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NL: Notices, Letters and Paragraphs

Effective Dates: 06/18/2013 - Present

A. Sample form

G-NL_00701.430A-1

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Reverse Side

G-NL_00701.430A-2

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B. Preparation of form

Refer to Form SSA-833 for completing the name, address and claim number. This notice will be designated in the LTR/PAR NO. block of Form SSA-833-U5. This notice will be shown followed by the block number(s) to be checked; the appropriate fill-in for the block, enclosed in parentheses. (E.g., L1014-1 (9-77), 2(6)). Any additional paragraphs, if applicable, will also be shown.

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