NL: Notices, Letters and Paragraphs
TN 25 (06-18)
BEN030 MBA Chart – Shows Changes to MBA on All DIB Awards and RR Certification Awards
The following chart shows (1) benefit amount(s) before any deductions or rounding. The amount (2) actually receive(s) may differ from (3) full benefit amount. When we figure how much to pay (4) , we must deduct certain amounts, such as Medicare premiums. We must also round down to the nearest dollar.
Beginning Date |
Benefit Amount |
Reason |
|---|---|---|
(5) (6) |
(7) |
(8) |
(9) (10)/> |
(11) |
(12) |
(13) (14) |
(15) |
(16) |
(17) (18) |
(19) |
(20) |
(21) (22) |
(23) |
(24) |
(25) (26) |
(27) |
(28) |
(29) (30) |
(31) |
(32) |
(33) (34) |
(35) |
(36) |
(37) (38) |
(39) |
(40) |
(41) (42) |
(43) |
(44) |
(45) (46) |
(47) |
(48) |
(49) (50) |
(51) |
(52) |
(53) (54) |
(55) |
(56) |
(57) (58) |
(59) |
(60) |
(61) (62) |
(63) |
(64) |
(65) (66) |
(67) |
(68) |
Fill-ins:
(1) your/beneficiary's given name plus “beneficiary's last name possessive”
(2) “you”/“she”/“he”
(3) “your”/“her”/“his”
(4) “you”/“her”/“him”
(5) EFD month
(6) EFD year associated with fill-in 5, in the format YYYY
(7) MBA amount, corresponding to EFD from fill-in 5
(8) Entitlement began/Cost-of-living adjustment/Benefits to another person began or ended/Credit for additional earnings
(9) Fill-ins (9) through (68) follow the logic of fill-ins (5) through (8)
BEN031 DIB Over RIB Entitlement
Since (1) now entitled to a higher monthly disability benefit, we are stopping (2) retirement benefits.
Fill-ins:
(1) you are/Ms. plus beneficiary's last name plus “is”/Mr. plus beneficiary's last name plus “is”
(2) “your”/“her”/“his”
BEN032 DIB Over RIB Entitlement/Dual Entitlement Involving an Adjustment in Retroactive Benefits
In (1) (2) payment, (3) will receive the difference between the benefits already paid and those now due.
Fill-ins:
(1) your/beneficiary's given name/beneficiary's given name plus beneficiary's last name, possessive/Ms. plus beneficiary's last name, possessive/Mr. plus beneficiary's last name, possessive
(2) “first”/“next”
(3) “you”/“she”/“he”
BEN051 Dual Entitlement Benefits Combined in One Check
We will send (1) both benefits in one check each month under (2) own Social Security claim number.
Fill-ins:
(1) “BGN plus BLN”/“you”
(2) “your”/“his”/“her”
BEN052 Benefits Paid in Separate Check
We will send (1) separate checks each month under each Social Security claim number.
Fill-in:
(1) “BGN plus BLN”/“you”
BEN053 Auxiliary Benefits Reduced by Primary Benefits
We are reducing (1) benefits as a (2) by the amount to which (3) entitled on (4) own Social Security record. This means (5) benefits will now be $ (6) as a (7) plus $ (8) on (9) own record.
Fill-ins:
(1) “your”/“her”/“his”
(2) type of benefit
(3) “you are”/“she is”/“he is”
(4) “your”/“her”/“his”
(5) “your”/“her”/“his”
(6) Money fill-in
(7) type of benefit
(8) Money fill-in
(9) “your”/“her”/“his”