NL 00720: Manual Adjustment, Credit and Award Process (MADCAP) Beneficiary Notice Print Program
BASIC (05-11)
SSI062 SSI OFFSET APPLIED AT THE TIME OF INITIAL TITLE II AWARD (B60)
(Requested)
Caption: Your Benefits
We are reducing (1) Social Security benefits for (2) . This is because we are subtracting the amount of the Supplemental Security Income (SSI) payments which (3) received for this period. We subtracted (4) because your SSI payments would have been that much less if we had paid the Social Security benefits to (5) when they were regularly due.
Fill-in values:
Fill-in (1) System Generated
Choice 1: your
Choice 2: Beneficiary's name possessive
Fill-in (2) Request in date format shown below
Choice 1: MM/CCYY to MM/CCYY
Choice 2: MM/CCYY
Fill-in (3) System Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) Requested as a money amount in $$$$$.¢¢
Amount withheld
Fill-in (5) System Generated
Choice 1: you
Choice 2: him
Choice 3: her
SSI066 AWARD CHECK PARAGRAPH SSI OFFSET (B61)
(Requested)
Caption: What We Will Pay
We are paying (1) beginning (2) .
(3) will receive (4) , which is the money (5) due for (6) .
After that, (7) will receive (8) each month.
Fill-in values:
Fill-in (1) System Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) Requested in date format shown below
MM/CCYY (com + 1)
Fill-in (3) System Generated
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (4) Request as a money amount in $$$$$.¢¢ format
Amount
Fill-in (5) System Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (6) Requested in date format shown below
MM/CCYY (com)
Fill-in (7) System Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (8)Request as a money amount in $$$$$.¢¢ format
Choice 1: Amount
SSI067 CRITICAL SSI OFFSET CASE (B63)
(Requested)
Caption: What We Will Pay
Although we are sending (1) (2) of the money (3) due for the past months, we are withholding your Social Security benefits for (4) . We may have to reduce these benefits if (5) received Supplemental Security Income (SSI) for this period. When we decide whether or not we have to reduce (6) Social Security benefits, we will send (7) another letter. We will pay (8) any benefits (9) due.
Fill-in values:
Fill-in (1) System Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) Request as a money amount in $$$$$.¢¢ format
Amount
Fill-in (3) System Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (4) Requested in date format shown below
Choice 1: MM/CCYY to MM/CCYY
Choice 2: MM CCYY
Fill-in (5) System Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) System Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) System Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (8) System Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (9) System Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is