NL 00720: Manual Adjustment, Credit and Award Process (MADCAP) Beneficiary Notice Print Program
BASIC (05-11)
INS001 MEDICAL INSURANCE BENEFICARY (BIC M) - NO HOSPITAL OR FULLY INSURED STATUS (Q03)
(Requested)
Caption: Your Benefits
(1) not worked long enough under Social Security to receive monthly benefits or premium free hospital insurance under Medicare.
Work under Social Security is figured in credits. Please read the enclosed pamphlet, “How You Earn Social Security Credits”, which explains how the credits are earned and how many a person needs to receive benefits.
To qualify for monthly benefits (2) a total of (3) work credits. For hospital insurance, (4) (5) credits. (6) earned (7) credits.
(8) may earn the additional credits (9) by working under Social Security. If (10) the credits, (11) should get in touch with us to apply again.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You have
Choice 2: Beneficiary's Name has
Fill-in (2) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (3) – Requested As A Number
Choice 1: Number of quarters for insured status
Fill-in (4) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (5) – Requested As A Number
Choice 1: Number of quarters for HI coverage
Fill-in (6) - Systems Generated
Choice 1: You have
Choice 2: He has
Choice 3: She has
Fill-in (7) – Requested As A Number
Choice 1: Number of acquired quarters
Fill-in (8) - Systems Generated
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (9) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (10) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
Fill-in (11) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
INS002 CLAIMANT NEITHER FULLY INSURED NOR INSURED FOR HI (Q06)
(Requested)
Caption: Your Benefits
Neither monthly benefits nor premium–free Hospital Insurance benefits are payable at this time because (1) not worked long enough under Social Security. To qualify for monthly benefits, (2) credit for (3) calendar quarters of work. For Hospital Insurance benefits (4) (5) quarters. Our records show that (6) (7) . The enclosed leaflet explains how a person earns Social Security work credits. If (8) the additional quarters, please contact any Social Security office promptly.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you have
Choice 2: Beneficiary's Name has
Fill-in (2) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (3) – Requested As A Number
Choice 1: Number of required quarters for fully insured status
Fill-in (4) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (5) – Requested As A Number
Choice 1: Number of required quarters for HI status
Fill-in (6) - Systems Generated
Choice 1: you now have
Choice 2: he now has
Choice 3: she now has
Fill-in (7) - Requested As A Number
Choice 1: Number of acquired quarters
Fill-in (8) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
INS003 BENE DOES NOT QUALIFY FOR REGULAR OR TRANSITIONAL BENEFITS - NOT ENOUGH QUARTERS (Q10)
(Requested)
Caption: Your Benefits
Benefits are not payable at this time because (1) not worked long enough under Social Security. To qualify for regular monthly benefits, (2) credit for (3) calendar quarters of work or for transitional monthly benefits (4) (5) quarters. Our records show that (6) (7) . The enclosed leaflet explains how a person earns Social Security work credits. If (8) the additional quarters and can furnish proof of (9) age, please contact any Social Security office promptly.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you have
Choice 2: Beneficiary's Name has
Fill-in (2) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (3) – Requested As A Number
Choice 1: Number of required quarters for fully insured status
Fill-in (4) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (5) – Requested As A Number
Choice 1: Number of quarters required for transitionally insured status
Fill-in (6) - Systems Generated
Choice 1: you now have
Choice 2: he now has
Choice 3: she now has
Fill-in (7) – Requested As A Number
Choice 1: Number of acquired quarters
Fill-in (8) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
Fill-in (9) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
INS004 SURVIVOR BENEFITS NOT PAYABLE - DECEASED DID NOT HAVE ENOUGH QUARTERS (Q14)
(Requested)
Caption: Your Benefits
Survivor benefits are not payable on this record because (1) did not work long enough under Social Security. To qualify, (2) needed credit for either a total of (3) calendar quarters of work or at least 6 quarters of work in the 13-quarter period ending with death. Since our records show that (4) has credit for a total of (5) quarters of work and (6) in the 13-quarter period, neither of these requirements is met. The enclosed leaflet explains how a person earns Social Security work credits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your husband
Choice 2: your former husband
Choice 3: your father
Choice 4: your mother
Choice 5: your wife
Fill-in (2) - Systems Generated
Choice 1: he
Choice 2: she
Fill-in (3) – Requested As A Number
Choice 1: Number of quarters for fully insured status
Fill-in (4) - Systems Generated
Choice 1: he
Choice 2: she
Fill-in (5) – Requested As A Number
Choice 1: Number of acquired quarters
Fill-in (6) – Requested As A Number
Choice 1: Number of acquired quarters in 13-quarter period
INS005 BENEFITS NOT PAYABLE - DID NOT WORK LONG ENOUGH UNDER U.S. SOCIAL SECURITY SYSTEM (Q15)
(Requested)
Caption: Your Benefits
Benefits are not payable at this time based on (1) work covered by the United States because (2) not worked long enough under the United States Social Security system. To qualify for benefits, (3) credit for (4) calendar quarters of work. Our records show that under the United States Social Security system (5) (6) .
The enclosed leaflet explains how (7) can earn Social Security work credits. If (8) the additional quarters of work, please contact any Social Security office right away.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2) - Systems Generated
Choice 1: you have
Choice 2: he has
Choice 3: she has
Fill-in (3) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (4) – Requested As A Number
Choice 1: Number of required quarters of coverage
Fill-in (5) - Systems Generated
Choice 1: you now have
Choice 2: he now has
Choice 3: she now has
Fill-in (6) - Requested As A Number
Choice 1: Number of acquired quarters of coverage
Fill-in (7) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (8) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
INS006 NH NOT INSURED FOR MEDICARE (Q18)
(Requested)
Caption: Your Benefits
(1) not eligible for Medicare coverage at this time because (2) not have enough work credits. To qualify, (3) credit for (4) calendar quarters of work. Our records show that (5) (6) . Government employees earn Medicare work credits for their Government employment in the same way Social Security credits are earned for non-Government employment. The enclosed leaflet explains how a person earns Social Security credits. If (7) the additional quarters, please contact any Social Security office promptly.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You are
Choice 2: Beneficiary's Name is
Fill-in (2) - Systems Generated
Choice 1: you do
Choice 2: he does
Choice 3: she does
Fill-in (3) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (4) - Requested As A Number
Choice 1: Required Government employment QCs
Fill-in (5) - Systems Generated
Choice 1: you now have
Choice 2: he now has
Choice 3: she now has
Fill-in 6 - Requested As A Number
Choice 1: Acquired Government employment QCs
Fill-in 7 - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
INS007 BENEFITS NOT PAYABLE - NOT ENOUGH QUARTERS TO BE FULLY OR CURRENTLY INSURED (Q17)
(Requested)
Caption: Your Benefits
Benefits are not payable on this record because (1) did not have enough work under Social Security to be fully or currently insured. To be fully insured, a total of (2) calendar quarters of work are needed. Our records show that this requirement has not been met. To be currently insured, at least 6 calendar quarters of work in the 13-quarter period ending in death are needed. Our records show that (3) has (4) . Since neither of these requirements are met, no benefits are payable. The enclosed leaflet explains how a person earns Social Security work credits.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: NH's name
Fill-in (2) - Requested As A Number
Choice 1: Number of required quarters for fully insured status
Fill-in (3) - Systems Generated
Choice 1: he
Choice 2: she
Fill-in (4) - Requested As A Number
Choice 1: Number of acquired quarters of coverage in the 13-quarter period
INS008 NO BENEFITS PAYABLE - NOT ENOUGH QUARTERS EARNED BASED ON DOB(Q05)
(Requested)
Caption: Your Benefits
Benefits are not payable at this time because (1) not worked long enough under Social Security. Based on the date of birth (2) gave us, (3) credit for (4) calendar quarters of work. Our records show that (5) (6) . The enclosed leaflet explains how a person earns Social Security work credits. If (7) the additional quarters and can furnish proof of (8) age, please contact any Social Security office promptly.
Enclosure: SSA-10072
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you have
Choice 2: Beneficiary's Name +has
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (3) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (4) - Requested As A Number
Choice 1: Number of quarters required for insured status
Fill-in (5) - Systems Generated
Choice 1: you now have
Choice 2: he now has
Choice 3: she now has
Fill-in (6) - Requested As A Number
Choice 1: Number of acquired quarters
Fill-in (7) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
Fill-in (8) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
INS017 SPOUSE OR CHILD CLAIMANT - NH NOT INSURED FOR MEDICARE BASED ON UNPROVEN DATE OF BIRTH (Q22)
Caption: Your Benefits
Requested
(1) not eligible for Medicare coverage at this time because (2) does not have enough work credits. Based on the date of birth given us, (3) needs credit for (4) calendar quarters of work. Our records show that (5) has (6) calendar quarters.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You are
Choice 2: Beneficiary Name plus is
Fill-in (2) - Systems Generated
Choice 1: Number holder name
Fill-in (3) - Systems Generated
Choice 1: he
Choice 2: she
Fill-in (4) - Requested As A Number
Choice 1: Required Government employment QCs
Fill-in (5) - Systems Generated
Choice 1: Number holder name
Fill-in (6) - Requested As A Number
Choice 1: Acquired Government employment QCs
INS018 NO BENEFITS PAYABLE - NOT ENOUGH QUARTERS EARNED (Q02)
(Requested)
Caption: Your Benefits
Benefits are not payable at this time because (1) not worked long enough under Social Security. To qualify, (2) credit for (3) calendar quarters of work. Our records show that (4) (5) . The enclosed leaflet explains how a person earns Social Security work credits. If (6) the additional quarters, please contact any Social Security office promptly.
Enclosure:
SSA-10072
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you have
Choice 2: Beneficiary's Name + has
Fill-in (2) - Systems Generated
Choice 1: you need
Choice 2: he needs
Choice 3: she needs
Fill-in (3) - Requested As A Number
Choice 1: Number of required quarters for fully insured status (zero suppressed)
Fill-in (4) - Systems Generated
Choice 1: you now have
Choice 2: he now has
Choice 3: she now has
Fill-in (5) - Requested As A Number
Choice 1: Number of acquired quarters (zero suppressed)
Fill-in (6) - Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
INS021 AUXILIARY CLAIMANT NOT INSURED ON OWN RECORD (C23)
(Requested)
Caption: Other Social Security Benefits
(1) (2) not worked long enough under Social Security to receive benefits (3) .
Work under Social Security is figured in credits. Please read the enclosed pamphlet, "How You Earn Social Security Credits," which explains how the credits are earned and how many a person needs to receive benefits.
To qualify for benefits, (4) (5) a total of (6) work credits. (7) (8) earned (9) credits, and still (10) (11) (12) more. These figures are based on (13) (14) , (15) .
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: You
Choice 2: number holder's fullname
Fill-in (2) - Systems Generated
Choice 1: have
Choice 2: has
Fill-in (3) - Systems Generated
Choice 1: on your own record
Choice 2: on his own record
Choice 3: on her own record
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: she
Choice 2: he
Fill-in (5) - Systems Generated
Choice 1: need
Choice 2: needs
Fill-in (6) – Requested As A Number
Required QCs
Fill-in (7) - Systems Generated
Choice 1: You
Choice 2: She
Choice 2: He
Fill-in (8) - Systems Generated
Choice 1: has
Choice 2: have
Fill-in (9) - Requested As A Number
earned QCs
Fill-in (10) - Systems Generated
Choice 1: need
Choice 2: needs
Fill-in (11) – Requested As a Number
quarters still needed
Fill-in (12) - Systems Generated
Choice 1: credit
Choice 2: credits
Fill-in (13) - Requested As A One Position Alpha Character
Choice A: the date of birth
Choice B: your
Choice C: Mr plus NH-NAME, possessive
Choice D: Ms plus NH-NAME, possessive
Fill-in (14) - Requested As A One Position Alpha Character
Choice A: NULL
Choice B: corrected date of birth
Choice C: date of birth
Fill-in (15) - Systems Generated
Choice 1: number holder's date of birth