NL 00720: Manual Adjustment, Credit and Award Process (MADCAP) Beneficiary Notice Print Program
BASIC (05-11)
WFO003 NON-CRITICAL SSI OFFSET CASE (B62)
(Requested)
Caption: What We Will Pay
We are withholding (1) Social Security benefits for (2) (3) (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 will have to reduce (6) Social Security benefits, we will send (7) another letter. We will pay (8) any Social Security benefits (9) due for this period.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (2) - Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) null
Choice 2: (B) and
Choice 3: (C) through
Fill-in (4) - Requested As A Date In Format Shown Below or Alpha Character
Choice 1: MM/CCYY
Choice 2: (A) Null
Fill-in (5) - Systems Generated
Choice 1: he
Choice 2: she
Choice 3: you
Fill-in (6) - Systems Generated
Choice 1: his
Choice 2: her
Choice 3: your
Fill-in (7) - Systems Generated
Choice 1: him
Choice 2: her
Choice 3: you
Fill-in (8) - Systems Generated
Choice 1: him
Choice 2: her
Choice 3: you
Fill-in (9) - Systems Generated
Choice 1: he is
Choice 2: she is
Choice 3: you are