TN 31 (04-94)

A. Procedure

1. When to Issue a Notice

Issue a manual notice only in cases where:

• receipt of a victims' compensation payment or State or local relocation assistance payment is established and developed per SI 01130.665 or SI 01130.670, respectively; and

• there is at least 1 month remaining in the exclusion period.

2. How to Issue a Notice

1. Issue the manual notice on a Form SSA-L8166-U2.

2. See NL 00801.010 E. on sending manual notices and NL 00804.100 ff. for the appropriate standard notice paragraphs.

3. Include the appropriate language in B. below.

   NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

B. Exhibit - insert paragraph for manual notices

  1   received   2   of   3   in   4   . We will not count this money toward   5   resource limit for 9 months after   6   . On   7   , we will then count any money that is left over as part of   8   resources. But things   9   with the money may count as resources the month after    10   . You can ask us which things count as resources.   11   cannot get SSI if the resources we count are worth over   12   .

Fill-ins

1. Choice 1: You

   Choice 2: She

   Choice 3: He

   Choice 4: Your spouse

   Choice 5: Her spouse

   Choice 6: His spouse

   Choice 7: You and your spouse

   Choice 8: She and her spouse

   Choice 9: He and his spouse

   Choice 10: Your parent

   Choice 11: Her parent

   Choice 12: His parent

   Choice 13: You and your parent

   Choice 14: She and her parent

   Choice 15: He and his parent

   Choice 16: Your parents

   Choice 17: Her parents

   Choice 18: His parents

   Choice 19: You and your parents

   Choice 20: She and her parents

   Choice 21: He and his parents

    

2. Money amount

    

3. Choice 1: State/local relocation assistance (use “State” and/or “local”, as applicable)

   Choice 2: victims' compensation payment(s)

    

4. Month/Year

    

5. Choice 1: your

   Choice 2: her

   Choice 3: his

    

6. Choice 1: you receive it

   Choice 2: she receives it

   Choice 3: he receives it

   Choice 4: you received it

   Choice 5: she received it

   Choice 6: he received it

   Choice 7: they receive it

   Choice 8: they received it

   Choice 9: it is received

   Choice 10: it was received

    

7. Month/Day/Year

    

8. Choice 1: your

   Choice 2: her

   Choice 3: his

    

9. Choice 1: you buy

   Choice 2: bought

    

10. Choice 1: you buy them

    Choice 2: they are bought

     

11. Choice 1: You

    Choice 2: She

    Choice 3: He

     

12. Choice 1: $2,000

    Choice 2: $3,000