NL 00720: Manual Adjustment, Credit and Award Process (MADCAP) Beneficiary Notice Print Program
BASIC (05-11)
PEN001 PENALTY DEDUCTED FROM BENEFITS DOMESTIC CASES (W23)
(Requested)
Caption: A Penalty Will Be Deducted From Payments
We are writing to you about a (1) penalty that will be held back from (2) benefits. We told you earlier that this penalty would be held back because you did not report (3) (4) earnings to us before April 15, (5) and did not give us a good reason for being late.
Fill-in values:
Fill-in (1) - Systems Generated
Amount
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name
Fill-in (3) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: Beneficiary's Name possessive
Fill-in (4) - Systems Generated
CCYY
Fill-in (5) - Systems Generated
CCYY
PEN016 HEALTH PLAN PREMIUM AMOUNT INCLUDES A PENALTY (H28)
(System Generated)
Caption: Information About Health Plan Premiums
This amount includes a penalty for (1) Medicare Prescription Drug Plan Premium.
Fill-in values:
Choice 1: your
Choice 2: his
Choice 3: her
PEN024 PENALTY DEDUCTED FROM BENEFITS FOREIGN CASES (W24)
(Requested)
Caption: A Penalty Will Be Deducted From Payments
We are withholding (1) from (2) monthly benefits. This is a penalty because (3) did not give us (4) report of work on time.
Fill-in values:
Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
Amount of penalty
Fill-in (2) Systems Generated
Choice 1: your
Choice 2: Beneficiary's name possessive
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
PEN025 PENALTY PROPOSED/GOOD REASON REQUESTED DOMESTIC CASES (W25)
(Requested)
Caption: A Penalty Will Be Deducted From Payments
(1) to let us know how much money (2) each year. To do this, (3) must give us a report of each year's earnings within 3 ½ months after the end of the taxable year. Since (4) did not do this for (5) , we will withhold (6) more from (7) benefits as a penalty. We will do this unless (8) can show that (9) had a good reason for not giving us the report on time.
If (10) (11) had a good reason for not reporting your earnings before (12) , please let us know within 30 days of the date of this letter. If (13) had a good reason for not reporting, we will not withhold the additional money. Otherwise, we will send (14) another letter to tell (15) when we will start withholding the money.
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You need
Choice 2: Beneficiary's name needs
Fill-in (2) Systems Generated
Choice 1: you earn
Choice 2: he earns
Choice 3: she earns
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) Requested as a date shown below
Year CCYY
Fill-in (6) Requested as Money amount in format $$$$$.¢¢
Amount
Fill-in (7) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (9) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (10) Systems Generated
Choice 1: you think
Choice 2: Beneficiary's name thinks
Fill-in (11) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (12)
MM/DD/CCYY
Fill-in (13) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (14) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (15) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
PEN026 PENALTY PROPOSED/GOOD REASON REQUESTED FOREIGN CASES (W26)
(Requested)
Caption: A Penalty Will Be Deducted From Payments
(1) to let us know when (2) more than 45 hours in a month. (3) must let us know about this work before (4) (5) third Social Security check after returning to work. Since (6) did not do this, we will withhold (7) more from (8) benefits as a penalty. We will do this unless (9) can show that (10) had a good reason for not giving us the report on time.
If (11) (12) had a good reason for not reporting (13) work on time, please let us know within 30 days of the date of this letter. If (14) had a good reason for not reporting, we will not withhold the additional money. Otherwise, we will send (15) another letter to tell (16) when we will start withholding the money.
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You need
Choice 2: Beneficiary's name needs
Fill-in (2) Systems Generated
Choice 1: you work
Choice 2: he works
Choice 3: she works
Fill-in (3) Systems Generated
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (4) Systems Generated
Choice 1: you receive
Choice 2: he receives
Choice 3: she receives
Fill-in (5) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (6) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (7) Requested as Money amount in format $$$$$.¢¢
Amount of penalty
Fill-in (8) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (9) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (10) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (11) Systems Generated
Choice 1: you think
Choice 2: Beneficiary's name thinks
Fill-in (12) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (13) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (14) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (15) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (16) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
PEN027 PENALTY TO BE DEDUCTED FROM FUTURE BENEFITS DOMESTIC CASES (W27)
(Requested)
Caption: A Penalty Will Be Deducted From Payments
When we start to pay (1) again, we will withhold (2) more from (3) benefits as a penalty because (4) did not let us know how much (5) earned in (6) within 3 ½ months after the end of the taxable year.
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) Requested as Money amount in format $$$$$.¢¢
Amount of penalty
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) Request As A Date in Format Shown Below
CCYY format
PEN028 PENALTY TO BE DEDUCTED FROM FUTURE BENEFITS FOREIGN CASES (W28)
(Requested)
Caption: A Penalty Will Be Deducted From Payments
When we start to pay (1) again, we will withhold (2) more from (3) benefits as a penalty. This is because (4) did not let us know that (5) started working before (6) received (7) third Social Security check after beginning to work.
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) Requested as Money amount in format $$$$$.¢¢
Amount of penalty
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: he
Choice 3: she
Fill-in (6) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (7) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
PEN029 REASON FOR NOT REPORTING ACCEPTED DOMESTIC CASES (SEE W34 FOR FOREIGN) (W30)
(Requested)
Caption: Your Benefits
We will not withhold a penalty from (1) benefits because (2) had a good reason for not telling us on time how much (3) earned in (4) .
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
Choice 2: he
Choice 3: she
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) Requested As A Date in Format Shown Below
CCYY
PEN030 REASON FOR NOT REPORTING ACCEPTED FOREIGN CASES (SEE W30 FOR DOMESTIC CASES) (W34)
(Requested)
Caption: Your Benefits
We will not withhold a penalty from (1) benefits because (2) had a good reason for not telling us on time that (3) began working.
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
Choice 2: he
Choice 3: she
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she