The file's text, extracted by GovTribe without its formatting.
Attachment 3 Attachment 3 Payment Coupon Scanline Format
The scanline is system-derived and is based on the information keyed on the ‘RFOR’ or ‘RCFR’ screens in PCOM.
The scanline field is printed in a machine-generated font. The scanline contains 70 alphanumeric characters of beneficiary information such as the SSN or BILL NUMBER and money amounts such as the remittance and/or credit amount. The scanline also contains 2 check digits, one for the account number and one for the remaining values of the scanline.
If any of the characters in the scanline are rejected/misread, the coupon will be presented at the High-Speed Keyer Station without running either check digit algorithms. If all characters are legible in the scanline, check digit edits will be run. If either of the check digits fail, the entire scanline will be presented at High Speed Keyer before running any additional edits. If the scanline check digits pass, the scanline edits will run.
Data not recognized by eFlow will be replaced with an ‘*’(asterisk) and the system will present the field to the user at High Speed Keyer to key the misread character.
Table: Scanline Field Descriptions
| Position |
| Description |
| Notes |
| 1 |
| Determines format of positions 2 thru 19 |
| 2-19 |
| Can be AccountID, SSN/BIC, Bill Number, SSN/SSI EST DT, SSN/SSI EST DT/BIC, or Other |
| If Position 1 = 1 |
| Position 2-19 = account ID with zeros in remaining spaces (padded right) |
| If Position 1 = 2 |
| Position 2-19 = SSN (2-10) and BIC (11-13) and zeros (14-19) |
| If Position 1 = 3 |
| Position 2-19 = BILL NUMBER with zeros in remaining spaces (padded right) |
| If Position 1 = 4 |
| Position 2-19 = SSN (2-10) and SSI EST DT (11-16) and zeros (17-19) |
| If Position 1 = 6 |
| Position 2-19 = SSN (2-10), SSI EST DT (11-16), zero (17), and BIC (18-19), Reason Code MUST be X |
| If Position 1 = 5 |
| “other” |
| 20 |
| Check Digit Field |
| Check digit for positions 1 through 19 |
| 21-25 |
| Last Name Field |
| “/” will be present in the scanline for remaining characters. |
| 26-28 |
| First Name Field |
| “/” will be present in the scanline for remaining characters. |
| 29 |
| Bill Stub Origin |
| Possible entries: |
R = Final Accounting (Rep Payee) C = Credit Card Process (WBDOC) M = Misapplied Funds
1 = RECOOP
2 = DMS – Foreign & non-foreign
3 = ROAR
4 = SSR
5 = Wage garnishment (ECO) 6 = (reserved for future)
7 = TOP (ECO)
8 = AJS
9 = T2/TATTER
| 30-38 |
| Remittance Amount |
| 8 digits, No decimals. |
last 2 positions are cents, first 6 are dollars left padded with zeros
| 39-47 |
| Credit Amount |
| 8 digits, No decimals. |
last 2 positions are cents, first 6 are dollars left padded with zeros
| 48-56 |
| Credit Amount |
| 8 digits, No decimals. |
last 2 positions are cents, first 6 are dollars left padded with zeros
| 57 |
| Reason Code |
| Possible entries: |
A = Annual Report C = Conserved Funds E = Wage Garnishment F = Fees G = Gift M = Misused Funds N = Other O = Overpayment P = Medicare Premium Installment R = Court-ordered Restitution S = Misapplied Funds V = Compromise X = SSI Claimant Rep Fee Refund
| 58 |
| Trust Fund |
| Possible entries: |
B = Black Lung (obsolete) D = Disability M = Misapplied Funds N = Not Applicable O = Other P = Prouty
R = RSI
S = SSI
U = Unknown
| 59-69 |
| Receipt Number |
| Digits 1-5 are Julian day (YYDDD) |
Digits 6-8 are field office code or non-depositing PC Code Digits 9-11 are Sequence Number (Field can be all zeros)
| 70 |
| Scanline check digit |
| Check digit for positions 21-69 |
Scanline Check Digit Edits Algorithm
The ‘Check Digit Algorithm’ will be run after recognition, High Speed Keyer, and Balancing Stations. If either of the two scanline check digit algorithms fail, the entire scanline will be presented to be keyed at the High Speed Keyer Station.
Table 5: Check Digit Edits Algorithm
| Requirement ID# |
| Check Digit Position |
| Computation for Check Digit Verification |
| CDE-001 |
| 20 |
| ACCOUNT NUMBER CHECK DIGIT / Formula = |
Assign a numeric value to each alpha character sequentially: A = 1, B = 2, C = 3, D = 4, and so on. ("P" indicates position in scan line)
ADD P1 + P3 + P5 + P7 + P9 + P11 + P13 + P15 + P17 + P19 = RESULT 1
ADD P2 + P4 + P6 + P8 + P10 + P12 + P14 + P16 + P18 = RESULT 2
MULTIPLY (RESULT 2) X 3 = RESULT 3
ADD RESULT 1 + RESULT 3 = RESULT 4
CHECK DIGIT = LAST POSITION OF RESULT 4
| CDE-002 |
| 70 |
| CHECK DIGIT FOR LINE / Formula = |
Assign a numeric value to each alpha character sequentially: A = 1, B = 2, C = 3, D = 4, and so on. ("P" indicates position in scan line)
ADD P21 + P23 + P25 + P27 + P29 + P31 + P33 + P35 + P37 + P39 + P41 + P43 + P45 + P47 + P49 + P51 + P53 + P55 + P57 + P59 + P61 + P63 + P65 + P67 + P69 = RESULT 1
ADD P22 + P24 + P26 + P28 + P30 + P32 + P34 + P36 + P38 + P40 + P42 + P44 + P46 + P48 + P50 + P52 + P54 + P56 + P58 + P60 + P62 + P64 + P66 + P68 = RESULT 2
MULTIPLY (RESULT 2) X 3 = RESULT 3
ADD RESULT 1 + RESULT 3 = RESULT 4
CHECK DIGIT = LAST POSITION OF RESULT 4
Scanline Edits The ‘Scanline Edits’ are required to run after recognition, High Speed Keyer, and Balancing Stations. The edits ensure data passes validation before continuing to output. A BIC List is included at the end of this document.
Table: Scanline Edits
| Requirement ID# |
| Position |
| Field Name |
| Condition |
| Edit Message |
| SLE-001 |
| 1 |
| Account Format Determination Code |
| If not numeric 1-5 |
| Invalid format code |
| SLE-002 |
| 2-19 |
| Account ID (position 1=1) |
| Field is blank |
| This is a mandatory field. It cannot be blank. |
SLE-003
| Field is all zeros |
| Field account ID is not valid |
SLE-004
| Field is alpha/spec characters |
| Field account ID is not valid |
SLE-005
| If first 3 positions of Account ID=000 |
| Field account ID is not valid, account ID cannot contain 000 in the first 3 positions. |
SLE-006
| Position 4-5 of Account ID =00 |
| Field account ID is not valid, account ID cannot contain 00 in positions 4 and 5. |
SLE-007
| Positions 6-9 of Account ID = 0000 |
| Field is not valid, account ID cannot contain 0000 in positions 6-9. |
SLE-008
| First 9 positions =123456789 |
| Field account ID is not valid, account id cannot contain 123456789 in the first 9 positions. |
SLE-009
| First 9 positions are all 9's and trust fund is not O |
| When first 9 positions of account ID = 9, trust fund must be O |
SLE-010
| First 9 positions match any SSN in the ‘hot file’ |
| Hot File Match, delete transaction. |
SLE-011
| SSN/BIC (position 1=2) |
| If field is blank |
| This is a mandatory field. It cannot be blank. |
SLE-012
| If field is not alphanumeric |
| Field is Invalid |
SLE-013
| If the field is all zeros |
| SSN must be valid, >0, when account format is 2,3,or 4. |
SLE-014
| If first 3 positions of SSN =000 |
| Field is not valid, account ID cannot contain 000 in the first 3 positions. |
SLE-015
| If positions 4-5 of SSN= 00 |
| Field is not valid, account ID cannot contain 00 in positions 4 and 5. |
SLE-016
| If positions 6-9 of SSN= 0000 |
| Field is not valid, account ID cannot contain 0000 in positions 6-9. |
SLE-017
| If SSN =123456789 |
| Field is not valid, account id cannot contain 123456789 in the first 9 positions. |
SLE-018
| If first 3 positions are not 001-665, 667-728,750-772 |
| SSN must be valid, first positions must be 001-665, 667-728,750-772 when account format is 2,3,or 4 |
SLE-019
| First 9 positions match any SSN in the ‘hot file’ |
| Hot File Match, delete transaction. |
SLE-020
| BIC is not in BIC list |
| Invalid BIC |
SLE-021
| Bill Number (position 1=3) |
| If field is blank |
| This is a mandatory field. It cannot be blank. |
SLE-022
| If the field is all zeros |
| SSN must be valid, >0, when account format is 2,3,or 4. |
SLE-023
| If first 3 positions =000 |
| Field account ID is not valid, account ID cannot contain 000 in the first 3 positions. |
SLE-024
| If positions 4-5 = 00 |
| Field is not valid, account ID cannot contain 00 in positions 4 and 5. |
SLE-025
| If positions 6-9 = 0000 |
| Field is not valid, account ID cannot contain 0000 in positions 6-9. |
SLE-026
| Field is alpha/spec characters |
| SSN, Bill number must be numeric when account format is 3 and must be 11 digits. |
SLE-027
| Bill number is not 11 positions |
| Invalid bill number |
SLE-028
| If first 3 positions are not 001-665, 667-728,750-772 |
| SSN must be valid, first positions must be 001-665, 667-728,750-772 when account format is 2,3,or 4 |
SLE-029
| If first 9 positions =123456789 |
| Field is not valid, account id cannot contain 123456789 in the first 9 positions. |
SLE-030
| First 9 positions match any SSN in the ‘hot file’ |
| Hot File Match, delete transaction. |
SLE-031
| If reason - A,C,G,M,P,R or S |
| Bill number invalid when reason = A,C,G,M,P,R or S |
SLE-032
| SSN/SSI EST DT (position 1=4) |
| Field is blank |
| This is a mandatory field. It cannot be blank. |
SLE-033
| Field is not numeric |
| Field is Invalid |
SLE-034
| Field is all zeros |
| Field is Invalid |
SLE-035
| If first 3 positions are not 001-665, 667-728,750-772 |
| SSN must be valid, first positions must be 001-665, 667-728,750-772 when account format is 2,3,or 4 |
SLE-036
| If first 3 positions of SSN=000 |
| Field is not valid, SSN cannot contain 000 in the first 3 positions. |
SLE-037
| If positions 4-5 of SSN= 00 |
| Field is not valid, SSN cannot contain 00 in positions 4 and 5. |
SLE-038
| If positions 6-9 of SSN= 0000 |
| Field is not valid, SSN cannot contain 0000 in positions 6-9. |
SLE-039
| If first 9 positions of SSN=123456789 |
| Field is not valid, SSN cannot contain 123456789 in the first 9 positions. |
SLE-040
| First 9 positions match any SSN in the ‘hot file’ |
| Hot File Match, delete transaction. |
SLE-041
| If position 10-15 (SSI EST DT) does not contain a valid Month/Day combination |
| SSI EST DT must be a date in MMDDYY format |
SLE-042
| If positions 10-17(SSI EST DT) is less than 010173 |
| SSI EST DT cannot be earlier than 10173 |
SLE-043
| If positions 10-17(SSI EST DT) is greater than current day |
| SSI EST DT cannot be later than current systems date |
SLE-044
| SSN/SSI EST DT/BIC position 1=5) |
| Field is blank |
| This is a mandatory field. It cannot be blank. |
SLE-045
| Field is not numeric |
| Field is Invalid |
SLE-046
| Field is all zeros |
| Field is Invalid |
SLE-047
| If first 3 positions of SSNare not 001-665, 667-728,750-772 |
| SSN must be valid, first positions must be 001-665, 667-728,750-772 when account format is 2,3,or 4 |
SLE-048
| If first 3 positions of SSN =000 |
| Field is not valid, SSN cannot contain 000 in the first 3 positions. |
SLE-049
| If positions 4-5 of SSN= 00 |
| Field is not valid, SSN cannot contain 00 in positions 4 and 5. |
SLE-050
| If positions 6-9 of SSN= 0000 |
| Field is not valid, SSN cannot contain 0000 in positions 6-9. |
SLE-051
| If positions 1-9 of SSN=123456789 |
| Field is not valid, SSN cannot be 123456789. |
SLE-052
| First 9 positions match any SSN in the ‘hot file’ |
| Hot File Match, delete transaction. |
SLE-053
| If position 10-15 (SSI EST DT) does not contain a valid Month/Day combination |
| SSI EST DT must be a date in MMDDYY format |
SLE-054
| If positions 10-17 (SSI EST DT)is less than 010173 |
| SSI EST DT cannot be earlier than 10173 |
SLE-055
| If positions 10-17(SSI EST DT) is greater than current day |
| SSI EST DT cannot be later than current systems date |
SLE-056
| BIC is not in BIC list |
| Invalid BIC |
| SLE-057 |
| 20 |
| Check digit for positions 1-19 |
| If verification not correct |
| SLE-058 |
| 21-25 |
| Last Name |
| If not Alphas or zeros |
| Last name can only contain alphas or zeros |
SLE-059
| If special characters |
| Invalid Name |
SLE-060
| If no first name is present |
| Last name must be present with first name |
| SLE-061 |
| 26-28 |
| First Name |
| If not Alphas or zeros |
| First name can only contain alphas or zeros |
SLE-062
| If special characters |
| Invalid Name |
| SLE-063 |
| 29 |
| Remittance Type (Bill Stub Origin) |
| If not R, C, M, or 1 through 9 |
| Invalid Bill Stub Origin |
| SLE-064 |
| 30-38 |
| Amount 1 - (remittance amount) |
| If alpha or special characters |
| Remittance Amount must be a valid amount |
SLE-065
| If blank or zero |
| Remittance Amount must be greater than 0.00 |
| SLE-066 |
| 39-47 |
| Amount 2 - (Credit amount) |
| If alpha or special characters |
| Remittance Amount must be a valid amount |
SLE-067
| If blank or zero |
| Remittance Amount must be greater than 0.00 |
| SLE-068 |
| 48-56 |
| Amount 3 - (Credit Amount) |
| if alpha or special characters |
| Remittance Amount must be a valid amount |
SLE-069
| If blank or zero |
| Remittance Amount must be greater than 0.00 |
| SLE-070 |
| 57 |
| Reason Code |
| If alpha or special characters |
| Invalid Reason Code |
SLE-071
| If blank or zero |
| Invalid Reason Code |
SLE-072
| If not A,C,E,G,M,N,O,P,R,S,V or X |
| Invalid Reason Code |
SLE-073
| If A and Trust Fund is not D, P, or R |
| when reason = A, trust fund must be D, P or R |
SLE-074
| If G, or N and Trust Fund is not O |
| When Reason = G or N, Trust fund must be O |
SLE-075
| If M and Trust Fund is not D, P, R, or S |
| If Reason=M, Trust Fund must be D, P, R or S. |
SLE-076
| If P and Trust Fund is not O or U |
| When Reason = P, Trust Fund must be O or U |
SLE-077
| If S and Trust Fund is not M |
| When Reason = S, Trust Fund must be M |
SLE-078
| If a,c,g,m,p,r or s and Account format code (position1) = 3 |
| Bill number invalid when reason = a,c,g,m,p,r or s |
| SLE-079 |
| 58 |
| Trust Fund |
| If O and reason Code is not G, N, or P |
| When Trust fund = O, Reason must be G, N, or P |
SLE-080
| If M and Reason Code is not S |
| When Trust fund = M, Reason must be S |
SLE-081
| If S and reason code is A |
| When trust fund = S, Reason cannot be A |
SLE-082
| Field is Blank |
| Invalid Trust Fund |
SLE-083
| If not B, D, M, N, O, P, R, S, U |
| Invalid Trust Fund |
| SLE-084 |
| 59-69 |
| Receipt Number |
| Field is Blank |
| Invalid Receipt Number |
SLE-085
| If special characters |
| Invalid Receipt Number |
SLE-086
| If field is not 11 characters |
| Invalid Receipt Number |
SLE-087
| If digits 59-60 are greater than current year or less than CY-1 |
| Invalid Receipt Number |
SLE-088
| If digits 61-63 are not in range 001-365 |
| Invalid Receipt Number |
SLE-089
| If digits 67-69 contain special characters or alpha |
| Invalid Receipt Number |
| SLE-090 |
| 70 |
| Scanline check digit |
| If verification not correct |
| Error: Reject to High-Speed Keyer; key positions 21-70 |
PAYMENT coupon
SSA-53-EP DETACH HERE. DO NOT STAPLE.
ACCOUNT NUMBER: 123-45-6789-01 []MASTERCARD []VISA []DISCOVER
JANE D SMITH
| Credit Card Number |
| Exp Date |
| DATE DUE: |
| July 1, 2002 |
| ________________ |
| _________ |
| PAYMENT AMOUNT |
| $_____________ |
| Cardholder's Signature |
| Date |
| ___________________ |
| _________ |
Check box if your address or [] telephone number has changed.
Make changes below.
SOCIAL SECURITY ADMINISTRATION
PO BOX 3430
PHILADELPHIA PA 19122-9985
31234567890100000100000001000034500000034500000034500OR000000006
BIC List
Table 22: BIC List
| BIC |
| Type of Benefit/Payment |
| B |
| Aged wife, age 62 or over (1st claimant) |
| B1 |
| Aged husband, age 62 or over (1st claimant) |
| B2 |
| Young wife, with a child in her care (1st claimant) |
| B3 |
| Aged wife (2nd claimant) |
| B4 |
| Aged husband (2nd claimant) |
| B5 |
| Young wife (2nd claimant) |
| B6 |
| Divorced wife, age 62 or over (1st claimant) |
| B7 |
| Young wife (3rd claimant) |
| B8 |
| Aged wife (3rd claimant) |
| B9 |
| Divorced wife (2nd claimant) |
| BA |
| Aged wife (4th claimant) |
| BD |
| Aged wife (5th claimant) |
| BG |
| Aged husband (3rd claimant) |
| BH |
| Aged husband (4th claimant) |
| BJ |
| Aged husband (5th claimant) |
| BK |
| Young wife (4th claimant) |
| BL |
| Young wife (5th claimant) |
| BN |
| Divorced wife (3rd claimant) |
| BP |
| Divorced wife (4th claimant) |
| BQ |
| Divorced wife (5th claimant) |
| BR |
| Divorced husband, age 62 or older (1st claimant) |
| BT |
| Divorced husband (2nd claimant) |
| BW |
| Young husband (2nd claimant) |
| BY |
| Young husband, with a child in his care (1st claimant) |
| D |
| Aged widow, age 60 or over (1st claimant) |
| D1 |
| Aged widower, age 60 or over (1st claimant) |
| D2 |
| Aged widow (2nd claimant) |
| D3 |
| Aged widower (2nd claimant) |
| D4 |
| Widow (remarried after attainment of age 60) (1st claimant) |
| D5 |
| Widower (remarried after attainment of age 60) (1st claimant) |
| D6 |
| Surviving divorced wife, age 60 or over (1st claimant) |
| D7 |
| Surviving divorced wife (2nd claimant) |
| D8 |
| Aged widow (3rd claimant) |
| D9 |
| Remarried widow (2nd claimant) |
| DA |
| Remarried widow (3rd claimant) |
| DC |
| Surviving divorced husband, age 60 or over (1st claimant) |
| DD |
| Aged widow (4th claimant) |
| DG |
| Aged widow (5th claimant) |
| DH |
| Aged widower (3rd claimant) |
| DJ |
| Aged widower (4th claimant) |
| DK |
| Aged widower (5th claimant) |
| DL |
| Remarried widow (4th claimant) |
| DM |
| Surviving divorced husband (2nd claimant) |
| DN |
| Remarried widow (5th claimant) |
| DP |
| Remarried widower (2nd claimant) |
| DQ |
| Remarried widower (3rd claimant) |
| DR |
| Remarried widower (4th claimant) |
| DS |
| Surviving divorced husband (3rd claimant) |
| DT |
| Remarried widower (5th claimant) |
| DV |
| Surviving divorced wife (3rd claimant) |
| DW |
| Surviving divorced wife (4th claimant) |
| DX |
| Surviving divorced husband (4th claimant) |
| DY |
| Surviving divorced wife (5th claimant) |
| DZ |
| Surviving divorced husband (5th claimant) |
| E |
| Mother (widow) (1st claimant) |
| E1 |
| Surviving divorced mother (1st claimant) |
| E2 |
| Mother (widow) (2nd claimant) |
| E3 |
| Surviving divorced mother (2nd claimant) |
| E4 |
| Father (widower) (1st claimant) |
| E5 |
| Surviving divorced father (widower) (1st claimant) |
| E6 |
| Father (widower) (2nd claimant) |
| E7 |
| Mother (widow) (3rd claimant) |
| E8 |
| Mother (widow) (4th claimant) |
| E9 |
| Surviving divorced father (widower) (1st claimant) |
| EA |
| Mother (widow) (5th claimant) |
| EB |
| Surviving divorced mother (3rd claimant) |
| EC |
| Surviving divorced mother (4th claimant) |
| ED |
| Surviving divorced mother (5th claimant) |
| EF |
| Father (widower) (3rd claimant) |
| EG |
| Father (widower) (4th claimant) |
| EH |
| Father (widower) (5th claimant) |
| EJ |
| Surviving divorced father (3rd claimant) |
| EK |
| Surviving divorced father (4th claimant) |
| EM |
| Surviving divorced father (5th claimant) |
| F5 |
| Parent (adopting Father) |
| F6 |
| Parent (adopting Mother) |
| F7 |
| Parent (2nd alleged Father) |
| F8 |
| Parent (2nd alleged Mother) |
| J1 |
| Primary Prouty entitled to Hospital Insurance Benefits (HIB) (less than 3 quarters of coverage (QCs) (General Fund) |
| J2 |
| Primary Prouty entitled to HIB (over 2 QCs.) (Retirement and Survivors Insurance (RSI) Trust Fund) |
| J3 |
| Primary Prouty not entitled to HIB (less than 3 QCs) (General Fund) |
| J4 |
| Primary Prouty not entitled to HIB (over 2 QCs) (RSI Trust Fund) |
| K1 |
| Prouty wife entitled to HIB (less than 3 QCs) (General Fund) (1st claimant) |
| K2 |
| Prouty wife entitled to HIB (over 2 QCs) (RSI Trust Fund) (1st claimant) |
| K3 |
| Prouty wife not entitled to HIB (less than 3 QCs) (General Fund) (1st claimant) |
| K4 |
| Prouty wife not entitled to HIB (over 2 QCs) (RSI Trust Fund) (1st claimant) |
| K5 |
| Prouty wife entitled to HIB (less than 3 QCs) (General Fund) (2nd claimant) |
| K6 |
| Prouty wife entitled to HIB (over 2 QCs) (RSI Trust Fund) (2nd claimant) |
| K7 |
| Prouty wife not entitled to HIB (less than 3 QCs) (General Fund) (2nd claimant) |
| K8 |
| Prouty wife not entitled to HIB (less than 3 QCS) (General Fund) (3rd claimant) |
| K9 |
| Prouty wife entitled to HIB (less than 3 QCs) (General Fund) (3rd Claimant) |
| KA |
| Prouty wife entitled to HIB (over 2 QCs) (RSI Trust Fund) (3rd claimant) |
| KB |
| Prouty wife not entitled to HIB (less than 3 QCs) (General Fund) (3rd claimant) |
| KC |
| Prouty wife not entitled to HIB (over 2 QCs) (RSI Trust Fund) (3rd claimant) |
| KD |
| Prouty wife entitled to HIB (less than 3 QCs) (General Fund) (4th claimant) |
| KE |
| Prouty wife entitled to HIB (over 2 QCs) (RSI Trust Fund) (4th claimant) |
| KF |
| Prouty wife not entitled to HIB (less than 3 QCs) (General Fund) (4th claimant) |
| KG |
| Prouty wife not entitled to HIB (over 2 QCs) (RSI Trust Fund) (4th claimant) |
| KH |
| Prouty wife entitled to HIB (less than 3 QCs) (General Fund) (5th claimant) |
| KJ |
| Prouty wife entitled to HIB (over 2 QCs) (RSI Trust Fund) (5th claimant) |
| KL |
| Prouty wife not entitled to HIB (less than 3 QCs) (General Fund) (5th claimant) |
| KM |
| Prouty wife not entitled to HIB (over 2 QCs) (RSI Trust Fund) (5th claimant) |
| M |
| Uninsured beneficiary (not qualified for automatic HIB) |
| M1 |
| Uninsured beneficiary (qualified for automatic HIB but requests only SMIB) |
| RA-RZ |
| Attorney Fees - Title 16 |
| SA-SZ |
| Used for attorney fee (payment is not an MBR recognized BIC) |
| T |
| · Fully insured beneficiaries who have elected entitlement only to HIB (usually but not always along with SMIB) |
· End Stage Renal Disease (ESRD) filing for Medicare only
· Deemed insured (hospital insurance only)
| TA |
| Medicare Qualified Government Employment (MQGE) primary beneficiary |
| TB |
| MQGE aged spouse (1st claimant) |
| TB2 |
| MQGE ESRD Wife (any age) |
| TBY |
| MQGE ESRD Husband (any age) |
| TB1 |
| MQGE Aged Husband (age 65) |
| TB6 |
| MQGE Divorced Wife (age 65) |
| TBR |
| MQGE Divorced Husband (age 65) |
| TC |
| MQGE childhood disability benefits (CDB) (1st claimant) (any age) |
T2-T9 (Additional children)
| TD |
| MQGE aged widow (1st claimant) |
| TD1 |
| MQGE aged widower (1st claimant) (age 65) |
| TD4 |
| MQGE remarried widow (1st claimant) (age 65) |
| TD5 |
| MQGE remarried widower (1st claimant) (age 65) |
| TD6 |
| MQGE surviving divorced aged wife (1st claimant) (age 65) |
| TDC |
| MQGE surviving divorced aged husband (1st claimant) (age 65) |
| TE |
| MQGE young widow (1st claimant) |
| TE4 |
| MQGE ESRD widower (1st claimant) any age |
| TE1 |
| MQGE surviving divorced ESRD wife (1st claimant) (any age) |
| TE5 |
| MQGE surviving divorced ESRD husband (1st claimant) (any age) |
| TF1 |
| MQGE father (1st claimant) (age 65) |
| TF7 |
| MQGE father (2nd claimant) (age 65) |
| TF3 |
| MQGE stepfather (1st claimant) (age 65) |
| TF5 |
| MQGE adopting father (1st claimant) (age 65) |
| TG |
| MQGE aged spouse (2nd claimant) |
| TG5 |
| MQGE ESRD Wife (2nd claimant) (any age) |
| TGW |
| MQGE ESRD Husband (2nd claimant) |
| TG3 |
| MQGE aged wife (2nd claimant) (age 65) |
| TG4 |
| MQGE aged husband (2nd claimant) (age 65) |
| TG9 |
| MQGE divorced wife (2nd claimant) (age 65) |
| TGT |
| MQGE divorced husband (2nd claimant) (age 65) |
| TH |
| MQGE aged spouse (3rd claimant) |
| TH7 |
| MQGE ESRD wife (3rd claimant) (any age) |
| TH8 |
| MQGE ESRD aged wife (3rd claimant) (age 65) |
| THG |
| MQGE aged husband (3rd claimant) (age 65) |
| THN |
| MQGE divorced wife (3rd claimant) (age 65) |
| TJ |
| MQGE aged spouse (4th claimant) |
| TJA |
| MQGE aged wife (4th claimant) (age 65) |
| TJH |
| MQGE aged husband (4th claimant) (age 65) |
| TJK |
| MQGE ESRD Wife (4th claimant) (any age) |
| TJP |
| MQGE divorced wife (4th claimant) (age 65) |
| TK |
| MQGE aged spouse (5th claimant) |
| TKD |
| MQGE aged wife (5th claimant) (age 65) |
| TKJ |
| MQGE aged husband (5th claimant) (age 65) |
| TKL |
| MQGE ESRD (5th claimant) (any age) |
| TKQ |
| MQGE ESRD (5th claimant) (age 65) |
| TL |
| MQGE aged widow(er) (2nd claimant) |
| TL2 |
| MQGE aged widow (2nd claimant) (age 65) |
| TL3 |
| MQGE aged widower (2nd claimant) (age 65) |
| TL9 |
| MQGE remarried widow (2nd claimant) (age 65) |
| TL7 |
| MQGE surviving divorced aged wife (2nd claimant) (age 65) |
| TLM |
| MQGE surviving divorced aged husband (2nd claimant) (age 65) |
| TLP |
| MQGE remarried widower (2nd claimant) (age 65) |
| TM |
| MQGE aged widow(er) (3rd claimant) |
| TM8 |
| MQGE aged widow (3rd claimant) (age 65) |
| TMH |
| MQGE aged widower (3rd claimant) (age 65) |
| TMA |
| MQGE remarried widow (3rd claimant) (age 65) |
| TMQ |
| MQGE remarried widower (3rd claimant) (age 65) |
| TMV |
| MQGE surviving divorced aged wife (3rd claimant) (age 65) |
| TMS |
| MQGE surviving divorced aged husband (3rd claimant) (age 65) |
| TN |
| MQGE aged widow(er) (4th claimant) |
| TND |
| MQGE aged widow (4th claimant) (age 65) |
| TNJ |
| MQGE age widower (4th claimant) (age 65) |
| TNL |
| MQGE remarried widow (4th claimant) (age 65) |
| TNR |
| MQGE remarried widower (4th claimant) (age 65) |
| TNW |
| MQGE surviving divorced aged wife (4th claimant) (age 65) |
| TNX |
| MQGE surviving divorced aged husband (4th claimant) (age 65) |
| TP |
| MQGE aged widow(er) (5th claimant) |
| TPG |
| MQGE aged widow (5th claimant) (age 65) |
| TPK |
| MQGE aged widower (5th claimant) (age 65) |
| TPN |
| MQGE remarried widow (5th claimant) (age 65) |
| TPT |
| MQGE remarried widower (5th claimant) (age 65) |
| TPY |
| MQGE surviving divorced aged wife (5th claimant) (age 65) |
| TPZ |
| MQGE surviving divorced aged husband (5th claimant) (age 65) |
| TQ2 |
| MQGE mother (1st claimant) (age 65) |
| TQ4 |
| MQGE stepmother (1st claimant) (age 65) |
| TQ6 |
| MQGE adopting mother (1st claimant) (age 65) |
| TQ8 |
| MQGE mother (2nd claimant) (age 65) |
| TR |
| MQGE young widow(er) (2nd claimant) |
| TR2 |
| MQGE ESRD Widow (2nd claimant) (any age) |
| TR3 |
| MQGE ESRD Widower (2nd claimant) (any age) |
| TR6 |
| MQGE Surviving Divorced ESRD wife (any age) |
| TR9 |
| MQGE Surviving Divorced ESRD husband (any age) |
| TS |
| MQGE young widow(er) (3rd claimant) |
| TS7 |
| MQGE ESRD Widow (3rd claimant) (any age) |
| TSF |
| MQGE ESRD Widower (3rd claimant) (any age) |
| TSB |
| MQGE Surviving Divorced ESRD wife (3rd claimant) (any age) |
| TSJ |
| MQGE Surviving Divorced ESRD husband (3rd claimant) (any age) |
| TT |
| MQGE young widow(er) (4th claimant) |
| TT8 |
| MQGE ESRD Widow (4th claimant) (any age) |
| TTG |
| MQGE ESRD Widower (4th claimant) (any age) |
| TTC |
| MQGE surviving divorced ESRD wife (4th claimant) (any age) |
| TTK |
| MQGE surviving divorced ESRD husband (4th claimant) (any age) |
| TU |
| MQGE young widow(er) (5th claimant) |
| TUA |
| MQGE ESRD Widow (5th claimant) (any age) |
| TUH |
| MQGE ESRD Widower (5th claimant) (any age) |
| TUD |
| MQGE surviving divorced ESRD wife (5th claimant) (any age) |
| TUM |
| MQGE surviving divorced ESRD husband (5th claimant) (any age) |
| TV |
| MQGE disabled widow(er) (1st claimant) |
| TVF |
| MQGE disabled widow (5th claimant) (age 50) |
| TVG |
| MQGE disabled widower (5th claimant) (age 50) |
| TVJ |
| MQGE disabled surviving divorced wife (5th claimant) (age 50) |
| TW |
| MQGE disabled widow (1st claimant) (age 50) |
| TW1 |
| MQGE disabled widower (1st claimant) (age 50) |
| TW6 |
| MQGE disabled surviving divorced wife (1st claimant) (age 50) |
| TWR |
| MQGE disabled surviving divorced husband (1st claimant) (age 50) |
| TX |
| MQGE disabled widow(er) (2nd claimant) |
| TX2 |
| MQGE disabled widow (2nd claimant) (age 50) |
| TX3 |
| MQGE disabled widower (2nd claimant) (age 50) |
| TX7 |
| MQGE disabled surviving divorced wife (2nd claimant) (age 50) |
| TXT |
| MQGE disabled surviving divorced husband (2nd claimant) (age 50) |
| TY |
| MQGE disabled widow(er) (3rd claimant) |
| TY4 |
| MQGE disabled widow (3rd claimant) (age 50) |
| TY5 |
| MQGE disabled widower (3rd claimant) (age 50) |
| TY8 |
| MQGE disabled surviving divorced wife (3rd claimant) (age 50) |
| TZ |
| MQGE disabled widow(er) (4th claimant) |
| TZ9 |
| MQGE disabled widow (4th claimant) (age 50) |
| TZB |
| MQGE disabled widower (4th claimant) (age 50) |
| TZC |
| MQGE disabled surviving divorced wife (4th claimant) (age 50) |
| T2-T9 |
| MQGE (CDB) (2nd to 9th claimant) |
| W |
| Disabled widow, age 50 or over (1st claimant) |
| W1 |
| Disabled widower, age 50 or over (1st claimant) |
| W2 |
| Disabled widow (2nd claimant) |
| W3 |
| Disabled widower (2nd claimant) |
| W4 |
| Disabled widow (3rd claimant) |
| W5 |
| Disabled widower (3rd claimant) |
| W6 |
| Disabled surviving divorced wife (1st claimant) |
| W7 |
| Disabled surviving divorced wife (2nd claimant) |
| W8 |
| Disabled surviving divorced wife (3rd claimant) |
| W9 |
| Disabled widow (4th claimant) |
| WB |
| Disabled widower (4th claimant) |
| WC |
| Disabled surviving divorced wife (4th claimant) |
| WF |
| Disabled widow (5th claimant) |
| WG |
| Disabled widower (5th claimant) |
| WJ |
| Disabled surviving divorced wife (5th claimant) |
| WR |
| Disabled surviving divorced husband (1st claimant) |
| WT |
| Disabled surviving divorced husband (2nd claimant) |