NL 00804: Manual Paragraphs for Use in SSI Initial Claims, Posteligibility and Overpayment Notices
TN 25 (02-95)
This section contains examples of notices for specific situations. In some samples, specific language is highlighted to show how it may be used in a notice. However, since there are many variables in SSI notices, e.g., representative payees, eligibility factors, etc., do not send the notices represented here to the public. Instead, use NL 00802 and
NL 00803 for additional paragraphs tailored to the specific situation for which you are sending the notice.
| Notice Number | Form | Highlighted Paragraph | Situation |
|---|---|---|---|
1 |
SSA-L8155-U2 |
SUSM50 |
We are suspending the following month's benefit by imputing N20 (failure to cooperate) during the Goldberg/Kelly temporary period. NOTE: We do not use the payment chart (paragraph 2016) when the only change the notice addresses is N20 for the current computation month (CCM). |
2 |
SSA-L8166-U2 |
PENM50 |
Penalty Notice—We are withholding a penalty ($25) for the first time. |
3 |
SSA-L8151-U2 |
PMTM01 |
N05 Unconfirmed Eligibility—Use of N05 for past nonpay months in reinstatement case. |
4 |
SSA-L8165-U2 |
GBKM06 |
Correcting Multiple Payments (including payments over the payment ceiling. |
5 |
SSA-L8165-U2 |
GBKM07 |
Correcting Payments Over the Payment Ceiling |
6 |
SSA-L8151-U2 |
COLM50 |
Correct Increased PPL During an |
7 |
SSA-L8155-U2 |
COLM50 |
Correct Reduced PPL During an |
Sample Notice #1 - SSA-L8155-U2, Notice of Planned Action
Sample Notice #1 - SSA-L8155-U2, Notice of Planned Action
Sample Notice #1 - SSA-L8155-U2, Notice of Planned Action
Sample Notice #2 - SSA-L8166-U2, Notice of Important Information
Sample Notice #2 - SSA-L8166-U2, Notice of Important Information
Sample Notice #2 - SSA-L8166-U2, Notice of Important Information
Sample Notice #3 - SSA-L8151-U2, Notice of Change in Payment
Sample Notice #3 - SSA-L8151-U2, Notice of Change in Payment
Sample Notice #3 - SSA-L8151-U2, Notice of Change in Payment
Sample Notice #4 - SSA-L8165-U2, Notice of Important Information
Sample Notice #4 - SSA-L8165-U2, Notice of Important Information
Sample Notice #4 - SSA-L8165-U2, Notice of Important Information
Sample Notice #4 - SSA-L8165-U2, Notice of Important Information
Sample Notice #5 - SSA-L8165-U2, Notice of Important Information
Sample Notice #5 - SSA-L8165-U2, Notice of Important Information
Sample Notice #5 - SSA-L8165-U2, Notice of Important Information
Sample Notice #6 - SSA-L8151-U2, Notice of Change in Payment
Sample Notice #6 - SSA-L8151-U2, Notice of Change in Payment
Sample Notice #7 - SSA-L8155-U2, Notice of Planned Action
Sample Notice #7 - SSA-L8155-U2, Notice of Planned Action
Sample Notice #7 - SSA-L8155-U2, Notice of Planned Action
