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.
