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r-lA'{-06-2005 08: 56
OPBP 0 i I) Pa\:jment
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•
[l I-e] COUNTRY
•
[13-C] SPOUSE (YIN)
Po
,
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.
410 597 0146
P.02/03
MCS blacks out the field "FILING FOR MEDICARE ONLY, RESTRICTING MONTHL Y BENEFITS" for al! claim
types except Retirement,
When the ADDB screen is entered in establish or update mode, the system will check for the presence of Windfall
Elimination (WEP) data:
•
IfWEP data exists, the ADDB field, CURRENTLY ENTITLED TO A PENSION NOT COVERED
UNDER SSA, will be prefilled with a "Y" value and the user will not be able to change it.
•
If no WEP data. exists, the ADDB will show whatever field value is currently stored on the MCS
pending file and the user will be able to change the value,
After the user completed the WEPXIWEPI mini-path, future entries to the ADDB screen will result in the software
checking for WEP data, If all occurrences of WEP data have been deleted, the ADDB field will be set to liN" If there
is still underlying MBR data, the value will be a protected "Y".
FACSIMILE: ADDB - ADDITIONAL BENEFITS
MCS
TRANSFER TO: XXXX
NH
SSSSS
S5SSS~SSS
ADDITIONA~
8ENEFIT~
ilDDB
sssso;
ssss.:;sssss
[1-M)
~C':'IVE
o, s .
NILIT,~RY IRI:5ERVE/NATL
GtlARD SEFiVICE U"IER SEPT 7 1939 (¥ IH1: X
[2-111
t.:ORn~lJ
[J-Ci
1,-J RI'. FOR 5 YP.J-RS OR !1ORE [YIN); x
SPOUSE
(Y/N):X
t s-c:
[4-~J
RECEIVING FR RETIREMENT PENSION/ANNUIT~ (YIN): X
SPOUSE iY/~): X
:6-!1]
[7-Cl
COVERE.D UNDER ~'CREIGN 55;" ('i/1J): X
COUNTRY: XXXXXXXXXX
IF COVEP.ED,
[8-,::J
rs-ci
FILING FOF
FOR~IGN
SSA (YIN):
X
REQUIRES FOREIGN QC'S FOR US FILING
('ill-): Y
:1')-:J
[l1-CJ
£;PCIJSE COVERElJ t:NDER SSA OF orHER COUI~TR\' ('1 INI: x
COUNTRY: xxxxxxxxxx
[12-XJ
[U-C)
:IvILIAIl l':MFVY1EE OF FEDF;RAL GOVT IN JMJ 1983 (Y/NI: X
SPOUSE (Y/NI: X
[:1-~!1
ClS-Cj
vot~
JALOAtl;;SE !NIEF.NEE (y/tJ): X
OF POVlCRTY (YIN1:
r~:.~j
JU1.LH'\' fi)R US FED/Sl"rlTE/LOCAL GOV'I PENGIOll 8.t.SED eN ;\~y WCRK yon PEHOP.MED
WHI,:H WAS NIH COVERED UNCt:ll. SSA (Y/Nl: X
fi'''i::'ii:
CUflRElJTLY r;:~1"ITLED TO 1\ PEnSION sor COVERED UNDER 55A (Y/tl):
[\1:I-C 1
X
IF NO. C'O YOT} F,:xPEcr TO BE ENTITLED TO r; PENSION NOT COVERED U"U:F.P.
S~A
IN rHf; FUTURE; i¥llll;
f"'T-c'"J
U' YES. Sf:OW rtJiURE ENTITLEMENT DATE (MMY'lI: !J999
l2',J:-C~
FILING FOR MEDICARE OSLY, RESTRICTING
NO"reL~
BENEFITS (YIN): x
[a-c]
WILL t1EnrCARE
r;:2-t-!;
~J?PLY;
9
1. YES
2, NO
3. ALREADY E:NROlLED ON 1\!JO'l'liER ';';101
http.z/policynet,ba,:;:;a.gov/msom.ns±/sectionlistl020015K!opendocument
r-1A'r'-06-2005
08:27
410 5'37 0146
5/512005
'38>;
P.02
.I.
f1A\'-B6- 2005
V-'lv), ...... w"",,"' __ ..·_·
138: 56_
OPBP
.._ ..
DIV
P~~ment Policy
4113 597 13146
P.B3/B3
Up to nine occurrences of Offset Data may be entered on each GPOD screen. A maximum of seventy-two (72)
occurrences of Offset Data may be entered for each spouse beneficiary.
DELETING GOVERNMENT PENSION RESULTS DATA
To delete a specific occurrence of Offset Data, enter spaces or delete the entries in [l-C] START, l2-C) STOP, [3-C]
TOTAL MONTHLY PENSION AMOUNT,
l4-C] PRORATED MONTHLY LS ONLY AMOUNT, and [5-Cl WITHHELD AMOUNT. The remaining
occurrences of Offset Data will be re-sorted in ascending chronological order.
To delete every occurrence of Offset Data on a full GPOD screen ([lO-M] \1.0RE OFFSET DETERMINATIONS is a
propagated "Y"), enter spaces Or delete the entries in every field in the table. You cannot delete a GPOD screen in the
path by changing a propa gated "Y" in
[IO-M] MORE OFFSET DETERMINATIONS to "N". The remaining occurrences of Offset Data will be re-sorted in
ascending chronological order.
In MACADE, to delete all of the occurrences of Offset Data from the MBR, enter "Y" in
[7-M] DEtETE ALL OFFSET DATA. When processed to update the result will be the deletion of all monthly
pension offset results data (GP MTHLY group) from the MBR.
To delete Exemption Data, enter spaces or delete the entries in [S-Cl START and
[9-C] REASON for the pension(s) that the exemption no longer applies,
FACSIMILE: GPOD - GOVERNMENT PENSION OFFSET DETERMINATION
(RESULTS INPUT)
:ctm
GOVERNMENT l'ENSIOt, OffSET DE:TE:RI1I!i!;:'.TION
NH SSN: S~S-$S-SSSS
[ OHSET JATA
[l-':J
f z-c:
::.TART
:')'t:OE'
PIC: 55S
CPOD
SS: sss-SS-SSSS
SSSSS SSSSSSSSSS
CS-Cl
WITHHELD
C'lH'S£T
[3-CJ
l4 -:J
TOTAL MONTHLY
t:RORA'l'ED
~~OlJTHLY
( G-OJ
II.fXCCYrI
Wl1CCYYJ
/lMOUNT
AMOU~T
9939,9
PENSION AMOU~r
9<;)(l099999
LS
33'l39~
~99999999
99999~9
sssssssss
;99999
q'~9999
999999999
~99999999
999999"
S~sssssss
;9~99~
99999~
0:)999999$1
999<;93999
9999999
SSSS:3S~SS
~H:"i'
1\XOrJNT
9= 399','
999999
999999999
SSS3SSSSS
:)Si999~
9999939~9
999999999
299999999
9999999
999999
9999999
$SSS5:~SSS
999993
999~99999
299999393
9999999
999999
I)J9999
g99999
999999999
9S9999999
9999999
99?99;
~~9999
99Sl~El(l99q
999993~H
9999999
5S~SSSSSS
393S:-l~
999999
999999999
(l9999999;
9~99999
SSSl>$SSSS
P-Ml
CEL[I~
(- eX£MPT:ON
n~tA
I?E~~,I')N
ALL OFFSBT DAtA (YIN': P
[e-c)
ID
[:)-CI
(MMCCYYI
TYPf.
ELIGIFlTLItt
START
SSSSSSSS
SSSSSSSS
999999
~
ssssssss
999999
9
SSSS:")!';SSSSSSSSS
SSSSSSSS
ss::;sssss
[lJ-H1
MeRE orFSET DETERMINATIO~S (YIN): P
I?F1 2ELP AVAILABLE
99999~
9
S$S~SS3SSSSSSSS
~~SS::;SS$SSSSSSS
"
••..•
~
t, -
f'1A\-06-2005
---
,--- , . / - - - -
08:28
~E~SON
TRANSF~R
_"C/~| File Type | application/pdf |
| File Modified | 2008-06-13 |
| File Created | 2008-06-13 |