NL: Notices, Letters and Paragraphs
TN 2 (11-06)
NOTE: On April 1, 2009, SSA changed its policy of not paying fleeing felons. Follow the instructions below only for felony warrants with offense codes 4901, 4902, or 4999. Follow the Martinez settlement instructions in GN 02613.860 – GN 02613.885 for all other felony warrant codes.
On March 18, 2011, upon remand from the Second Circuit, the District Court for the Southern District of New York certified a nationwide class in Clark v. Astrue that includes all individuals whose benefits or payments we suspended or denied after October 29, 2006. Given the pending litigation, including continuing litigation about the class certification, at this time we are not suspending or denying payments based solely on a report of a probation or parole violation warrant. Follow the instructions in EM-11032, dated May 9, 2011 for processing cases with probation or parole violation warrants with offense codes: 5011, 5012, 8101, 8102, or 9999 or “Blank” and an offense charge symbol of “probation or parole violation.”
We will make additional changes to this section, as necessary, in the future.
For Martinez Title II and Title XVI notice information, see the references indicated in the chart in this section below:
| Martinez Paragraphs and Notices | Reference |
|---|---|
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Title II Martinez Post-2006 Paragraphs and Captions Title II Martinez Settlement Post-2006 Generic Notice |
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Title XVI Martinez Post-2006 Notices
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Title II Martinez Pre-2007 Paragraphs and Captions Title II Martinez Settlement Pre-2007 Informational Notice |
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Title XVI Martinez Pre-2007 Notices
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A. Exhibit - Fugitive Felon/Probation or Parole Violator Paragraphs for Initial Award Plus Suspension Notice
1. Fugitive Felon Paragraphs and Captions to Include in the Initial Award Plus Suspension Notice
a. Good Cause Determination Was Made at the Time of the Application
|
UTI# on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
|
DPS FUG049 |
*F1 monthly benefit is *F2 beginning *F3. We cannot pay benefits to *F4 beginning *F5 because *F6 an outstanding arrest warrant for a *F7. Fill-Ins: *F1-1 Pronoun (Your/Client Name Possessive) *F4-1 Pronoun (you/Client Name) |
|
AURORA WCP034 |
*F1 monthly benefit is $*F2 *F3 *F4 *F5 *F6. Fill-Ins: *F1-1 BGN plus BLN |
|
DPS FUG056 AURORA FUG056 |
Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F1 *F2 into one of these categories. Fill-Ins: *F1-1 Pronoun (you/he/she/Client Name) *F2-2 falls |
|
DPS FUG050 |
We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F4 –3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant. *F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant. *F5-1 null *F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty. *F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant. |
|
AURORA FUG050 |
CAUTION: PSC staff should review the instructions found in (NL 00755.330 B.1.a.); (NL 00755.330B.1.b.) and (NL 00755.330D) for the limited use of this good cause denial paragraph. We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
|
DPS INFCO1 AURORA INFC01 |
The Information We Have |
| DPS FUG029 AURORA FUG029 |
Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest for a *F5 crime on *F6. Fill-Ins: *F1-1 Warrant Issuing Agency Name |
| DPS PAYC27 AURORA PAYC27 |
How *F1 Benefits Can Be Paid Fill-Ins: *F1-1 Pronoun (Your/Client/Beneficiary Name Possessive) |
| DPS FUG030 AURORA FUG030 |
We will pay *F1 if you contact us at any time,*F2 and can show us within 90 days from the date that you contact us that any of the following apply: The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name. *F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges. The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges. The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn. *F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges. Fill-Ins:*F1-1 Pronoun (you/Client/Beneficiary Name) |
|
DPS FUG031 AURORA FUG031 |
If none of the above apply, we also may pay *F1 if you contact us within 12 months from the date of this letter, *F2 and can show us that: The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F3 paroled or put on probation was both nonviolent and not drug related. And *F4 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The law enforcement agency that issued the warrant reports that it will not extradite *F5 for the charges on the warrant or that it will not take action on the warrant for *F6 arrest. Or The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F7 paroled or put on probation was both nonviolent and not drug related. And F8 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The only existing warrant was issued 10 or more years ago. And *F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11 incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security has appointed a representative payee to handle *F14 benefits or *F15 residing in a long-term care facility, such as a nursing home or mental treatment/care facility. |
|
Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) |
|
| AURORA FUG504 DPS FUG504 |
*F1 entitled to receive monthly *F2 benefits beginning *F3. Fill-Ins: *F1 – 1 Pronoun (You are/Client is/Beneficiary Name is) *F2 – 1 (retirement/survivors/disability/supplemental security income) *F3 – 1 (MM/CCYY--date of fugitive felon/probation or parole violator suspension/date of entitlement to benefits) |
|
AURORA PAYC01 DPS PAYC01 |
What We Will Pay and When |
| DPS BENC08 |
Information About Your Benefits |
| AURORA BENC09 |
About *F1 Benefits Fill-Ins: *F1-1 Your |
b. Good Cause Determination is Pending at the Time of Application of Claim
| UTI # DPS and AURORA |
Language for Paragraphs and Captions |
| DPS FUG507 AURORA FUG507 |
You have told us that there is a good cause for not satisfying the outstanding warrant but we need information from you to prove this. Once you submit the information necessary for us to decide if *F1 shown good cause for not satisfying the outstanding warrant, we will send you another letter to let you know if we can start paying *F2 Social Security benefits. Fill-Ins: *F1 – 1 Pronoun (you have/he has/she has) *F2 – 1 Pronoun (you/him/her) |
2. Miscellaneous Paragraphs and Captions to Use in the Initial Award Plus Suspension Notice
| UTI # DPS and AURORA |
Language for Paragraph |
| DPS INFC08 AURORA INFC08 |
Things To Remember |
| DPS PRI023 AURORA CLO022 |
Even though *F1 benefits will stop, we can pay other members of the family if they are entitled on *F2 record. Fill-Ins: *F1-1 Pronoun (your/Client/Beneficiary Name Possessive) |
B. Exhibit - of Proposed Suspension Paragraphs and Captions-Post-adjudicative
|
UTI# on DPS and AURORA |
Language for Paragraph |
|---|---|
| DPS FUG056 AURORA FUG056 |
Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F1 *F2 into one of these categories. Fill-Ins: *F1-1 Pronoun (you/he/she/Client/Beneficiary Name) |
| DPS SUS210 AURORA SUS210 |
Based on the information we have, we should have stopped the Social Security benefits beginning *F1. Fill-Ins: *F1-1 MM/CCYY |
| AURORA FUG048 |
We are writing to tell you that we plan to stop *F1 Social Security benefits. Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F2 into one of these categories. Based on the information we have, we should have stopped the Social Security benefits beginning *F3. Fill-Ins: *F1-1 beneficiary’s name (possessive) |
| DPS INFC01 AURORA INFC01 |
The Information We Have |
| DPS FUG029 AURORA FUG029 |
Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest for a *F5 crime on *F6. Fill-Ins: *F1-1 Warrant Issuing Agency Name *F6-1 MM/CCYY(date of the warrant) |
| DPS PAYC27 AURORA PAYC27 |
How *F1 Benefits Can Be Paid Fill-Ins: *F1-1 Pronoun (Your/Client/Beneficiary Name Possessive) |
| DPS FUG030 AURORA FUG030 |
We will pay *F1 if you contact us at any time*F2 and can show us within 90 days from the date that you contact us that any of the following apply: The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name. *F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges. The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges. The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn. *F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
| DPS FUG031 AURORA FUG031 |
If none of the above apply, we also may pay *F1 if you contact us within 12 months from the date of this letter *F2 and can show us that: The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F3 paroled or put on probation was both nonviolent and not drug related. And *F4 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The law enforcement agency that issued the warrant reports that it will not extradite *F5 for the charges on the warrant or that it will not take action on the warrant for *F6 arrest. OR The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F7 paroled or put on probation was both nonviolent and not drug related. And *F8 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The only existing warrant was issued 10 or more years ago. And *F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11 incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security has appointed a representative payee to handle *F14 benefits or *F15 residing in a long-term care facility, such as a nursing home or mental treatment/care facility. Fill-Ins: |
| DPS MESC02 AURORA MESC02 |
*F13-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) What You Can Do |
| DPS PAY157 AURORA PAY157 |
Our records show that *F1 already *F2 the following requirement(s) for *F3 benefits to be paid: Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) |
| DPS FUG032 AURORA FUG032 |
The crime for which the warrant was issued was both nonviolent and not drug related. NOTE: Do not use this paragraph for offense codes 5011 or 5012. |
| DPS FUG033 AURORA FUG033 |
The original crime(s) for which *F1 paroled or put on probation was both nonviolent and not drug related. Fill-Ins: *F1-1 Pronoun (you were/Client/Beneficiary Name was) NOTE: Use this paragraph for offense codes 5011 or 5012. |
| DPS FUG034 AURORA FUG034 |
*F1 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. Fill-Ins: *F1-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has) |
| DPS FUG035 AURORA FUG035 |
The law enforcement agency that issued the warrant reports that it will not extradite *F1 for the charges on the warrant or that it will not take action on the warrant for *F2 arrest. Fill-Ins: *F1-1 Pronoun (you/him/her/Client/Beneficiary Name) |
| DPS FUG036 AURORA FUG036 |
The only existing warrant was issued 10 or more years ago. |
| DPS FUG037 AURORA FUG037 |
*F1 medical condition impairs *F2 mental capacity to resolve the warrant. Fill-Ins: *F1-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive) |
| DPS FUG038 AURORA FUG038 |
Social Security has appointed a representative payee to handle *F1 benefits. Fill-Ins: *F1-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) |
| DOC FUG039 AURORA FUG039 |
*F1 residing in a long-term care facility, such as a nursing home or mental treatment/care facility. Fill-Ins: *F1-1 Pronoun (You are/Client/Beneficiary Name is) |
| DPS PAY158 AURORA PAY158 |
However, we do not have all the information we need to pay benefits. If you contact us within 12 months from the date of this letter, we will pay *F1 benefits if you can show us within 90 days from the date you contact us that: Fill-Ins: *F1-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) |
| DPS FUG042 AURORA FUG042 |
The probation or parole violation was both nonviolent and not drug related and, the original crime(s) for which *F1 paroled or put on probation was both nonviolent and not drug related. To prove this, submit an official court document that explains the criminal charges on which *F2 originally convicted. Such documents include, but are not limited to a docket, a conviction notice, or a plea agreement. Fill-Ins: *F1-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) |
| DPS FUG040 AURORA FUG040 |
The crime for which the warrant was issued is both nonviolent and not drug related. To prove this, submit an official copy of the arrest warrant. Such documents include, but are not limited to a docket, a conviction notice or a plea agreement. |
| DPS FUG041 AURORA FUG041 |
The original crime for which *F1 paroled or put on probation was both nonviolent and not drug related. To prove this, submit an official court document that explains the criminal charges on which *F2 originally convicted. Such documents include but are not limited to a docket, a conviction notice, or a plea agreement. Fill-Ins: *F1-1 Pronoun (you were/Client/Beneficiary Name was) |
| DPS FUG043 AURORA FUG043 |
*F1 neither been convicted of nor pled guilty to any other felony crime since the warrant was issued on *F2. To prove this, give us a statement as to whether *F3 been convicted of or pled guilty to any such crimes since *F4. Fill-Ins: *F1-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has) |
| DPS FUG044 AURORA FUG044 |
The law enforcement agency that issued the warrant is unwilling to act on it. To prove this, submit an official document from the law enforcement agency that issued the warrant stating that it will not extradite *F1 for the charges on the warrant or that it will not take action on the warrant for *F2 arrest. Fill-Ins: *F1-1 Pronoun (you/him/her/Client/Beneficiary Name) |
| DPS FUG045 AURORA FUG045 |
*F1 incapable of managing *F2 benefits or *F3 legally incompetent. To prove this, submit a copy of the court order that appointed a conservator or guardian to handle *F4 affairs or that declared *F5 legally incompetent. Fill-Ins: *F1-1 Pronoun (You are/He is/She is/Client/Beneficiary Name is) *F5-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) |
| DPS FUG046 AURORA FUG046 |
Or *F1 residing in a long-term care facility, such as a nursing home or mental treatment /care facility. To prove this, submit a statement that *F2 residing in such a facility. Fill-Ins: *F1-1 Pronoun (You are/Client Name/Beneficiary is) |
| DPS CAPC40 AURORA CAPC40 |
If We Don't Hear From You |
| DPS ALS039 |
If we do not hear from you within *F1 days from the date of this letter, we will assume the information in this letter is correct and will stop *F2 Social Security benefits. We will send another letter at that time. It will explain the change in *F3 benefits, the amount of any overpayment, and how to appeal our decision. You will have 60 days to ask for an appeal. The 60 days will start the day after you receive the next letter. Fill-Ins: *F1-1 30 *F1 2 10 *F2-1 Pronoun (your/his/her/Client Name Possessive) *F3-1 Pronoun (your/his/her/Client Name Possessive) |
| AURORA BRR029 |
If we do not hear from you within *F1 days from the date of this letter, we will assume the information in this letter is correct and will stop *F2 Social Security benefits. We will send another letter at that time. It will explain the change in *F3 benefits, the amount of any overpayment, and how to appeal our decision. You will have 60 days to ask for an appeal. The 60 days will start the day after you receive the next letter. Fill-Ins: *F1-1 30 (due process period) *F1-2 10 (due process period) |
| DPS INFC08 AURORA INFC08 |
Things To Remember |
| DPS PRI023 AURORA CLO022 |
Even though *F1 benefits will stop, we can pay other members of the family if they are entitled on *F2 record. Fill-Ins: *F1-1 Pronoun (your/Client/Beneficiary Name Possessive) |
| DPS REFC01 AURORA REFC01 |
If You Have Any Questions |
| DPS REF003 AURORA REF003 |
We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 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: *F1-1 FO Phone Number |
C. Exhibit- Fugitive Felon Good Cause Paragraphs and Captions
1. Initial Award Plus Suspension Notice Good Cause Paragraphs
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
| FUG052 |
We will pay *F1 if you contact us at any time and can show us that any of the following apply:
Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
| FUG031 |
If none of the above apply, we also may pay *F1 if you contact us within 12 months from the date of this letter, *F2 and can show us that:
And
And
Or
And
And
And
Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) ) |
|
*F8-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has) |
2. Fugitive Felon Advance Notice of Proposed Suspension
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
| FUG030 |
We will pay *F1 if you contact us at any time,*F2 and can show us within 90 days from the date that you contact us that any of the following apply:
Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F3-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) |
| FUG031 |
If none of the above apply, we also may pay *F1 if you contact us within 12 months from the date of this letter *F2 and can show us that:
And
And
Or
And
And
And
Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) ) |
| *F8-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has) *F9-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive) *F10-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F11-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) *F12-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F13-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) *F14-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F15-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is). |
3. Suspension Notice Good Cause Paragraphs
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
| FUG052 |
We will pay *F1 if you contact us at any time and can show us that any of the following apply: The warrant was issued incorrectly in *F2 name because someone stole *F3 identity. To prove this submit a copy of the police report *F4 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F5 name. *F6 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F7 found not guilty of the criminal charges or a copy of the court decision showing that *F8 found not guilty of the criminal charges. The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges. The warrant for *F9 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn. *F10 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F11 cleared of the criminal charges. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F4-1 Pronoun (you/he/she/Client/Beneficiary Name) |
| FUG053 |
If none of the above apply, we also may pay *F1 benefits if you contact us within 12 months from *F2 and can show us that: The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F3 paroled or put on probation was both nonviolent and not drug related. And *F4 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The law enforcement agency that issued the warrant reports that it will not extradite *F5 for the charges on the warrant or that it will not take action on the warrant for *F6 arrest. Or The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F7 paroled or put on probation was both nonviolent and not drug related. And *F8 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The only existing warrant was issued 10 or more years ago. And *F9 medical condition impairs *F10 mental capability to resolve the warrant; or *F11 incapable of managing *F12 benefits; or *F13 legally incompetent; or Social Security has appointed a representative payee to handle *F14 benefits or *F15 residing in a long-term care facility, such as a nursing home or mental treatment/care facility. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F3-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) |
|
*F12-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F13-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) *F14-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F15-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) |
4. Closed Period of Suspension Notices Good Cause Paragraphs
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
| FUG054 |
F1 will not be overpaid for the months that *F2 had an outstanding felony warrant for a crime or a warrant for a probation or parole violation if you contact us at any time and can show us that any of the following apply: The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name. *F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges. The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges. The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn. *F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges. Fill-Ins: *F1-1 Pronoun (You/Client/Beneficiary Name)) |
| FUG055 |
If none of the above applies, we also may not consider *F1 overpaid *F2 for the months of *F3 if you contact us within 12 months from the date of this notice and can show us that: The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F4 paroled or put on probation was both nonviolent and not drug related. And *F5 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The law enforcement agency that issued the warrant reports that it will not extradite *F6 for the charges on the warrant or that it will not take action on the warrant for *F7 arrest. Or The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F8 paroled or put on probation was both nonviolent and not drug related. And *F9 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The only existing warrant was issued 10 or more years ago. And *F10 medical condition impairs *F11 mental capability to resolve the warrant; or *F12 incapable of managing *F13 benefits; or *F14 legally incompetent; or Social Security has appointed a representative payee to handle *F15 benefits or *F16 residing in a long-term care facility, such as a nursing home or mental treatment/care facility. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F4-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) *F7-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) |
| *F11-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F12-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) *F13-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F14-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) *F15-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F16-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) |
5. Paragraphs and Captions That Explain What Evidence or Proof is Necessary to Qualify for Good Cause
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
| MESC02 |
What You Can Do |
| PAY157 |
Our records show that *F1 already *F2 the following requirement(s) for *F3 benefits to be paid: Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name)) |
|
FUG032 |
The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related. |
| FUG033 |
The original crime(s) for which *F1 paroled or put on probation was both nonviolent and not drug related. Fill-Ins: *F1-1 Pronoun (you were/Client/Beneficiary Name was) |
| FUG034 |
*F1 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. Fill-Ins: *F1-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has) |
| FUG035 |
The law enforcement agency that issued the warrant reports that it will not extradite *F1 for the charges on the warrant or that it will not take action on the warrant for *F2 arrest. Fill-Ins: *F1-1 Pronoun (you/him/her/Client/Beneficiary Name) |
| FUG036 |
The only existing warrant was issued 10 or more years ago. |
| FUG037 |
*F1 medical condition impairs *F2 mental capacity to resolve the warrant. Fill-Ins: *F1-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive) |
| FUG038 |
Social Security has appointed a representative payee to handle *F1 benefits. Fill-Ins: *F1-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) |
| FUG039 |
*F1 residing in a long-term care facility, such as a nursing home or mental treatment/care facility. Fill-Ins: *F1-1 Pronoun (You are/Client/Beneficiary Name is) |
| PAY158 |
However, we do not have all the information we need to pay benefits. If you contact us within 12 months from the date of this letter, we will pay *F1 benefits if you can show us within 90 days from the date you contact us that: Fill-Ins: *F1-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) |
| FUG042 |
The probation or parole violation was both nonviolent and not drug related and, the original crime(s) for which *F1 paroled or put on probation was both nonviolent and not drug related. To prove this, submit an official court document that explains the criminal charges on which *F2 originally convicted. Such documents include, but are not limited to a docket, a conviction notice, or a plea agreement. Fill-Ins: *F1-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) |
| FUG040 |
The crime for which the warrant was issued is both nonviolent and not drug related. To prove this, submit an official copy of the arrest warrant. Such documents include, but are not limited to a docket, a conviction notice or a plea agreement. |
| FUG041 |
The original crime for which *F1 paroled or put on probation was both nonviolent and not drug related. To prove this, submit an official court document that explains the criminal charges on which *F2 originally convicted. Such documents include but are not limited to a docket, a conviction notice, or a plea agreement. Fill-Ins: *F1-1 Pronoun (you were/Client/Beneficiary Name was) |
| FUG043 |
*F1 neither been convicted of nor pled guilty to any other felony crime since the warrant was issued on *F2. To prove this, give us a statement as to whether *F3 been convicted of or pled guilty to any such crimes since *F4. Fill-Ins: *F1-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has) |
| FUG044 |
The law enforcement agency that issued the warrant is unwilling to act on it. To prove this, submit an official document from the law enforcement agency that issued the warrant stating that it will not extradite *F1 for the charges on the warrant or that it will not take action on the warrant for *F2 arrest. Fill-Ins: *F1-1 Pronoun (you/him/her/Client/Beneficiary Name) |
| FUG045 |
*F1 incapable of managing *F2 benefits or *F3 legally incompetent. To prove this, submit a copy of the court order that appointed a conservator or guardian to handle *F4 affairs or that declared *F5 legally incompetent. Fill-Ins: *F1-1 Pronoun (You are/He is/She is/Client/Beneficiary Name is) *F5-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) |
| FUG046 |
Or *F1 residing in a long-term care facility, such as a nursing home or mental treatment /care facility. To prove this, submit a statement that *F2 residing in such a facility. Fill-Ins: *F1-1 Pronoun (You are/Client/Beneficiary Name is) |
D. Exhibit - Fugitive Felon/Probation or Parole Violator Suspension Paragraphs
1. DPS Fugitive Felon/Probation or Parole Violator Suspension Paragraphs and Captions
| UTI # ON DPS | Language for Paragraph |
|---|---|
| FUG049 |
*F1 monthly benefit is *F2 beginning *F3. We cannot pay benefits to *F4 beginning *F5 because *F6 an outstanding arrest warrant for a *F7. Fill-Ins: *F1-1 Pronoun (Your/Client Name Possessive) *F4-1 Pronoun (you/Client Name) |
|
DPS FUG050 |
We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F4 –3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant. *F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant. *F5-1 null *F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty. *F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant. |
| FUG051 |
We cannot pay benefits to *F1 for the months of *F2 because during that period *F3 had an outstanding arrest warrant for a *F4. Fill-Ins: *F1-1 Pronoun (you/Client Name) |
2. AURORA Fugitive Felon/Probation or Parole Violator Suspension Paragraphs
|
UTI # On AURORA |
Language for Paragraph |
|---|---|
|
FUG048 |
We are writing to tell you that we plan to stop *F1 Social Security benefits. Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F2 into one of these categories. Fill-Ins: *F1-1 Pronoun (your/client/beneficiary name Possessive) |
|
FUG050 |
CAUTION: PSC staff should review the instructions found in (NL 00755.330 B.1.a.); (NL 00755.330B.1.b.) and (NL 00755.330D) for the limited use of this good cause denial paragraph. We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
| FUG051 |
We cannot pay benefits to *F1 for the months of *F2 because during that period *F3 had an outstanding arrest warrant for a *F4. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
| SUS210 |
Based on the information we have, we should have stopped the Fill-Ins: *F1-1 MM/CCYY (Date of suspension) |
E. Exhibit - Fugitive Felon or Probation or Parole Violator Overpayment Paragraphs and Captions
1. Paragraphs and Captions for a Fugitive Felon/Probation or Parole Violator Suspension Notice with An Overpayment
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
|
DPS FUG050 |
We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F4 –3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant. *F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant. *F5-1 null *F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty. *F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant. |
|
AURORA FUG050 |
CAUTION: PSC staff should review the instructions found in (NL 00755.330 B.1.a.); (NL 00755.330B.1.b.) and (NL 00755.330D) for the limited use of this good cause denial paragraph. We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
| FUG056 |
Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F1 *F2 into one of these categories. Fill-Ins: *F1-1 Pronoun (you/he/she/Client/Beneficiary Name) *F2-2 falls |
| INFC01 |
The Information We Have |
| FUG057 |
Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest for a felony crime or a violation of Federal or State probation or parole on *F5. Fill-Ins: *F1-1 Warrant Issuing Agency |
| OPTC04 |
How *F1 Can Avoid Being Overpaid Fill-Ins: *F1-1 Pronoun (You/Client/Beneficiary Name) |
| FUG054 |
F1 will not be overpaid for the months that *F2 had an outstanding felony warrant for a crime or a warrant for a probation or parole violation if you contact us at any time and can show us that any of the following apply: Fill-Ins: *F1-1 Pronoun (You/Client/Beneficiary Name) |
| FUG055 |
If none of the above applies, we also may not consider *F1 overpaid *F2 for the months of *F3 if you contact us within 12 months from the date of this notice and can show us that: |
|
Fill-Ins: *F1-1 Pronoun (you/Client Name)*F2-1 $$$$.00 (amount of overpayment) *F3-1 MM/CCYY through MM/CCYY (period of suspension) *F4-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) *F5-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has) *F6-1 Pronoun (you/him/her/Client/Beneficiary Name) *F7-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F8-1 Pronoun (you were/he was/she was/Client/Beneficiary Name was) *F9-1 Pronoun (You have/He has/She has/Client/Beneficiary Name has)*F10-1 Pronoun (Your/His/Her/Client/Beneficiary Name Possessive) *F11-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F12-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) *F13-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F14-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) *F15-1 Pronoun (your/his/her/Client/Beneficiary Name Possessive) *F16-1 Pronoun (you are/he is/she is/Client/Beneficiary Name is) |
|
| OPT135 |
Since we did not stop *F1 payments until *F2, *F3 paid *F4 too much in benefits. Fill-Ins: *F1-1 Pronoun (your/Client/Beneficiary Name Possessive) |
2. Paragraphs and Captions for a Fugitive Felon/Probation or Parole Violator Closed Period Suspension Notice with An Overpayment
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
| FUG051 |
We cannot pay benefits to *F1 for the months of *F2 because during that period *F3 had an outstanding arrest warrant for a *F4. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
| FUG056 |
Beginning January 2005, the law prohibits us from paying Social Security benefits to individuals who have an outstanding arrest warrant for a crime which is a felony (or, in jurisdictions that do not define crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year), or who have violated a condition of probation or parole under Federal or State law. We have information that *F1 *F2 into one of these categories. Fill-Ins: *F1-1 Pronoun (you/he/she/Client/Beneficiary Name) *F2-2 falls |
| INFC01 |
The Information We Have |
| FUG057 |
Our records show that the *F1 *F2, telephone number *F3 issued a warrant for *F4 arrest for a felony crime or a violation of Federal or State probation or parole on *F5. Fill-Ins: *F1-1 Warrant Issuing Agency *F2-1 address of the Warrant Issuing Agency |
| OPTC04 |
How *F1 Can Avoid Being Overpaid Fill-Ins: *F1-1 Pronoun (You/Client/Beneficiary Name) |
| FUG054 |
F1 will not be overpaid for the months that *F2 had an outstanding felony warrant for a crime or a warrant for a probation or parole violation if you contact us at any time and can show us that any of the following apply: The warrant was issued incorrectly in *F3 name because someone stole *F4 identity. To prove this submit a copy of the police report *F5 filed as a victim of identity theft or another official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in *F6 name. *F7 found not guilty of the criminal offense. To prove this submit a copy of the court docket indicating *F8 found not guilty of the criminal charges or a copy of the court decision showing that *F9 found not guilty of the criminal charges. The underlying charges relating to the criminal offense were dismissed. To prove this, submit a copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges. The warrant for *F10 arrest for the criminal offense was withdrawn. To prove this, submit a copy of the court docket or another official document from the warrant issuing agency indicating the warrant in question was withdrawn. *F11 otherwise cleared of the criminal offense. To prove this, submit a copy of the court docket or other court document indicating *F12 cleared of the criminal charges. Fill-Ins: *F1-1 Pronoun (You/Client/Beneficiary Name) |
|
FUG055 |
If none of the above applies, we also may not consider *F1 overpaid *F2 for the months of *F3 if you contact us within 12 months from the date of this notice and can show us that: The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if a probation or parole violation is involved, the original crime(s) for which *F4 paroled or put on probation was both nonviolent and not drug related. And *F5 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The law enforcement agency that issued the warrant reports that it will not extradite *F6 for the charges on the warrant or that it will not take action on the warrant for *F7 arrest. Or The crime for which the warrant was issued or the probation or parole violation was both nonviolent and not drug related and, if probation or parole violation is involved, the original crime(s) for which *F8 paroled or put on probation was both nonviolent and not drug related. And *F9 neither been convicted of nor pled guilty to another felony crime since the date of the warrant. And The only existing warrant was issued 10 or more years ago. And *F10 medical condition impairs *F11 mental capability to resolve the warrant; or *F12 incapable of managing *F13 benefits; or *F14 legally incompetent; or Social Security has appointed a representative payee to handle *F15 benefits or *F16 residing in a long-term care facility, such as a nursing home or mental treatment/care facility. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
|
OPT136 |
Since we did not stop *F1 payments for the period *F2, *F3 paid *F4 too much in *F5. Fill-Ins: *F1-1 Pronoun (your/Client/Beneficiary Name Possessive) *F5-1Title II benefits |
3. Deferred Overpayment Paragraphs and Captions for Fugitive Felon or Probation or Parole Violator Notices
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
| OPT027 |
Because we did not stop *F1 checks *F2 *F3, *F4 *F5 paid *F6 too much in benefits. Fill-Ins: *F1-1 Pronoun (your/his/her/Client/Beneficiary Name possessive/their) |
| FUG505 |
We will wait until we learn of the final outcome regarding (F1) criminal charges before we determine whether (F2) must repay the money (F3) received for the months of (F4) because of (F5) outstanding warrant. If (F6) found not guilty or acquitted of the criminal charges or the criminal charges are dismissed, (F7) will not be considered overpaid. If (F8) found guilty of the criminal charges, we will notify you when we will begin collection of the overpayment. Fill-Ins: *F1-1 Pronoun (your/Beneficiary Name Possessive) *F5-1 Pronoun (your/his/her/Beneficiary Name Possessive) |
| REP002 |
You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your Social Security office has a list of groups that can help you with your appeal. If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it. |
| ALSC06 |
Do You Think We Are Wrong About The Overpayment? |
|
FUG506 |
You have certain rights with respect to this overpayment and its recovery. Right to Appeal: If you disagree in any way with this overpayment determination, you have the right, within 60 days of the date you receive this notice, to request that the determination be reconsidered. If you request this independent review of the overpayment determination, please submit any additional information you have which pertains to the overpayment. Right to Request Waiver: You also have the right to request a determination concerning the need to recover the overpayment. An overpayment must be refunded or withheld from benefits unless both of the following are true: The overpayment was not your fault in any way, and You could not meet your necessary living expenses if we recovered the overpayment, or recovery would be unfair for some other reason. If you request waiver, we may need a statement of your assets and monthly income and expenses. The attached form SSA-3105, Important Information About Your Appeal and Waiver Rights, explains your appeal and waiver rights in detail. You may contact any Social Security office for help with completing the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration) and/or waiver (SSA-632-13K, Overpayment Recovery Questionnaire). Even if you do not want to request reconsideration or waiver, please call, write or visit any Social Security office if you have questions or need more information. Please take this letter with you if you do visit an office. |
F. Exhibit - Fugitive Felon or Probation or Parole Violator Reinstatement/Resumption/Good Cause Approval/Good Cause Denial Paragraph
1. Title II Fugitive Felon Reinstatement/Resumption/Good Cause Approval/Denial Paragraph
This paragraph will be used in the following situations:
Good cause established (mandatory or discretionary)--benefits resumed effective with the suspension date;
Good cause denied—because the beneficiary could not establish mandatory or discretionary good cause or did not satisfy his/her outstanding warrant (no change in payment status unless suspension applies). (See NL 00755.900F.2. for additional good cause denial reasons language.)
Warrant satisfied--reinstatement effective with date the warrant was satisfied; and
Individual incorrectly identified in EVS match--benefits resumed effective with the suspension date.
If you are issuing a reinstatement notice, this paragraph is placed under the Caption – Information About [Your] Benefits (DPS caption BENC08). If you are using paragraph FUG502 for a payment resumption notice or a good cause denial notice, this paragraph is used under the Caption – Our Decision (DIBC03). See the examples illustrating the FUG502 paragraph in NL 00755.320B.1.d. for good cause approvals and NL 00755.330C.2. for good cause denials.
2. FUG 502-- Fugitive Felon Reinstatement/Resumption/Good Cause Approval/Denial Paragraph
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|---|---|
|
FUG502 |
Based on the information __(*F1)__, we __(*F2)__ __(*F3)__ __(*F4)__ __(*F5)__ __(*F6)__ __(*F7)__ because _(*F8)_ __(*F9)__ Fill-Ins: *F1-1 Pronoun (we have/you have provided us) *F6-2 through *F6-1 null *F7-1 MM/CCYY *F7-2 null *F8-1-Pronoun (you were/he was/she was)(your/his/her) (you have/he has/she has) (you are)/he is/she is) (you do not have/he does no have/she does not have) *F8-2- null *F9-1 Pronoun(your/his/her) warrant was issued incorrectly because of an identity issue *F9-2 Pronoun (you were/he was/she was)found not guilty of the criminal offense *F9-3 Pronoun (your/his/her) criminal charges were dismissed *F9-4 Pronoun (your/his/her) warrant was withdrawn *F9-5 Pronoun (your/his/her) criminal charges were otherwise cleared *F9-6 law enforcement is not taking action on the warrant *F9 7 Pronoun (you do have/he does have/she does have) a mental condition impairing the capability to resolve the warrant *F9-8 Pronoun (you do have/he does have/she does have) a representative payee *F9 9 Pronoun (you are/he is/she is) residing in a long-term care facility *F9 10 Pronoun (you have/she has/she has) satisfied the warrant *F9 11 Pronoun (your/his/her) warrant was issued correctly *F9 12 Pronoun (you were/he was/she was) found guilty of the criminal offense *F9 13 Pronoun (your/his/her) criminal charges were not dismissed *F9 14 Pronoun (your/his/her) warrant was not withdrawn *F9 15 Pronoun (your/his/her) criminal charges were not otherwise cleared *F9 16 (null) law enforcement is taking action on the warrant *F9 17 Pronoun (you do not have/he does not have/she does not have) a mental condition impairing the capability to resolve the warrant *F9 18 Pronoun (you do not have/he does not have/she does not have) a representative payee |
|
*F9 19 Pronoun (you are/he is/she is) not residing in a long-term care facility *F9 20 Pronoun (you were/he was/she was) incorrectly identified in connection with this warrant. |
3. Good Cause Denial Paragraph (Other)
|
UTI # on DPS or AURORA |
Language for Paragraph or Caption |
|
DPS FUG050 |
NOTE: This revised version of this paragraph is currently only available for use in DPS. We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4 *F5. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) *F4–3 violent or drug-related felony crime and based on this reason we cannot grant you good cause for not satisfying the outstanding warrant. *F4-4 violent or drug related probation or parole violation or the original offense upon which the probation or parole violation was based was violent or drug-related and based on one or both of these reasons we cannot grant you good cause for not satisfying the outstanding warrant. *F5-1 null *F5-2 and we cannot grant you good cause for not satisfying the outstanding warrant because there also is another felony crime on which (you have/he has/she has) been convicted or pled guilty. *F5-3 and (you did not/he did not/she did not) provide evidence to SSA to establish good cause for not satisfying your outstanding warrant. |
|
AURORA FUG050 |
CAUTION: PSC staff should review the instructions found in (NL 00755.330 B.1.a.); (NL 00755.330B.1.b.) and (NL 00755.330D) for the limited use of this good cause denial paragraph. We cannot pay benefits to *F1 beginning *F2 because *F3 an outstanding arrest warrant for a *F4. Fill-Ins: *F1-1 Pronoun (you/Client/Beneficiary Name) |
4. Paragraphs for Resumption from Fugitive Felon/Probation or Parole Violator Erroneous Suspension—Timely Protest to Due Process Period Benefits Incorrectly Suspended
|
UTI # on DPS and AURORA |
Language for Paragraph or Caption |
|
FUG503 |
You asked us to consider (1) request for good cause for not satisfying (2) outstanding arrest warrant. While we review this request, we are sending you the money we withheld for (3). If we find that we cannot grant (4) good cause for not satisfying (5) outstanding arrest warrant, you will have to pay back this money. Fill-Ins: *F1-1 Pronoun (your/Beneficiary Name Possessive) |