NL: Notices, Letters and Paragraphs
TN 4 (02-95)
A. Procedure
The following chart lists the captions and paragraphs to consider when you complete the body of the notice.
NOTE: We labeled the captions with capital letters in alphabetic order as a place-keeping device due to the length of the chart.
Apply the instructions in NL 00802.001B when using this chart.
B. Your payments will be changed as follows
(Mandatory for all SSA-L8155-U2's.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.115 | 2019 | Tells recipient SSI check will stop or be reduced - Mandatory paragraph for caption. |
C. Our decision about how we'll pay you
(Use this caption and the following paragraphs only if the notice addresses a representative payee issue.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.185 | 1291 | Notices to recipient and representative payee -SSI payments will go to a representative payee. |
2290 | Notice to recipient - Direct payment to recipient. | |
2292 | Notice to representative payee - New payee selected or direct payment to recipient. | |
2301 | Reporting responsibilities for new representative payee. | |
2302 | Notice to new representative payee - Use of SSI payments. | |
2294 | No SSI payments due now. | |
NL 00804.200 | 2600 | Drug addiction/alcoholism contributes to recipient's disability- Treatment and representative payee requirements. |
2602 | Recipient continues to need representative payee. |
D. Why your payments changed
(Mandatory caption for all three notices.)
NL Reference | Paragraph | Use |
---|---|---|
WITHDRAWAL OR TERMINATION - Use the following paragraphs on the SSA-L8155-U2 to notify a recipient about his/her request for withdrawal or termination of SSI payments: | ||
NL 00804.215 | 2470 | N19 - Request for termination approved. |
1503 | Provides 60-day notice to recipient to change decision about withdrawal or termination. Use with paragraph 2470 above. | |
2471 | Recipient received SSI payments for termination (N19) month-request for refund. SUSPENSION ACTIONS - Use the following paragraphs to notify a recipient about a suspension action: | |
NL 00804.175 | 2523 | N01 - Suspension due to excess income. |
NL 00804.165 | 2200 | N02 suspension - Recipient is resident of a public institution. |
NL 00804.170 | 2216 | N03 suspension - Recipient is outside the U.S. |
2219 | N13 suspension - Recipient not a U.S. citizen, resident or eligible alien. | |
NL 00804.180 | 1272 1274 |
N04 - Suspension due to excess resources. Use both paragraphs if the recipient does not have a conditional payment agreement. |
2285 | N04 suspension - Sponsor-to-alien deeming involved. | |
NL 00804.130 | 2082 | N06 suspension - Failure to file for other benefits. |
NL 00804.200 | 2603 | N10/N11 suspension - Recipient not receiving required treatment for drug addiction/alcoholism. |
NL 00804.140 | 2118 | N14 suspension - Recipient not age 65 or older. |
NL 00804.135 | 2100 | N20 suspension - Recipient failed to furnish a required report or evidence. |
NL 00804.190 | 2325 | N52/N53 - Deleted from State rolls for December 1973. |
NL 00804.240 | 2527 | S07 suspension - Recipient's SSI check returned for miscellaneous reasons. |
NL 00804.185 | 2291 | S08 suspension - Representative payee development pending. |
2300 | S08 suspension - Recipient newly determined to be a drug addict or alcoholic and payee development is pending. REINSTATEMENTS - Use these paragraphs to notify a recipient after a period of suspension that payments will resume: |
|
NL 00804.170 | 2217 | N03 to C01 - Recipient resumes residence in U.S. |
NL 00804.180 | 2284 | N04 to C01 - Recipient within resource limits. |
2286 | N04 to C01 - Sponsor-to-alien deeming involved. | |
NL 00804.130 | 2080 | N06 to C01 - Recipient has taken steps to file for other benefits. |
NL 00804.200 | 2617 | N09 to C01 - Recipient willing to cooperate with vocational rehabilitation agency. |
2618 | N10/N11 to C01 - Recipient receiving required treatment for drug addiction/alcoholism. | |
NL 00804.135 | 2101 | N20 to C01 - Recipient provided required report or evidence. OPTIONAL STATE SUPPLEMENT (OSS) - Consider the following paragraphs if an OSS is an issue: |
NL 00804.190 | 2338 | Recipient is not eligible for an OSS payment. |
2333 | Recipient waived OSS payments. | |
2310 | Recipient moves from State that pays OSS to another OSS State. | |
2311 | Tells recipient effective date of new OSS payments. | |
2312 | Tells recipient effective date former State of residence stops paying OSS. | |
2317 | Tells recipient about change in OSS amount due to State rate change. MULTICATEGORY ELIGIBILITY (SI 00501.300) - Consider the following paragraphs when multicategory eligibility is an issue: |
|
NL 00804.195 | 2638 | Aged recipient also eligible on basis of disability and/or blindness. |
2347 | Multicategory eligibility results in increase in OSS payments. | |
2351 | Multicategory eligibility for spouse results in SSI increase. | |
2346 | Recipient or spouse loses eligibility in one or more categories resulting in reduced SSI payment. | |
2640 | Sponsor-to-alien deeming no longer applies - Recipient's date of onset is after date of admission to U.S. for permanent residence. MISCELLANEOUS - The following paragraphs cover a variety of topics: | |
NL 00804.155 | 2161 | Living arrangement change - Household of another to own household. |
NL 00804.225 | 2371 | Appeal pending - Interim change results in change in amount of SSI. |
NL 00804.160 | 2180 | Spouse becomes eligible for SSI - Payment decrease for other member of couple. |
2181 | Spouse's presumptive disability/blindness payments stop - Refigured payment for other member of couple results in increase. | |
NL 00804.240 | 2534 | Death of eligible spouse, deemor, or sponsor. |
E. Information about your payments
(Consider this caption if the notice will include check payment information or if an overpayment, Goldberg-Kelly, or an interim assistance reimbursement (IAR) issue exists.)
NL Reference | Paragraph | Use |
---|---|---|
CHECK PAYMENT INFORMATION - Consider the following paragraphs if the notice will have check payment information: | ||
NL 00804.115 | 1012 | Notifies recipient about the retroactive check. |
1479 | Tells the retroactive check delivery date. | |
2509 | Tells recipient balance due after check adjustment is for a past period. | |
2510 | Tells recipient no additional payment is due for a past period. | |
2524 | Gives check delivery information for the regular monthly check. | |
2511 | Explains underpayment is being withheld to recover an overpayment - states balance of underpayment due to the recipient. | |
NL 00804.120 | 2043 | Explains that advance payments were recovered. Specifies the ongoing amount due. |
2040 | Explains that advance payments were made and no additional payments are due now. | |
NL 00804.235 | 1014 | Explains that proration applies and tells recipient the first day of eligibility. |
NL 00804.240 | 2525 | Retroactive change does not affect current payments. |
NL 00804.210 | 2520 | First-of-month payment paid in two checks. OVERPAYMENT - Consider the following paragraphs if there is an overpayment issue: |
NL 00804.210 | 2526 | U1 or U2 diary - Notifies recipient about possible underpayment. |
2444 | Last month of overpayment collection - Regular monthly checks will resume. | |
2434 | Overpayment recovery complete - Regular monthly checks will resume. | |
2437 | Overpayment partially recovered from underpayment - Regular monthly check also reduced. | |
1015 1016 |
Overpayment recovery will begin. 10 percent overpayment recovery rate - Ongoing checks due. | |
1017 | 10 percent overpayment recovery rate results in withholding of entire check. | |
1018 | Amount of check changes and 10 percent recovery changes. | |
2042 | Overpayment recovery in progress - Subsequent reduction in SSI payments results in withholding of entire SSI payment. | |
2450 | SSI payment change while overpayment recovery is in process. | |
2455 | Living arrangement of overpaid recipient changes to “D” - Overpayment withholding postponed. GOLDBERG-KELLY - Consider the following paragraphs if there is a Goldberg-Kelly issue: |
|
NL 00804.225 | 2021 | Next month's check not reduced to allow time to appeal. Use only on the SSA-L8155-U2 after the Goldberg-Kelly cutoff, when appropriate. |
2022 | Similar to paragraph 2021 above - Overpayment involvement. | |
2370 | Payment continuation pending appeal decision. | |
2381 | Payment stopped - Payment resumed pending outcome of appeal. | |
2372 | Change in payment amount not implemented - Appeal pending. | |
2375 | Appeal pending - Recipient may have to repay incorrect payments. | |
2373 | New determination differs from issue under appeal - Change in SSI payment results. | |
GBKM01 | Appeal pending - Recipient requests payment maintenance - OTP or supplemental payment made. INTERIM ASSISTANCE REIMBURSEMENT (IAR) - Consider the following paragraphs if there is an IAR issue: |
|
NL 00804.125 | 1046 | Check sent to IAR agency per agreement. |
1069 | Balance of SSI payments that are not IAR excluded from resources for 6 months. |
F. Information about medicaid
(Use this caption before the next caption, “Your SSI Is Based On These Facts,” only when a 1619(b) participant loses 1619(b) status due to excess income other than earned income.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.250 | 2053 | 1619(b) participant will lose Medicaid based on SSI due to loss of 1619(b) status due to computer matching income (Mandatory paragraph) |
2054 | State Medicaid office will make final Medicaid decision - Always use this paragraph under paragraph 2053 above. |
G. Your (payment/SSI) is based on these facts
(Use this caption when one or more of the paragraphs below is appropriate for explaining the reason for the payment change. When reinstating payments, use all the paragraphs that address facts that affect the payment computation. When the individual is a 1619(b) participant replace “Payment” with “SSI.” )
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.215 | 2473 | Recipient revoked request to terminate SSI payments. |
NL 00804.145 | 1130 | Correction in category of eligibility. |
NL 00804.200 | 2641 | Tells date of onset. |
NL 00804.160 | 1161 | Change in spouse's eligibility causes SSI payment to increase or stay the same. |
NL 00804.135 | PMTM01 | Past period of N05 - Unable of confirm eligibility for past nonpay month(s). |
NL 00804.170 | 2218 | N13 to C01 - Tells effective date for “color of law” determination. |
NL 00804.155 | 1165 | Statement - living arrangement “C” or “D.” |
2162 | Living arrangement change from “C” or “D” to “A.” | |
DCMM06 | A child can no longer receive SSI based on section 1614(f)(2) of the Act. Explains why he is ineligible. | |
NL 00804.165 | 2201 | N02 to C01 - Recipient leaves public institution. |
NL 00804.190 | 1312 | Change in recipient's county or State of residence causes payment change. |
1163 1164 |
Living arrangement for purpose of optional State supplement. Choose the appropriate paragraph. INCOME - The following paragraphs address income related issues: |
|
NL 00804.175 | 1240 | Recipient has no income or deemed income. |
1601 | Change in recipient's or deemor's income does not affect SSI payments. | |
1280 1281 1282 |
Choose the appropriate paragraph when windfall offset applies. | |
1231 | Lead-in preceding list of monthly income in paragraph 1232 below. | |
1232 | Describes type, period and amount of countable income. | |
1253 | Recipient received one-time income payment other than SSI. Also use paragraph 1261 (NL 00804.175) if one-time payment will result in N01 suspension for a future month. | |
1258 | Recipient subject to value of the one- third reduction (VTR). | |
1260 | Recipient receives in-kind support and maintenance. | |
1603 | Recipient had net loss from self- employment. | |
1257 | Special income disregards apply. | |
1602 | Student earned income exclusion applies. DEEMING - Consider the following paragraphs if the claimant is subject to deeming: |
|
1248 | Describes type, period and amount of income deemed from spouse or parent(s). | |
1234 | Spouse, parent(s) or sponsor(s) have income deemed to recipient. | |
1254 | Spouse or parent(s) has one-time income payment other than SSI. | |
2230 | Spouse or parent(s) no longer receives public assistance - Deemed income results. | |
1249 | Spouse or parent(s) receive public assistance - No deemed income. | |
1604 | Spouse or parent(s) has net loss from self-employment. COMPUTER MATCHING - Consider the following paragraphs if computer matching is an issue: |
|
NL 00804.250 | 2050 | Tells recipient about payment reduction and to check computer matching data within 30 days. Use on the SSA-L8155-U2 only. |
2051 | Tells recipient about payment increase and to check computer matching data within 30 days. Use only on the SSA-L8151-U2. | |
2052 | Payment due increases in the current calendar month of the interface or the supplemental month - FO must issue the additional amount due. GRANDFATHERED RECIPIENTS - The following paragraphs address changes that only apply to recipients grandfathered into the SSI program in December 1973. Choose any appropriate paragraphs as follow: |
|
NL 00804.190 | 2326, 2327, 2328, 2329, 2330, 2318, 2335, 2336 and 2337. |
H. Information about your back payments
(Mandatory caption when paragraph 1497 below applies.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.180 | 1497 | Mandatory paragraph when recipient will receive a retroactive SSI check and there is no IAR involvement, or will receive a retroactive title II check. |
I. Our decision on your waiver request
(Use only when paragraph 2439 below applies.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.210 | 2439 | Waiver request approval. (Mandatory paragraph for this caption.) |
J. About your request for direct deposit
(Use only when direct deposit is an issue.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.230 | 2772 | Recipient requests direct deposit. |
2773 | Recipient cancels direct deposit. | |
2774 | Recipient changes direct deposit. Consider the following paragraphs if the recipient's payments are or will be in suspense: 2766, 2767, 2768, 2769, 2770, and 2771. |
K. Information about medicaid and other benefits
(Use “AND OTHER BENEFITS” only if paragraph 1311 below will follow. Use this caption only if a change has occurred that may affect Medicaid eligibility.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.190 | 1311 | Recipient moves to a State that administers its own supplementation program. |
NL 00804.110 | 1150 | Recipient moves to a State (or the District of Columbia) for which SSA makes Medicaid determinations. |
1156 | We are developing for recipient's eligibility under section 1619(b). | |
1152 or 1170 |
Recipient resides in or moves to a State where SSA makes Medicaid determinations. Use on the SSA-L8155-U2 when you suspend or terminate SSI payments. Use 1170 instead of 1152 if the recipient resides in Texas. | |
1154 | Change in State of residence - New State of residence makes its own Medicaid determinations. | |
1146 | Recipient did not provide third-party liability (TPL) information. | |
1149 | Recipient did not assign rights to medical support payments to the State. | |
1143 | Notifies title II early widow(er) beneficiaries of possible special Medicaid eligibility. Use this paragraph only on the SSA-L8155-U2. Remember to include the caption labeled K. below and the mandatory paragraph under caption K. when you use this paragraph. | |
1197 | SSI checks have stopped - Recipient may qualify for Medicaid under section 1619(b). | |
1198 | Similar to paragraph 1197 except that State makes Medicaid eligibility determination. | |
1199 | Recipient not eligible for Medicaid based on SSI rules under section 1619(b). (Does not meet use and/or insufficiency tests.) | |
NL 00804.155 | DCMM07 | A child is ineligible for SSI because he does not meet the requirements of section 1614(f)(2) of the Act. Tells which State agency can tell him about Medicaid eligibility. |
L. Where you can apply for medicaid
(Use only on an SSA-L8155-U2 when you use paragraph 1143 under the preceding caption.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.110 | 1144 | Notifies title II early widow(er) beneficiaries ineligible for SSI because of their title II income (N01) where to apply for special Medicaid coverage. (Mandatory paragraph for this caption.) |
M. Please remember this
(Mandatory caption on SSA-L8155-U2 when a disabled/blind recipient is N01 due to earnings and eligibility under section 1619(b) is an issue or the recipient is ineligible under section 1619(b) because of the use and/or insufficiency of earnings test.)
NL Reference | Paragraph | Use |
---|---|---|
The following paragraphs are mandatory when 1619(b) eligibility is an issue. | ||
NL 00804.110 | 1157 | Lead-in for reporting responsibilities when recipient is potentially eligible for Medicaid under section 1619(b). |
1191 1192 1193 |
Reporting responsibilities - use all three paragraphs. Use the following when the recipient is ineligible under section 1619(b). |
|
1195 | Reminder - Recipient should report change(s) by deadline to avoid filing new application. | |
NL 00804.250 | 2055 | Similar to paragraph 1195 above - Use when computer matching causes 1619(b) participant to lose eligibility. |
N. we will review your case
(Use only for section 1619(b) eligibles when paragraph 1190 below applies.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.110 | 1190 | Information for section 1619(b) eligibles about continuing disability reviews. (Mandatory paragraph for this caption.) |
O. Things to remember
(Mandatory caption for all three notices.)
NL Reference | Paragraph | Use |
---|---|---|
NL 00804.240 | 2453 | Standard reporting responsibilities. (Mandatory paragraph for recipients in current pay.) |
1620 | Advises eligible recipient to report changes even though no SSI payments are due now. (Mandatory paragraph when you suspend a recipient's payments.) | |
1487 | Concurrent case - Decision applies only to title XVI. | |
2750 | Determination replaces all previous determinations for period. | |
2507 | Tells recipient to contact SSA if payment still due or if he/she believes she/he can qualify for SSI again. | |
2508 | Similar to paragraph 2507 above - Retroactive payments not an issue. | |
1481 | SSI terminated - Recipient must file new application to qualify. | |
NL 00804.220 | 2834 | Value of the one-third reduction (VTR) applies - Instructs recipient to contact SSA if he/she begins to share. |
NL 00804.195 | 2352 | Aged recipient or aged spouse loses eligibility based on disability or blindness, but SSI eligibility continues for both. |
NL 00804.210 | 1438 | Recipient may be overpaid. |
NL 00804.190 | 2331 | State countable income (Vermont) changed. Recipient is not currently a resident of Vermont and was not a resident during the period covered by the income change. |
NL 00804.200 | 1619 | Treatment requirement - DDS determined drug addiction/ alcoholism now contributes to disability. |
NL 00804.180 | 1270 | Payment continuation based on agreement to dispose of excess resources. |
NL 00804.185 | 2489 | Representative payee will receive a copy of notice. |