To authorize supplemental mercury benefits, complete a blank Form 552 as follows:

  • Item 1 - Complete.
  • Item 2 - Enter the effective fiscal month and year (4 digits). If the effective fiscal month has passed, authorize the benefits as past month's benefits (see PM 23-01-02 and WAG 23-01-02-b).
  • Item 3 - Enter TA 56.
  • Item 4 - Enter 7.
  • Items 5, 6 - Complete.
  • Items 8-10 - Enter the name and address as it currently exists in the Client Database.
    • NOTE: If the name or address has recently changed, the change must be made on the regular roll before the mercury request is authorized to the new name or address.
  • Item 23 - Complete.
  • Item 33 - Enter 11.
  • Item 38 - Enter the amount of supplemental benefit.