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Beneficiary Impact: Having this model application available in the most often used languages will provide additional access to beneficiaries applying for MSP.
State Action: No action is required by the States to implement this provision, although States are encouraged to take full advantage of the translated applications. States may need to develop internal processes for the receipt and handling of the applications. Appendix A: LIS Data Exchange Output Record Layout
Table: This table describes the layout and field descriptions for the LIS Data Exchange Output Record RECORD POSITION FIELD NAME FIELD SIZE &TYPE DESCRIPTION 1-9 Claim Own Social Security Number (COSSN) PIC X(09) Beneficiary’s Social Security Number 10-20 Beneficiary’s HICN PIC X(11) This is the claim number the beneficiary’s Medicare/Social Security benefit records are filed under. It consists of a HICN RRB Claim # (9 digits), a prefix (1 digit) and a symbol (1 digit). Social Security determines this from its records. 21-35 First Name PIC X(15) Beneficiary’s First Name 36-50 Middle Name PIC X(15) Beneficiary’s Middle Name 51-72 Last Name PIC X(22) Beneficiary’s Last Name 73-76 Suffix PIC X(04) Beneficiary's Suffix 77-84 Beneficiary's Date of Birth PIC 9(08) This is the beneficiary’s date of birth provided in the format of a two-digit month a two-digit day and a four-digit year. Format: MMDDCCYY 85 Beneficiary's Gender PIC X(01) Gender of beneficiary. Values: F (Female) or M (Male) 86-89 Beneficiary’s Burial/Funeral Expenses PIC 9(04) Question 5 on the SSA LIS application asks if some money will be used for burial expenses. If the beneficiary checks no, a zero will be shown here. If “no” was not checked on question 5, SSA allowed the $1,500 burial expense exclusion when counting the resources and $1,500 will be displayed in this field. Values: 0 or 1500 90-98 Spouse’s COSSN PIC X(09) Spouse’s Social Security Number 99-109 Spouse’s HICN PIC X(11) This is the claim number the spouse’s Medicare/Social Security benefit or Railroad records are filed under. It consists of a HICN RRB Claim # (9 digits), a prefix (1 digit) and a symbol (1 digit). Social Security determines this from its records. 110-124 Spouse’s First PIC X(15) Spouse’s First Name