with automatically generated fill-ins.

The notice must include:

1. An introductory paragraph, RPY039 (new payee) or AWD012 (beneficiary own payee).

2. The check paragraph, ADJ054, ADJ055, ADJ046, or ADJ047. If there has been no break in benefit payments, the first payment amount will be for the current operating month (COM). If there was a suspension and benefits are being resumed, the first payment amount will be for the month benefits are resumed through the COM.

3. Only pertinent information about the case applicable from the month of resumption or the COM. Therefore, it will not include information that would have been on the initial award (e.g. date of birth, military service, etc.) or information on changes in benefits that occurred prior to the date benefits are starting on this award (month of resumption or COM).

4. The system will also generate the following:

   • The appropriate reporting responsibilities paragraphs (e.g., BEN088, BRR004, BRR016); and RPY041 which refers the payee to the enclosure. (If a manual award must be prepared, request RPY041.)

   • The appropriate closeout, reconsideration, and referral paragraphs.

   • The “Enclosure: SSA-10076”remark.

   • As with any MADCAP notice there may be a need, depending on the circumstances, to request one or more paragraphs or include dictated language.

D. Procedure enclosures with award notices

All awards for monthly benefits must have at least one of the following enclosures:

• RSI awards (including HB's and HC's) and student awards - Your Social Security Rights and Responsibilities, Retirement and Survivors Benefits - SSA 05-10077.

• DIB, DWB, CDB Awards - When You Get Social Security Disability Benefits - SSA 05-10153.

• Foreign RSI Awards - Your Social Security Checks While You Are Outside the United States - SSA 05-10137.

• Representative Payee - A Guide For Representative Payees - SSA 05-10076.

E. Procedure copies of award notices

1. System-generated copies

Do not send a copy to the ALJ if the claimant was not represented by an attorney or nonattorney or if the fee was waived. The PC's should throw away the ALJ copy in these situations.

2. When copies must be manually prepared

1. How copies are made

   MADCAP does not generate any copies.

   Designated personnel will prepare photocopies.

   If the word processor is being used to produce the notice, the typist should have the machine produce an extra copy(ies) in addition to the file copy.

2. How copies are indicated:

   • MADCAP On the SSA-2795-U2 show paragraph COP001 when an ALJ/attorney and/or representative is involved; do NOT request COP001 merely to send a copy to the ALJ if there is no attorney or representative involved; show COP013 when claimant requests copy for other third party. Enter *IM32 when copies of a complete notice are needed.

     For both complete and incomplete notices PC personnel will show all cc: information on the SSA-573. FO personnel will follow SSA-3601 procedure (GN 01020.250).

Do not add cc: information to the bottom of the notice if it is mentioned in the text of the notice (i.e., RM30, COP001, COP013 fill-ins indicate designated addressees).

Do not include enclosures with the copy.

F. Policy - award notice folder documentation

SSA must have a record of the date we send a notice to determine the time period for filing an appeal and the content to document our determination. Folder documentation is not necessary for notices that are available on the Online Retrieval System (ORS).