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NL: Notices, Letters and Paragraphs

Effective Dates: 03/02/2016 - Present

BASIC (05-11)

LIS004 INTRODUCTORY STATEMENT A 20, A21, A 22 ADJUSTMENT NOTICE (G52)

(System Generated)

Caption: None

We are writing to give you new information about the  (1)  benefits which  (2)  on this Social Security record.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: disability

Choice 2: retirement

Choice 3: wife's

Choice 4: husband's

Choice 5: child's

Choice 6: widow's

Choice 7: widower's

Choice 8: mother's

Choice 9: father's

Choice 10: disabled widow's

Choice 11: disabled widower's

Choice 12: disabled divorced widow's

Choice 13: disabled divorced widower's

Choice 14: Medicare

Choice 15: null

Fill-in (2) - Systems Generated

Choice 1: you receive

Choice 2: Beneficiary Name receives

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