NL 00720: Manual Adjustment, Credit and Award Process (MADCAP) Beneficiary Notice Print Program
BASIC (05-11)
LVY022 IRS TAX LEVY AMOUNT THAT WILL BE WITHHELD FROM A PMA (B02)
(System Generated)
Caption: What We Will Pay
We withheld (1) from (2) benefits due through (3) to pay (4) obligation to IRS.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Money amount
Fill-in (2) - Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: your
Fill-in (3) - Systems Generated
Choice 1: MM/CCYY in format "January 2006"
Fill-in (4) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Choice 4: the
LVY023 IRS. ONGOING CHECK AMOUNT AFTER WITHHOLDING FROM THE PMA OR CMA (B03)
(System Generated)
Caption: What We Will Pay
Thereafter, we will withhold (1) from (2) benefit each month to pay (3) obligation to IRS.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Money amount
Fill-in (2) - Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: his
Choice 3: her
Choice 4: your
Fill-in (3) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Choice 4: the
LVY024 TAX LEVY - NO CHANGE IN THE IRS TAX LEVY AMOUNT (A05)
(System Generated)
Caption: What We Will Pay
We will continue to withhold from (1) benefit each month to pay (2) obligation to IRS.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: your
Fill-in (2) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Choice 4: the
LVY025 TAX LEVY - WITHHOLDING DISCONTINUED (A06)
(System Generated)
Caption: What We Will Pay
We changed (1) payment to (2) beginning (3) because we are no longer withholding benefits to pay (4) obligation to IRS.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: your
Fill-in (2) - Systems Generated
Choice 1: Money amount
Fill-in (3) - Systems Generated
Choice 1: MM/CCYY in format "January 2006"
Fill-in (4) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Choice 4: the
LVY026 TAX LEVY AMOUNT INCREASING (A08)
(System Generated)
Caption: Your Benefits
We changed (1) payment to (2) beginning (3) because we are increasing the amount we are withholding each month to pay (4) obligation to IRS.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: your
Fill-in (2) - Systems Generated
Choice 1: Money amount
Fill-in (3) - Systems Generated
Choice 1: MM/CCYY in format "January 2006"
Fill-in (4) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Choice 4: the
LVY027 IRS TAX LEVY - AMOUNT BEING WITHHELD IS DECREASING (A25)
(System Generated)
Caption: What We Will Pay
We changed (1) payment to (2) beginning (3) because we are reducing the amount we are withholding each month to pay (4) obligation to IRS.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: your
Fill-in (2) - Systems Generated
Choice 1: Money amount
Fill-in (3) - Systems Generated
Choice 1: MM/CCYY in format "January 2006"
Fill-in (4) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Choice 4: the
LVY038 TAX LEVY AMOUNT WITHHELD FROM A CMA (B87)
(System Generated)
Caption: What We Will Pay
We withheld (1) from (2) next scheduled payment which is for (3) to pay (4) obligation to IRS.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: Money amount withheld from CMA payment
Fill-in (2) - Systems Generated
Choice 1: Beneficiary's Name possessive
Choice 2: your
Fill-in (3) - Systems Generated
Choice 1: MM/CCYY
Fill-in (4) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
LVY054 REFUND OF TAX — GENERAL PARAGRAPH FOR USE WHEN REFUND IS DUE FOR REASON OTHER THAN BENEFICIARY ESTABLISHING U.S. CITIZENSHIP OR RESIDENCY, OR RESIDENCY IN TAX TREATY COUNTRY — SSA CAN MAKE PARTIAL REFUND, IRS MUST REFUND BALANCE (A73)
(Requested)
Caption: Your Benefits
We deducted (1) in Federal income tax from (2) Social Security benefits in (3) . Since we should have deducted (4) , (5) due a (6) refund. Part of this amount is for this year and part is for (7) . We can only refund (8) , which is the part for this year. We will send (9) a check for this amount soon. IRS should refund the rest of this money.
If IRS has not refunded the (10) (11) due for (12) , (13) must request a refund from IRS in order to get this money. To request this refund, (14) must file a U.S. tax return and report (15) income. The return should be filed with the Internal Revenue Service Center, Philadelphia, PA 19255.
IRS has advised us that there is a time limit to request a refund. Generally, (16) must request a refund within 3 years after the due date of the tax return for the year we deducted the tax.
Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Amount of tax withheld in $$$$$.¢¢ format
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (3) - Requested As A Date In Format MM/CCYY, OR MM/CCYY AND MM/CCYY, OR MM/CCYY THROUGH MM/CCYY
Choice 1: Month(s)/year(s) tax withheld in “MM/CCYY” or “MM/CCYY through MM/CCYY” format
Fill-in (4) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Amount of tax SSA should have withheld in $$$$$.¢¢ format
Fill-in (5) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (6) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Amount of refund in $$$$$.¢¢ format
Fill-in (7) - Requested As A Date In Format MM/CCYY
Choice 1: Year in “MM/CCYY” format
Fill-in (8) - Systems Generated
Choice 1: Amount SSA can pay in $$$$$.¢¢ format
Fill-in (9) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (10) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Amount IRS can pay in $$$$$.¢¢ format
Fill-in (11) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (12) - Requested As A Year In Format CCYY
Choice 1: Year
Fill-in (13) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (14) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (15) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (16) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
LVY055 REFUND OF TAX FOR REASON OTHER THAN BENEFICIARY ESTABLISHING U.S. CITIZENSHIP OR RESIDENCY, OR RESIDENCY IN TAX TREATY COUNTRY — SSA CAN MAKE REFUND (A75)
(Requested)
Caption: Your Benefits
We deducted (1) in Federal income tax from (2) Social Security benefits in (3) . We should have deducted (4) . For this reason, (5) should receive a (6) refund. We will send (7) a check for this amount soon.
Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Amount of tax withheld in $$$$$.¢¢ format
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (3) - Requested As A Date In Format MM/CCYY, OR MM/CCYY AND MM/CCYY,
OR MM/CCYY THROUGH MM/CCYY
Choice 1: Month(s) when tax was erroneously withheld in “MM/CCYY” or
“MM/CCYY through MM/CCYY” format
Fill-in (4) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Amount we should have withheld in $$$$$.¢¢ format
Fill-in (5) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) - Requested As A Money Amount In Format $$$$$$.¢¢
Choice 1: Amount of refund in $$$$$.¢¢ format
Fill-in (7) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
LVY056 REFUND OF TAX FOR REASON OTHER THAN BENEFICIARY ESTABLISHING U.S. CITIZENSHIP OR RESIDENCY, OR RESIDENCY IN TAX TREATY COUNTRY — SSA CAN MAKE REFUND (A76)
(Requested)
Caption: Your Benefits
We deducted (1) in Federal income tax from (2) Social Security benefits in (3) . Since (4) a (5) (6) , we should not have deducted any tax for this period. (7) due a (8) refund. Part of this refund is for this year and part is for (9) . We can only refund (10) , which is the part that is for this year. We will send (11) a check for this amount soon. IRS should refund the rest of this money.
If IRS has not refunded the (12) (13) due for (14) , (15) must request a refund from IRS in order to get this money. To request this refund, (16) must file a U.S. tax return and report (17) income. The return should be filed with the Internal Revenue Center, Philadelphia, PA 19255.
IRS has advised us that there is a time limit to request a refund. Generally, (18) must request a refund within 3 years after the due date of the tax return for the year we deducted the tax.
Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format Shown Below
Choice 1: Amount of tax withheld in $$$$$.¢¢ format
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (3) - Requested As A Date In Format Shown Below
Choice 1: Month(s)/year(s) tax was erroneously withheld in MM/CCYY or MM/CCYY through MM/CCYY format
Fill-in (4) - Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was
Fill-in (5) - Requested As A One Position Alpha Character
Choice A: U.S. citizen
Choice B: resident of
Fill-in (6) - Requested As A One Position Alpha Character
Choice A: CANADA
Choice B: EGYPT
Choice C: GERMANY
Choice D: INDIA
Choice E: IRELAND
Choice F: ISRAEL
Choice G: ITALY
Choice H: JAPAN
Choice I: ROMANIA
Choice J: SWITZERLAND
Choice K: UNITED KINGDOM
Choice Z: NULL
Fill-in (7) - Systems Generated
Choice 1: You are
Choice 2: He is
Choice 3: She is
Fill-in (8) - Requested As A Money Amount In Format Shown Below
Choice 1: Amount of tax refund in $$$$$.¢¢ format
Fill-in (9) - Requested As A Date In Format Shown Below
Choice 1: Year in “MM/CCYY” format
Fill-in (10) - Requested As A Money Amount In Format Shown Below Choice 1: Amount SSA refunds in $$$$$.¢¢ format
Fill-in (11) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (12) - Requested As A Money Amount In Format Shown Below
Choice 1: Amount IRS should refund in $$$$$.¢¢ format
Fill-in (13) - Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (14) - Requested As A Date In Format Shown Below
Choice 1: Year in “MM/CCYY” format
Fill-in (15) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (16) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (17) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (18) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she