NL 00720: Manual Adjustment, Credit and Award Process (MADCAP) Beneficiary Notice Print Program
BASIC (05-11)
AMN008 SSI OFFSET APPLIED (A58)
(Requested)
Caption: Your Benefits
In an earlier letter, we told you we were withholding (1) Social Security benefits for (2) . We did this because we thought we might have to reduce (3) Social Security benefits if (4) also received Supplemental Security Income (SSI) money for this period.
Now we are writing to let you know that we cannot pay (5) (6) of the Social Security benefits we withheld. This is because (7) received SSI money for (8) .
When you receive SSI money for a month, and later you receive Social Security benefits, we sometimes have to reduce your Social Security benefits. We do this to make sure that your total SSI and Social Security monthly payment is not more than it would have been if the Social Security benefits had been paid on time.
Allowing for (9) Social Security benefits, we should have paid (10) (11) less in SSI money. Because of this, we are reducing (12) Social Security benefits by (13) . (14)
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2) Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (6) Requested As A One Position Alpha Character
Choice 1 (A): any
Choice 2 (B): all
Fill-in (7) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (8) Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (9) Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (10) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (11) Request As A Money Amount in Format $$$$$.¢¢
Amount of SSI payments
Fill-in (12) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (13) Request As A Money Amount in Format $$$$$.¢¢
Amount of the reduction
Fill-in (14) - Requested As A One Position Alpha Character
Choice 1 (A): In your next check, we will pay you the amount due for this period.
Choice 2 (B): We cannot pay you any back benefits.
Choice 3 (C): null
AMN009 ADDITIONAL BENEFITS SUBJECT TO SSI OFFSET (A60)
(Requested)
Caption: Your Benefits
Additional benefits for (1) have been (2) because (3) received Supplemental Security Income checks for this period.
Fill-in values:
Fill-in (1) Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (2) Requested As A One Position Alpha Character
Choice 1 (A): withheld
Choice 2 (B): reduced
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name