NL 00720: Manual Adjustment, Credit and Award Process (MADCAP) Beneficiary Notice Print Program
BASIC (05-11)
WIB – Widow(er)'s Insurance Benefits
WIB001 ARF AND/OR DRC NOT PROPERLY APPLIED (A53)
(Requested)
Caption: Your Benefits
We reviewed our records and found that we owe (1) money. This is because we had not given (2) credit for months in which (3) continued to work and did not receive benefits. We will send (4) a back payment for past months and will increase (5) monthly benefit amount.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
WIB002 ARF/AND OR DRC NOT PROPERLY APPLIED — BENEFICIARY IN NON-PAY STATUS (A54)
(Requested)
Caption: Your Benefits
We reviewed our records and found that we owe (1) money. This is because we had not given (2) credit for months in which (3) continued to work and did not receive benefits. We will send (4) a back payment for past months.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (3) - Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) - Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her