TN 30 (03-96)

Document Identifier for Word Processor: E3123

A. Exhibit Letter

We plan to reduce your Social Security payments (1) to $ (2) in (3) because (4) .

If You Disagree With The Decision

Please tell us within 10¹ days of the date of this letter if you disagree with the decision. You will also need to give us any proof you have to show that what we were told is wrong.

If you let us know within 10¹ days that you disagree with the decision, we will not reduce your checks. We will continue to pay you while we review your case to see if you are right. However, if you are wrong we will ask you to pay back any money you received that was not due.

If we do not hear from you within 10¹ days, we will reduce your checks. We will send you another letter at that time with more information about our action.

If You Have Any Questions

3901C - Domestic

3901D - Foreign

B. Requesting Instructions

• The person who determines that benefits will be reduced is responsible for requesting this notice and providing the appropriate fill-ins. The notice should be requested on an SSA-573 and all fill-ins listed.

   

Fill-ins:

• Refer to NL 00703.005E for 3901C and 3901D text and fill-ins.

C. Typing Instructions

FOs will use standard FO letterhead. If sent from PC, use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice is shown on Form SSA-573.

¹ For foreign beneficiaries, 30 days.