NL: Notices, Letters and Paragraphs
TN 1 (07-11)
ERN022 ENFORCEMENT-FRA CASES (W18)
(Requested)
Caption: Your Benefits
In the year (1) age (2) , we only count (3) earnings for months before (4) age (5) . If (6) less than (7) in the months before (8) age (9) , (10) can get all of (11) benefits. Our records show (12) became age (13) on (14) . We figured (15) earned about (16) in the months before full retirement age.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you become
Choice 2: beneficiary's full name becomes
Fill-in (2) - Systems Generated
Choice 1: 65
Choice 2: 65 and 2 months
Choice 3: 65 and 4 months
Choice 4: 65 and 6 months
Choice 5: 65 and 8 months
Choice 6: 65 and 10 months
Choice 7: 66
Choice 8: 66 and 2 months
Choice 9: 66 and 4 months
Choice 10: 66 and 6 months
Choice 11: 66 and 8 months
Choice 12: 66 and 10 months
Choice 13: 67
Choice 14: 70
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: (beneficiary‘s first name)‘s
Choice 5: (beneficiary’s first name)‘s
Fill-in (4) - Systems Generated
Choice 1: you turn
Choice 2: he turns
Choice 3: she turns
Choice 4: null
Fill-in (5) - Systems Generated
Choice 1: 65
Choice 2: 65 and 2 months
Choice 3: 65 and 4 months
Choice 4: 65 and 6 months
Choice 5: 65 and 8 months
Choice 6: 65 and 10 months
Choice 7: 66
Choice 8: 66 and 2 months
Choice 9: 66 and 4 months
Choice 10: 66 and 6 months
Choice 11: 66 and 8 months
Choice 12: 66 and 10 months
Choice 13: 67
Choice 14: 70
Fill-in (6) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
Choice 4: null
Fill-in (7) - Systems Generated
Choice 1: annual exempt amount
Fill-in (8) - Systems Generated
Choice 1: you turn
Choice 2: he turns
Choice 3: she turns
Choice 4: null
Fill-in (9) - Systems Generated
Choice 1: same as Fill-in 5
Fill-in (10) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (11) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: (beneficiary's first name)'s
Choice 5: (beneficiary's first name)'s
Fill-in (12) - Systems Generated
Choice 1: you
Choice 2: beneficiary's full name
Fill-in (13) - Systems Generated
Choice 1: same as Fill-in 5
Fill-in (14) - Systems Generated
Choice 1: enter DOB (format: MONTH DD, CCYY)
Fill-in (15) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Choice 4: (beneficiary's first name) format John
Fill-in (16) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: DOLLAR AMOUNT
ERN025 ENFORCEMENT-FRA CASES (W18)
(Requested)
Caption: Your Benefits
Here is how we figured (1) earnings for the months before (2) became age (3) . First, we had to find (4) average earnings for each month. Our records show (5) earned (6) in (7) . So we divided these earnings by 12 (the number of months in a year). Then, we multiplied this number times (8) , which is the number of months before (9) turned age (10) . Based on this, we figure (11) earned about (12) in the months before (13) turned age (14) .
Please let us know right away if:
(15) did not work all months in the year; or
(16) earnings were not evenly spaced throughout the year.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: beneficiary's full name
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Choice 4: beneficiary's first name
Fill-in (3) - Systems Generated
Choice 1: 65
Choice 2: 65 and 2 months
Choice 3: 65 and 4 months
Choice 4: 65 and 6 months
Choice 5: 65 and 8 months
Choice 6: 65 and 10 months
Choice 7: 66
Choice 8: 66 and 2 months
Choice 9: 66 and 4 months
Choice 10: 66 and 6 months
Choice 11: 66 and 8 months
Choice 12: 66 and 10 months
Choice 13: 67
Choice 14: 70
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: (beneficiary's first name)'s
Choice 5: (beneficiary's first name)'s
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Choice 4: beneficiary's first name
Fill-in (6) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: reported earnings
Fill-in (7) - Systems Generated
Choice 1: age 70 or FRA year (same as enforcement year)
Fill-in (8) - Requested As A Number
Choice 1: number of calendar months before the person turned age 70 or FRA:
Fill-in (9) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Choice 4: beneficiary's first name
Fill-in (10) - Systems Generated
Choice 1: 65
Choice 2: 65 and 2 months
Choice 3: 65 and 4 months
Choice 4: 65 and 6 months
Choice 5: 65 and 8 months
Choice 6: 65 and 10 months
Choice 7: 66
Choice 8: 66 and 2 months
Choice 9: 66 and 4 months
Choice 10: 66 and 6 months
Choice 11: 66 and 8 months
Choice 12: 66 and 10 months
Choice 13: 67
Choice 14: 70
Fill-in (11) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Choice 4: beneficiary's first name
Fill-in (12) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: wages on TID=EAR finder
Fill-in (13) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Choice 4: beneficiary name
Fill-in (14) - Systems Generated
Choice 1: 65
Choice 2: 65 and 2 months
Choice 3: 65 and 4 months
Choice 4: 65 and 6 months
Choice 5: 65 and 8 months
Choice 6: 65 and 10 months
Choice 7: 66
Choice 8: 66 and 2 months
Choice 9: 66 and 4 months
Choice 10: 66 and 6 months
Choice 11: 66 and 8 months
Choice 12: 66 and 10 months
Choice 13: 67
Choice 14: 70
Fill-in (15) - Systems Generated
Choice 1: you
Choice 2: beneficiary's full name
Fill-in (16) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: beneficiary's name possessive
ERN038 SELF-EMPLOYMENT EARNINGS ADJUSTED (E05)
(Requested)
Caption: Your Benefits
Self-employment earnings for (1) have been adjusted to (2) because (3) .
Fill-in values:
Fill-in (1) - Requested As A Year In Format Shown Below
Choice 1: CCYY
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) income from renting rooms and apartments cannot be included unless special personal services are furnished to the tenants
Choice 2: (B) a farm owner's share of income cannot be included when a tenant works the farm unless the farm landlord materially participates in the production activities on his farm
Choice 3: (C) income from renting real estate cannot be included unless it is received in the ordinary course of business by a real estate dealer
Choice 4: (D) capital gains or losses not derived from the disposition of inventoriable property, stock in trade, or property held primarily for sale cannot be included
Choice 5: (E) income received from the sale of livestock held for dairy, work or breeding purposes cannot be included
Choice 6: (F) you have elected to use the option method of computing your self-employment income
Choice 7: (G) some business deductions were not taken. All expenses paid or incurred in carrying on a trade or business and a reasonable allowance for depreciation of property must be deducted in computing net earnings from self-employment
ERN039 PAYMENTS RECEIVED FROM EMPLOYER NOT COUNTED (E52)
(Requested)
Caption: Your Benefits
Payments received from (1) from (2) through (3) were not counted because the evidence presented to us does not show the amounts are wages.
Fill-in values:
Fill-in (1) - Requested As A Language
Choice 1: Name of employer
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
ERN040 PERMANENT DEDUCTIONS/ANNUAL REPORT PROCESSED/ADJUSTMENT LETTER TO WORKER (W01)
(Requested)
Caption: Your Benefits
(1) reported earnings of (2) for (3) . Based on these earnings, (4) of (5) benefits for that year should have been withheld. Since (6) of the benefits were withheld, (7) (8) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Worker's name
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of earnings reported.
Fill-in (3) - Requested As A Year In Format Shown Below
Choice 1: CCYY
Fill-in (4) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$$.¢¢
Choice 1: (A) all
Choice 2: (B) none
Choice 3: amount that should have been withheld
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (6) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢
Choice 1: (A) all
Choice 2: (B) none
Choice 3: actual amount withheld
Fill-in (7) - Requested As A One Position Alpha Character
Choice 1: (A) you were paid correctly
Choice 2: (B) you were overpaid
Choice 3: (C) you are due
Choice 4: (D) he was paid correctly
Choice 5: (E) he was overpaid
Choice 6: (F) he is due
Choice 7: (G) she was paid correctly
Choice 8: (H) she was overpaid
Choice 9: (I) she is due
Fill-in (8) Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢
Choice 1: (A) null
Choice 2: amount due in $$$$$.¢¢ format
ERN041 PERMANENT DEDUCTIONS/AWARD LETTER TO WORKER (W02)
(Requested)
Caption: Your Benefits
(1) reported earnings of (2) for (3) . Based on these earnings, (4) of (5) benefits for that year have been withheld.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You
Choice 2: Worker's name
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (4) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢
Choice 1: (A) all
Choice 2: (B) none
Choice 3: amount (show in $$$$$.¢¢)
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN042 PERMANENT DEDUCTIONS/PRIMARY WORKING/AWARD LETTER TO AUXILIARY (W04)
(Requested)
Caption: Your Benefits
Based on (1) earnings for (2) , (3) of (4) benefits for that year have been withheld.
Fill-in values:
Fill-in (1) - Requested As A One Position Alpha Character
Choice 1: (A) NH's name (possessive)
Choice 2: (B) your
Choice 3: (C) your husband's
Choice 4: (D) your wife's
Choice 5: (E) your father's
Choice 6: (F) your mother's
Choice 7: (G) bene's name possessive + husband's
Choice 8: (H) bene's name possessive + wife's
Choice 9: (I) bene's name possessive + father's
Choice 10: (J) bene's name possessive + mother's
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$$.¢¢
Choice 1: (A) all
Choice 2: (B) none
Choice 3: amount (show in $$$$$.¢¢)
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) your
Choice 2: (B) his
Choice 3: (C) her
Choice 4: (D) your husband's
Choice 5: (E) her husband's
Choice 6: (F) your wife's
Choice 7: (G) his wife's
Choice 8: (H) the children's
ERN043 TEMPORARY DEDUCTIONS/LETTER TO WORKER (AWARD OR ADJ) (W05)
(Requested)
Caption: Your Benefits
Based on (1) estimated earnings of (2) for (3) , (4) of (5) benefits for this year should be withheld.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's name possessive
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (4) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$$.¢¢
Choice 1: (A) all
Choice 2: (B) none
Choice 3: amount (show in $$$$$.¢¢)
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: Beneficiary's name (possessive)
ERN044 TEMPORARY DEDUCTIONS/PRIMARY WORKING/LETTER TO AUXILIARY (AWARD OR ADJ) (W06)
(Requested)
Caption: Your Benefits
Based on (1) estimated earnings for (2) , (3) of (4) benefits for this year should be withheld.
Fill-in values:
Fill-in (1) - Requested As A One Position Alpha Character
Choice 1: (A) your
Choice 2: (B) Beneficiary's name possessive
Choice 3: (C) your husband's
Choice 4: (D) your wife's
Choice 5: (E) the children's
Choice 6: (F) bene's name possessive + husband's
Choice 7: (G) bene's name possessive + wife's
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) - Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢
Choice 1: (A) all
Choice 2: (B) none
Choice 3: amount (show in $$$$$.¢¢)
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) your
Choice 2: (B) his
Choice 3: (C) her
Choice 4: (D) your husband's
Choice 5: (E) her husband's
Choice 6: (F) your wife's
Choice 7: (G) his wife's
Choice 8: (H) the children's
ERN045 SPOUSE REINSTATED BASED ON N/H'S WORK/EARNINGS (W08)
(Requested)
Caption: Your Benefits
Based on (1) spouse's work, we can pay benefits beginning (2) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's name possessive
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
ERN046 NOTIFICATION TO BENEFICIARY THAT WE WILL WRITE AGAIN WHEN EARNINGS REPORT IS RECEIVED (W11)
(System Generated)
Caption:
We will write to you again after we know how much (1) actually earned. At that time, we will tell you whether (2) due additional benefits or (3) overpaid.
Fill-in values:
Fill-in (1)
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2)
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (3)
Choice 1: are
Choice 2: is
ERN047 REGO II ENFORCEMENT – MONTHLY TEST MAY APPLY (W12)
(Requested)
Caption: Your Benefits
Our records show earnings of (1) were reported for (2) for (3) . We assume that (4) earned all of this money in (5) and that (6) worked all months of (7) after (8) became entitled to benefits.
(9) earnings affect the amount of Social Security benefits (10) due for (11) . However, we may not have to count all of the earnings reported for (12) . If any of the following apply to (13) , get in touch with any Social Security office and have a record of (14) earnings with you. Let us know if:
(15) earned some of the money before (16) , or
(17) earned a different amount in (18) , or
(19) did little or no work in at least one month of (20) after (21) became entitled to benefits, or
(22) had a loss from (23) self employment in (24) .
Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of earnings
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY year of earnings
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) - Systems Generated
Choice 1: CCYY (same as #3)
Fill-in (6) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (7) - Systems Generated
Choice 1: CCYY (same as #3)
Fill-in (8) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (9) - Systems Generated
Choice 1: Your
Choice 2: His
Choice 3: Her
Fill-in (10) - Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was
Fill-in (11) - Systems Generated
Choice 1: CCYY (same as #3)
Fill-in (12) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (13) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (14) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (15) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (16) - Systems Generated
Choice 1: CCYY (same as #3)
Fill-in (17) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (18) - Systems Generated
CCYY (same as #3)
Fill-in (19) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (20) - Systems Generated
CCYY (same as #3)
Fill-in (21) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (22) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (23) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (24) - Systems Generated
CCYY (same as #3)
ERN048 REGO II ENFORCEMENT – MONTHLY TEST DOES NOT APPLY (W13)
(Requested)
Caption: Your Benefits
Our records show earnings of (1) were reported for (2) for (3) . We assume that (4) earned all of this money in (5) .
(6) earnings affect the amount of Social Security benefits (7) due for (8) . However, we may not have to count all of the earnings reported for (9) . If any of the following apply to (10) , get in touch with any Social Security office and have a record of (11) earnings with you. Let us know if:
(12) earned some of the money before (13) , or
(14) earned a different amount in (15) , or
(16) had a loss from (17) self employment in (18) .
Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of earnings
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY year of earnings
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) - Systems Generated
Choice 1: CCYY (same as #3)
Fill-in (6) - Systems Generated
Choice 1: Your
Choice 2: His
Choice 3: Her
Fill-in (7) - Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was
Fill-in (8) - Systems Generated
Choice 1: CCYY (same as #3)
Fill-in (9) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (10) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (11) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (12) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (13) - Systems Generated
Choice 1: CCYY (same as #3)
Fill-in (14) - Systems Generated
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (15) - Systems Generated
Choice 1: CCYY (same as #3)
Fill-in (16) - Systems Generated
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (17) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (18) - Systems Generated
CCYY (same as #3)
ERN049 NO ESTIMATE/BENEFITS NOT PAID FOR CURRENT YEAR (W14)
(Requested)
Caption: Your Benefits
We do not have an estimate of how much (1) will earn in (2) . For this reason, we will assume that (3) will earn too much money to receive benefits this year.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
ERN050 FACILITY OF PAYMENT CURRENT YEAR (W15)
(Requested)
Caption: Your Benefits
For this reason, the other members of the household together are due (1) more each month. We will pay (2) this amount instead of increasing the other benefits. However, since this money is really due the other family members, it should be used only for their needs.
Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of increase
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
ERN051 FACILITY OF PAYMENT CLOSED YEAR (W16)
(Requested)
Caption: Your Benefits
Because of (1) work and earnings in (2) , (3) of (4) benefits for the year should have been withheld. For this reason, the other members of the household together were due (5) more. However, we continued to pay (6) instead of increasing the other benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: NH's name (possessive)
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) all
Choice 2: (B) amount
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
Amount (total increase)
Fill-in (6) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
ERN052 MONTHLY EARNINGS TEST MONTHS PAYABLE (W17)
(Requested)
Caption: Your Benefits
We can pay (1) benefits for months during (2) when (3) (4) or less and (5) not active in self-employment. Therefore, we will pay (6) (7) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: beneficiary name
Fill-in (2) - Requested As A One Position Alpha Character or a date in format shown below
Choice 1: (A) this year
Choice 2: (B) last year
Choice 3: CCYY
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) you earn
Choice 2: (B) you earned
Choice 3: (C) (name) earns
Choice 4: (D) (name) earned
Fill-in (4) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount
Fill-in (5) - Requested As A One Position Alpha Character
Choice 1: (A) are
Choice 2: (B) is
Choice 3: (C) were
Choice 4: (D) was
Fill-in (6) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (7) - Requested As A Date In Format Shown Below (Must Code the word ‘for’ or ‘beginning’ before the date)
Choice 1: for MM/CCYY
Choice 2: for MM/CCYY and MM/ CCYY
Choice 3: for MM/ CCYY through MM/ CCYY
Choice 4: beginning MM/ CCYY
ERN053 TO WORKING BENEFICIARY PAYMENT BASED ON ATTAINMENT OF FULL RETIREMENT AGE IN FUTURE MONTH (W21)
(Requested)
Caption: Your Benefits
We are withholding (1) benefits for (2) because of (3) earnings. We will begin paying (4) when (5) full retirement age. In (6) case that is (7) . We will pay (8) for all future months after (9) full retirement age.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Your
Choice 2: Beneficiary name
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
Fill-in (6) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) - Systems Generated
Choice 1: 65 and 2 months (Full Retirement Age as determined from FRA utility, displayed in format shown)
Fill-in (8) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (9) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
ERN054 TEMPORARY DEDUCTIONS EQUAL PERMANENT DEDUCTIONS (MAY BE USED IN PLACE OF W01) (W29)
Caption: Your Benefits
(Requested)
(1) reported earnings of (2) for (3) . We withheld the right amount of benefits for the year based on (4) work and earnings.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You
Choice 2: Beneficiary name
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of earnings
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN055 REQUEST FOR ESTIMATE/REMINDER TO REPORT EARNINGS (W32)
Caption: Your Responsibilities
(Requested)
If (1) more than (2) in (3) , please let us know right away, because it can affect the amount of benefits (4) due. (5) will also have to report how much (6) earned at the end of the year.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You earn
Choice 2: Beneficiary name earns
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of yearly earnings limit
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY of earnings
Fill-in (4) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (5) - Systems Generated
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (6) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
ERN056 ESTIMATE EQUAL TO OR LESS THAN EXEMPT AMOUNT (W36)
(Requested)
Caption: Your Benefits
Since (1) estimated (2) would earn (3) or less for (4) , we do not have to withhold any of (5) benefits for the year. If (6) work plans change and (7) that (8) will earn over (9) , please let us know right away.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (3) - Systems Generated
Choice 1: Current year earnings limitation
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (6) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) - Systems Generated
Choice 1: you find
Choice 2: he finds
Choice 3: she finds
Fill-in (8) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (9) - Systems Generated
Choice 1: Current year earnings limitation (same as Fill-in 3)
ERN057 BENEFITS PAYABLE IN CURRENT OR PRIOR YEAR BECAUSE OF NON-SERVICE MONTHS (W37)
(Requested)
Caption: Your Benefits
We can pay (1) benefits (2) (3) because (4) (5) (6) (7) .
Please be sure to let us know right away if (8) work or earnings change, because changes would affect the amount of (9) benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Requested As A One Position Alpha Character
Choice 1: (A) for
Choice 2: (B) beginning
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) you did not
Choice 2: (B) you will not
Choice 3: (C) you are not
Choice 4: (D) he did not
Choice 5: (E) he will not
Choice 6: (F) he is not
Choice 7: (G) she did not
Choice 8: (H) she will not
Choice 9: (I) she is not
Fill-in (5) - Requested As A One Position Alpha Character
Choice 1: (A) earn more than
Choice 2: (B) earning more than
Choice 3: (C) perform substantial services in self-employment
Choice 4: (D) performing substantial services in self-employment
Fill-in (6) - Systems Generated
Choice 1: Show appropriate monthly earnings limit in format $$$$$¢¢
Fill-in (7) - Requested As A One Position Alpha Character
Choice 1: (A) during that month
Choice 2: (B) during each of those months
Choice 3: (C) Null
Fill-in (8) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (9) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN058 PARTIAL BENEFIT FOLLOWED BY FULL BENEFITS PAID IN CURRENT YEAR BECAUSE OF NON-SERVICE MONTHS (W39)
(Requested)
Caption: Your Benefits
We can pay (1) benefits (2) because (3) (4) (5) during (6) . Because of (7) estimated earnings of (8) for (9) , we can pay (10) only part of (11) benefits for (12) , and (13) full benefit for all months after that.
Please be sure to let us know right away if (14) work or earnings change, because changes would affect the amount of (15) benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and MM/CCYY
Choice 3: MM/CCYY through MM/CCYY
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) you are not
Choice 2: (B) you will not
Choice 3: (C) he is not
Choice 4: (D) he will not
Choice 5: (E) she is not
Choice 6: (F) she will not
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) earn more than
Choice 2: (B) earning more than
Choice 3: (C) perform substantial services in self-employment
Choice 4: (D) performing substantial services in self-employment
Fill-in (5) - Systems Generated
Choice 1: Monthly earnings limit
Choice 2: null
Fill-in (6) - Requested As A One Position Alpha Character
Choice 1: (A) that month
Choice 2: (B) each of those months
Fill-in (7) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Estimated earnings amount
Fill-in (9) - Systems Generated
Choice 1: CCYY (current year)
Fill-in (10) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (11) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (12) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY partial benefit is paid
Fill-in (13) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (14) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (15) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN059 FULL BENEFITS PAYABLE TO AUXILIARY BECAUSE OF NUMBER HOLDER'S WORK AND EARNINGS (W41)
(Requested)
Caption: Your Benefits
Because of (1) work and earnings, only a partial benefit is payable for (2) (3) .
Fill-in values:
Fill-in (1) - Requested As A One Position Alpha Character
Choice 1: (A) your husband's
Choice 2: (B) your wife's
Choice 3: (C) your former husband's
Choice 4: (D) your father's
Choice 5: (E) your mother's
Choice 6: (F) bene's name possessive + husband's
Choice 7: (G) bene's name possessive + wife's
Choice 8: (H) bene's name possessive + former husband's
Choice 9: (I) bene's name possessive + father's
Choice 10: (J) bene's name possessive + mother's
Fill-in (2) – Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and MM/CCYY
Choice 3: MM/CCYY through MM/CCYY
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) null
Choice 2: (B) and each month thereafter
ERN060 PAYMENT IN CURRENT YEAR BASED ON NON-SERVICE MONTHS – THE FULL RETIREMENT AGE (W43)
(Requested)
Caption: Your Benefits
We can pay (1) benefits for (2) because (3) will not (4) (5) during (6) . Because of (7) work, we cannot pay (8) any other benefits until (9) full retirement age. In (10) case that is (11) .
Please be sure to let us know right away if (12) work or earnings change, because changes could affect the amount of (13) benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary’s name
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and MM/CCYY
Choice 3: MM/CCYY through MM/CCYY
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) earn more than
Choice 2: (B) perform substantial services in self-employment
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢ or Alpha Character
Choice 1: Monthly earnings limit
Choice 2: (B) null
Fill-in (6) - Requested As A One Position Alpha Character
Choice 1: (A) that month
Choice 2: (B) each of those months
Fill-in (7) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (9) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
Fill-in (10) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (11) - Systems Generated
Choice 1: full retirement age
Fill-in (12) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (13) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN061 PAYMENT BASED ON ATTAINMENT OF FULL RETIREMENT AGE - NO PAYMENT PRIOR TO ATTAINMENT OF FULL RETIREMENT AGE (W44)
(Requested)
Caption: Your Benefits
Because of (1) work in (2) , we cannot pay (3) any other benefits until (4) full retirement age. In (5) case that is (6) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name, possessive
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (4) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
Choice 4: performing substantial services in self-employment
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (6) - Systems Generated
Choice 1: 66 and 2 months (full retirement age from FRA utility in format )
ERN062 PARTIAL AND FULL PAYMENT IN CURRENT YEAR BASED ON ESTIMATE (W45)
(Requested)
Caption: Your Benefits
Because of (1) estimated earnings of (2) for (3) , we can only pay (4) part of (5) benefit for (6) , and (7) full benefit for all months after that.
Please be sure to let us know right away if (8) work or earnings change, because changes could affect the amount of (9) benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name, possessive
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Estimated earnings amount
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (6) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY of partial payment
Fill-in (7) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (9) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN063 FULL AND INTERMITTENT PAYMENTS IN CURRENT YEAR BASED ON ESTIMATE (W46)
(Requested)
Caption: Your Benefits
Based on (1) estimated earnings of (2) for (3) , benefits are payable for (4) . If (5) estimate of earnings for the rest of the year changes or (6) neither earn over (7) as an employee nor perform (8) substantial services in self-employment in any months before (9) , please notify any Social Security office promptly.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name, possessive
Fill-in (2) - Requested As A Money Amount In Format Shown Below
Choice 1: Amount (in format $$$$$.¢¢)
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and MM/CCYY
Choice 3: MM/CCYY through MM/CCYY
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (6) - Systems Generated
Choice 1: you neither earn
Choice 2: he neither earns
Choice 3: she neither earns
Fill-in (7) - Systems Generated
Choice 1: Monthly earnings limit (in format $$$$$.¢¢)
Fill-in (8) - Systems Generated
Choice 1: perform
Choice 2: performs
Fill-in (9) - Systems Generated
Choice 1: age 65” or full retirement age (i.e., 66 and 2 months)
Note: This is the FRA from the FRA utility.
ERN064 RESPONSIBILITIES OF PEOPLE ENTITLED TO A PERIOD OF DISABILITY FOR MEDICARE COVERAGE (W50)
(Requested)
Caption: Your Benefits
If (1) to work while (2) still disabled, (3) may be entitled to a trial work period to test (4) ability to resume work. During this period (5) may work in as many as 9 months (which need not be consecutive) and still be considered disabled for entitlement to Medicare coverage no matter how high (6) earnings. After the trial period has ended, we will consider the work (7) did in determining whether (8) shown by (9) work activity that (10) disability has ended. However, (11) not entitled to a trial work period if (12) entitled to a second period of disability for which (13) did not have to complete a waiting period.
To prevent any incorrect entitlement, please notify us promptly if:
(14) already returned to work when (15) received this notice; or
(16) to work in the future, regardless of how much (17) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you return
Choice 2: Beneficiary's Name returns
Fill-in (2) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (8) - Systems Generated
Choice 1: you have
Choice 2: he has
Choice 3: she has
Fill-in (9) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (10) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (11) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (12) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (13) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (14) - Systems Generated
Choice 1: you have
Choice 2: he has
Choice 3: she has
Fill-in (15) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (16) - Systems Generated
Choice 1: you return
Choice 2: he returns
Choice 3: she returns
Fill-in (17) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
ERN065 ENFORCEMENT/NO DEDUCTIONS HAD BEEN MADE/OPTIONAL STATEMENT REGARDING MONTHLY EARNINGS TEST (W53)
(Requested)
Caption: Your Benefits
Our records show that (1) earned (2) in (3) (4) Because of this, we should have withheld (5) from (6) benefits for (7) . Therefore, we paid (8) (9) too much in benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of posted earnings
Fill-in (3) - Requested As A Year In Format CCYY
Choice 1: CCYY
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) “.”
Choice 2: (B) and we assume that you worked in all months of that year after you became entitled to Social Security benefits.
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Full amount that should have been withheld
Fill-in (6) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (8) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (9) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of overpayment
ERN066 ENFORCEMENT/SOME DEDUCTIONS MADE BASED ON ANNUAL REPORT/OPTIONAL STATEMENT REGARDING MONTHLY EARNINGS TEST (W54)
(Requested)
Caption: Your Benefits
(1) told us that (2) earned (3) in (4) . However, our records show that (5) earned (6) that year (7) . Because of this, we should have withheld (8) from (9) benefits for (10) . Since we only withheld (11) , we paid (12) (13) too much in benefits.
If (14) we are wrong, please get in touch with us. (15) should also give us any facts (16) to show that our records are wrong.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary Name
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of earnings shown on annual report
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Choice 2: CCYY and CCYY
Choice 3: CCYY through CCYY
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of posted earnings
Fill-in (7) - Requested As A One Position Alpha Character
Choice 1: (A) “.”
Choice 2: (B) and we assume that you worked in all months of that year after you became entitled to Social Security benefits.
Choice 3: (C) and we assume that he worked in all months of that year after he became entitled to Social Security benefits.
Choice 3: (C) and we assume that he worked in all months of that year after he became entitled to Social Security benefits.
Choice 4: (D) and we assume that she worked in all months of that year after she became entitled to Social Security benefits.
Fill-in (8) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Amount that should have been withheld
Fill-in (9) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (10) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (11) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount actually withheld
Fill-in (12) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (13) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of overpayment
Fill-in (14) - Systems Generated
Choice 1: you think
Choice 2: he thinks
Choice 3: she thinks
Fill-in (15) - Systems Generated
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (16) - Systems Generated
Choice 1: you have
Choice 2: he has
Choice 3: she has
ERN067 FACILITY OF PAYMENT BENEFIT REDUCED/ANOTHER BENEFICIARY WORKING (W58)
(Requested)
Caption: Your Benefits
We are reducing (1) benefits to (2) beginning (3) because of a change in the earnings of (4) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Name (possessive)
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Reduced benefit amount
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (4) - Requested As A Language
Choice 1: Name of other beneficiary
ERN068 REASON FOR NOT REPORTING EARNINGS NOT ACCEPTED - DOMESTIC CASES (W61)
(Requested)
Caption: A Penalty Will Be Deducted From Payments
We have decided that (1) did not have a good reason for not giving us (2) (3) report of earnings on time.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Name
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: CCYY
ERN069 PAYMENTS BASED ON ATTAINMENT OF FULL RETIREMENT AGE IN CURRENT OR PRIOR MONTH (W62)
(Requested)
Caption: Your Benefits
Because of (1) work in (2) , we cannot pay (3) (4) . We will pay (5) for the month (6) full retirement age. In (7) case that is (8) . We will pay (9) for the month (10) full retirement age and the months after that.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Name possessive
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: for MM/CCYY
Choice 2: for MM/CCYY and MM/CCYY
Choice 3: from MM/CCYY through MM/CCYY
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (6) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
Fill-in (7) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) - Systems Generated
Choice 1: age 65 or full retirement age
Note: this Fill-in is the FRA from FRA utility passed in skelcomp record as follow: FRA years + FRA months
Fill-in (9) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (10) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
ERN070 MONTHLY EARNINGS TEST APPLIES/BENEFICIARY EARNING EXEMPT AMOUNT OR LESS (W72)
(Requested)
Caption: Your Responsibilities
Please let us know right away if (1) more than (2) per month or if (3) will be active in self-employment.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you earn
Choice 2: Beneficiary's full name earns
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Monthly earnings limit
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
ERN071 DUAL ENTITLEMENT/SPOUSE BENEFIT WITHHELD BUT OWN “A” BENEFIT PAID (MAY BE USED ON AN AWARD OR ADJ. LETTER, CLOSED YEAR OR CURRENT YEAR) (W75)
(Requested)
Caption: Your Benefits
Because of (1) spouse's work and earnings, we cannot pay (2) a (3) benefit (4) . However, we will still pay (5) own retirement benefit.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: beneficiary's name possessive
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) wife's
Choice 2: (B) husband's
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: for MM/CCYY
Choice 2: for MM/CCYY and MM/CCYY
Choice 3: from MM/CCYY through MM/CCYY
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN072 BENEFITS RESUMED NO LONGER WORKING (W76)
(Requested)
Caption: Your Benefits
We are starting to pay (1) because (2) no longer working.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
ERN073 BENEFIT INCREASE TO NON-WORKING AUXILIARIES (W80)
(Requested)
Caption: Your Benefits
(1) is not due benefits because of (2) work and earnings. Therefore, we will pay (3) an increased benefit beginning (4) . This is the payment due (5) . The new benefit amount is (6) .
Fill-in values:
Fill-in (1) - Requested As A Language
Choice 1: Working Beneficiary's full name
Fill-in (2) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (3) - Requested As A One Position Alpha Character or Language
Choice 1: (A) you
Choice 2: (B) the children
Choice 3: the non-working beneficiary's first name
Fill-in (4) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY date of increase
Fill-in (5) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY payment was due
Fill-in (6) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: new monthly benefit amount
ERN074 BENEFITS WITHHELD PENDING RECEIPT OF ANNUAL REPORT (W83)
(Requested)
Caption: Things To Remember
We will decide whether (1) due any benefits for months before (2) , the month (3) (4) (5) after (6) let us know how much money (7) actually earned in (8) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Requested As A One Position Alpha Character
Choice 1: (A) applied for benefits
Choice 2: (B) reached age 65
Choice 3: (C) reached full retirement age
Fill-in (5) - Systems Generated
Choice 1: Full Retirement Age as determined from FRA utility
Choice 2: Null
Fill-in (6) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (7) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (8) - Requested As A Date In Format Shown Below
Choice 1: CCYY
ERN075 ANNUAL EARNINGS TEST APPLIES (W85)
(Requested)
Caption: Information About Work and Earnings
We will pay (1) benefits for the year after (2) based on the total amount (3) each year.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's full name
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
ERN076 BENEFITS TO WORKING AUXILIARY STOPPED (W86)
(Requested)
Caption: Your Benefits
We told (1) earlier that (2) not due benefits because of (3) work and earnings, but that we would pay (4) instead of increasing the benefits to other family members.
For benefits payable beginning January 1996, we can no longer pay (5) the increase due other family members. We must pay them directly because of a change in the law.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary name
Fill-in (2) - Systems Generated
Choice 1: you are
Choice 2: Name is
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
ERN077 BENEFITS STOPPED DUE TO WORK OUTSIDE THE U.S. (W92)
(Requested)
Caption:
We cannot pay (1) benefits beginning (2) because (3) working outside the United States for more than 45 hours each month.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's full name
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (3) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
ERN078 FACILITY OF PAYMENT FOREIGN CASES (W94)
(Requested)
Caption: Your Benefits
Because (1) working outside the United States for more than 45 hours each month, (2) not due benefits now. For this reason, the other members of the household are due (3) more money. We will pay (4) this amount instead of increasing the other benefits. However, since this money is really due the other family members, it should be used only for their needs.
If (5) working or if (6) 45 hours or less in any month, please let us know right away, because (7) may be eligible for benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you are
Choice 2: Beneficiary name is
Fill-in (2) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (3 - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount payable
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: her
Choice 3: him
Fill-in (5) - Systems Generated
Choice 1: you stop
Choice 2: she stops
Choice 3: he stops
Fill-in (6) - Systems Generated
Choice 1: you work
Choice 2: she works
Choice 3: he works
Fill-in (7) - Systems Generated
Choice 1: you
Choice 2: she
Choice 3: he
ERN079 ADDITIONAL PAYMENT DUE MEMBER OF OTHER HOUSEHOLD (W95)
(Requested)
Caption: Your Benefits
(1) due more money for (2) because of the work and earnings of another person who is getting benefits on this Social Security record.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You are
Choice 2: Beneficiary name is
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
ERN080 BENEFITS WITHHELD DUE TO WORK OUTSIDE THE U.S (W99)
(Requested)
Caption: Your Benefits
We cannot pay (1) benefits (2) because (3) worked outside the United States for more than 45 hours each month.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary Name
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: for MM/CCYY
Choice 2: for MM/CCYY and MM/CCYY
Choice 3: from MM/CCYY through MM/CCYY
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
ERN081 POSSIBLE MOE CHANGE AFTER ANNUAL REPORT IS PROCESSED (W47)
(Requested)
Caption: Your Benefits
As (1) requested, the month of entitlement shown above may be changed after we receive and process (2) annual report of earnings. If (3) estimate of earnings for the year changes or there are one or more months in which (4) not work in self employment or for wages, please notify any Social Security office promptly.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name non possessive
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) - Systems Generated
Choice 1: you do
Choice 2: he does
Choice 3: she does
ERN082 FACILITY OF PAYMENT BENEFIT PAYABLE/ANOTHER BENEFICIARY STOPPED WORK OR REDUCED EARNINGS (W60)
(Requested)
Caption: Your Benefits
We can pay (1) because of a change in the earnings of (2) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Requested As A Language
Choice 1: Name of other beneficiary
ERN083 BENEFITS WITHHELD FOR MONTH(S) PRIOR TO FILING/ATTAINMENT OF FULL RETIREMENT AGE PENDING RECEIPT OF ANNUAL REPORT (W81)
(Requested)
Caption: Your Benefits
(1) are due benefits for (2) because (3) did not work during that period. Based on (4) estimated earnings of (5) for (6) , (7) due (8) for (9) , and (10) due (11) full benefit for each month after that.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You are
Choice 2: Beneficiary's name is
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and MM/CCYY
Choice 3: MM/CCYY through MM/CCYY
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of the Estimate
Fill-in (6) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (7) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (8) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount
Fill-in (9) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (10) - Systems Generated
Choice 1: are
Choice 2: is
Fill-in (11) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN084 (WB3) EARNINGS
(Requested)
Caption: Your Benefits
(1) current estimate of total earnings for (2) offset period this year is (3) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Your
Choice 2: Name possessive
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: Name possessive
Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Estimated total earnings for the offset period
ERN085 (WB4) EARNINGS
(Requested)
Caption: Your Benefits
(1) revised estimate of total earnings for (2) offset period this year is (3) . (4) previously estimated total earnings of (5) for this period.
Fill-in values: :
Fill-in (1) - Systems Generated
Choice 1: Your
Choice 2: Name possessive
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Revised estimate of total earnings for the offset period
Fill-in (4) - Systems Generated
Choice 1: You
Choice 2: Name
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Previous estimate of total earnings for same period
ERN086 EARNINGS LIMIT INCREASED - BENEFITS DUE EARLIER BASED ON ESTIMATE (W10)
(Requested)
Caption: None
We are writing to let (1) know that the annual earnings test limit increased this year. The earnings limit is the amount (2) may earn in a year without causing a reduction in (3) benefits. Based on (4) estimate of (5) for this year, we told (6) that (7) benefits would begin (8) . Because the earnings limit was raised we can pay (9) benefits sooner.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: beneficiary name
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) - Requested As A Money Amount In Format Shown Below
Choice 1: Estimate in $$$$$.¢¢ format
Fill-in (6) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (7) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) - Requested As A Date In Format Shown Below
Choice 1: Month of entitlement in MM/CCYY format
Fill-in (9) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
ERN087 EARNINGS LIMIT INCREASED - ADDITIONAL BENEFITS DUE (W09)
(Requested)
Caption: None
We are writing to let (1) know that the annual earnings test limit increased this year. The earnings limit is the amount (2) may earn in a year without causing a reduction in (3) benefits. Based on (4) estimate of (5) for this year, (6) due more benefits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You
Choice 2: Beneficiary's name is
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Estimate in $$$$$.¢¢ format
Fill-in (6) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
ERN088 TO WORKING BENEFICIARY PAYMENT BASED ON ATTAINMENT OF FULL RETIREMENT AGE IN CURRENT OR PRIOR MONTH (W22)
(Requested)
Caption: Your Benefits
We withheld (1) benefits for (2) because of (3) earnings. We are paying (4) because (5) reached full retirement age. In (6) case that is (7) . We are paying (8) for the month (9) reached full retirement age and all later months.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: beneficiary name possessive
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and MM/CCYY
Choice 3: MM/CCYY through MM/CCYY
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) - Systems Generated
Choice 1: FRA from FRA utility in format of (i.e., 66 and 2 months)
Fill-in (8) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (9) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
ERN089 SPOUSE REINSTATED AND COMBINED WITH OWN RETIREMENT BENEFIT/BASED ON N/H's WORK/EARNINGS (W07)
(Requested)
Caption: Your Benefits
Based on (1) spouse's work, we can pay (2) (3) benefits beginning (4) . We will combine these benefits with (5) own retirement benefits, and send (6) one check each month.
(7) next check includes (8) benefits for (9) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) husband's
Choice 2: (B) wife's
Fill-in (4) - Requested As A Date In Format Shown Below
MM/CCYY
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (6) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (7) - Systems Generated
Choice 1: Your
Choice 2: His
Choice 3: Her
Fill-in (8) - Systems Generated
Choice 1: husband's
Choice 2: wife's
Fill-in (9) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and MM/CCYY
Choice 3: MM/CCYY through MM/CCYY
ERN090 EMPLOYER REPORTED EARNINGS USED TO DETERMINE BENEFITS DUE (W19)
(Requested)
Caption: Your Benefits
We adjusted (1) (2) Social Security benefits based on earnings of (3) that (4) employer reported. We are writing to let (5) know that we will use the same amount of earnings to decide the benefits (6) due in (7) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: CCYY
Fill-in (3) Requested As A Money Amount in Format Shown Below
Choice 1: $$$$$.¢¢
Fill-in (4) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (6) – Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (7) - Systems Generated
Choice 1: CCYY
ERN091 EARNINGS COUNTED FOR MONTHS BEFORE FULL RETIREMENT AGE (W65)
(Requested)
Caption: You May Be Due More Benefits
Because (1) worked while getting Social Security, we reduced (2) benefits when (3) earned over certain limits each year. However, (4) may be due more Social Security benefits because of a rule that applies in the year when (5) full retirement age.
In the year (6) became (7) , which is (8) full retirement age; we count (9) earnings only for the months before (10) (11) .
Therefore, if through (12) (13) :
Less than the limit of (14) , (15) due payments for all months.
More than the limit of (16) , (17) due the amount left after we subtract $1 for every $3 (18) over the limit.
Remember that, beginning with the month (19) full retirement age, the earnings test no longer applies. We will send (20) a form to find out how much (21) earned for the months before (22) reached (23) full retirement age. Once we receive (24) reply, we will pay (25) any additional benefits due.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you have
Choice 2: beneficiary name plus has
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
Fill-in (6) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (7) - Systems Generated
Choice 1: Full Retirement Age (i.e., 66 years and 2 months)
Fill-in (8) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (9) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (10) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
Fill-in (11) - Systems Generated
Choice 1: Full Retirement Age (i.e., 66 years and 2 months)
Fill-in (12) - Systems Generated
Choice 1: CCYY
Fill-in (13) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
Fill-in (14) - Systems Generated
Choice 1: Earnings Limit
Fill-in (15) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (16) - Systems Generated
Choice 1: Earnings Limit
Fill-in (17) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (18) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
Fill-in (19) - Systems Generated
Choice 1: you reach
Choice 2: he reaches
Choice 3: she reaches
Fill-in (20) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (21) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (22) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (23) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (24) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (25) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
ERN092 BENEFITS PAYABLE IN CURRENT OR PRIOR YEAR BECAUSE OF NON-SERVICE MONTHS FOLLOWED BY SUSPENSION (W38)
(Requested)
Caption: Your Benefits
We can pay (1) benefits for (2) because (3) (4) (5) during (6) . We are withholding the rest of (7) benefits for (8) because of (9) work and earnings.
Please be sure to let us know right away if (10) work or earnings change, because changes would affect the amount of (11) benefits.
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: beneficiary's name
Fill-in (2) Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and MM/CCYY
Choice 3: MM/CCYY through (MM/CCYY
Fill-in (3) Systems Generated
Choice 1: you are not
Choice 2: he is not
Choice 3: she is not
Choice 4: you will not
Choice 5: he will not
Choice 6: she will not
Fill-in (4) Requested As A One Position Alpha Character
Choice 1: (A) earn more than
Choice 2: (B) earning more than
Choice 3: (C) perform substantial services in self employment
Choice 4: (D) performing substantial services in self-employment
Fill-in (5) Requested As A One Position Alpha Character Or As A Money Amount In Format $$$$$.¢¢
Choice 1: (A) null
Choice 2: Amount
Fill-in (6) Requested As A One Position Alpha Character
Choice 1: (A) that month
Choice 2: (B) those months
Choice 3: (C) each of those months
Fill-in (7) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY and (MM/CCYY
Choice 3: MM/CCYY through (MM/CCYY
Fill-in (9) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (10) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (11) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ERN093 PARTIAL BENEFIT PAID TO AUXILIARY DUE TO WORKERS EARNINGS POSSIBLE FULL BENEFITS PAYABLE AFTER PARTIAL MONTH (W40)
(Requested)
Caption: Your Benefits
Because of (1) work and earnings, only a partial benefit is payable for (2) (3) (4) .
Fill-in values:
Fill-in (1) Requested As A One Position Alpha Character
Choice 1: (A) your husband's
Choice 2: (B) your wife's
Choice 3: (C) your former husband's
Choice 4: (D) your father's
Choice 5: (E) your mother's
Choice 6: (F) bene's name possessive + husband's
Choice 7: (G) bene's name possessive + wife's
Choice 8: (H) bene's name possessive + former husband's
Choice 9: (I) bene's name possessive + father's
Choice 10: (J) bene's name possessive + mother's
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
MM/CCYY of partial payment
Fill-in (3) Requested As A One Position Alpha Character
Choice 1: (A) null
Choice 2: (B) and your full benefit for each month thereafter
Choice 3: (C) and his full benefit for each month thereafter
Choice 4: (D) and her full benefit for each month thereafter
Choice 5: (E) and your full benefit for
Choice 6: (F) and his full benefit for
Choice 7: (G) and her full benefit for
Fill-in (4) Requested As A One Position Alpha Character or Date In Format Shown Below
Choice 1: (A) null
Choice 2: MM/CCYY
Choice 3: MM/CCYY and MM/CCYY
Choice 4: MM/CCYY through MM/CCYY
ERN094 NO BENEFITS DUE AUXILIARY BECAUSE OF NUMBER HOLDER'S WORK AND EARNINGS (W42)
(Requested)
Caption: Your Benefits
Because of (1) work and earnings, no benefits are payable at this time. If (2) work activity changes, some benefits may be payable to (3)
Fill-in values:
Fill-in (1) Requested As A One Position Alpha Character
Choice 1: (A) your husband's
Choice 2: (B) your wife's
Choice 3: (C) your former husband's
Choice 4: (D) your father's
Choice 5: (E) your mother's
Choice 6: (F) bene's name possessive + husband's
Choice 7: (G) bene's name possessive + wife's
Choice 8: (H) bene's name possessive + former husband's
Choice 9: (I) bene's name possessive + father's
Choice 10: (J) bene's name possessive + mother's
Fill-in (2) Systems Generated
Choice 1: his
Choice 3: her
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
ERNR09 LAG EARNINGS PENDING (E09)(C33)
(Requested)
Caption: Information About Work and Earnings; or Caption: Your Benefits
We used (1) earnings through (2) to figure the benefit amount. Later, we will refigure the benefit to include any earnings (3) had after (4) . (5) will not have to ask us to do this. After we have refigured the benefit amount, we will let you know about any increase.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's name
Choice 2: your
Fill-in (2) - Requested As A Year In Format CCYY
Choice 1: last year included in the computation
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Requested As A Year In Format CCYY
Choice 1: last year included in the computation
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
ERNR10 WAGES FROM EMPLOYER COULD NOT BE COUNTED (E50)
(Requested)
Caption: Your Benefits
We could not use the money received from (1) for (2) because (3) .
Fill-in values:
Fill-in (1) - Requested As A Language
Choice 1: employers name
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: year(s) CCYY
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) the facts we have do not show that there was an employer-employee relationship
Choice 2: (B) the money does not meet our requirements to be considered wages
Choice 3: (C) the money was paid as a pension
Choice 4: (D) pension
Choice 5: (E) the money was paid because of sickness or accident, and paid more than 6 months after work ended
ERNR11 WAGE DETERMINATION PENDING (E51)
(Requested)
Caption: Your Benefits
We have not used the payments (1) received from (2) for (3) through (4) because we have not yet decided whether these payments are wages. We will let you know as soon as we make a decision.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Requested As A Language
Choice 1: employers name
Fill-in (3) - Requested As A Year In Format CCYY
Choice 1: year
Fill-in (4) - Requested As A Year In Format CCYY
Choice 1: year