NL: Notices, Letters and Paragraphs
TN 34 (05-98)
(See GN 00503.130)
Document Identifier for Word Processor: E3824
A. Exhibit Letter
We have decided that it would be best for (1) to have (2) as (3) representative payee. This payee will get (4) payments for (5) each month and will use this money for (6) needs.
Check Information
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3824A |
(1) sending (2) regular monthly check of $ (3) to (4) about (5) . |
|
OR |
We (1) $ (2) to (3) for (4) about (5) . We (6) sending (7) regular monthly check of $ (8) to (9) around (10) . |
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(Optional) |
If You Have Saved Any Money While you were (1) representative payee, you may have saved some money for (2) . If you have, you should return it to us unless you have already made other plans with us for handling it. The money you will need to return includes:
How To Pay Us Back To do this, you should write us a check or money order. Make it out to the Social Security Administration. Be sure to write “Conserved Funds for (3) , (4) ” on that check or money order. Please mail it in the enclosed envelope. |
| (Optional) 3100FC |
|
| (Optional) 3821B |
What You Need To Do |
| As soon as possible, you should send us a final report of how you used the benefits you got. Use the “Representative Payee Report” we are sending you to do this. It tells you the period of time for which you have to report. | |
| (Optional) 3824C |
We are enclosing a copy of a letter that we sent to (1) payee. Please be sure to read it. If you disagree with anything in that letter, you can ask for an appeal. |
If You Have Any Questions
3901C - Domestic
3901D - Foreign
B. Requesting Instructions
In title II cases, the PC sends the notice to the beneficiary's legal guardian, parent or person standing in place of parent, whether or not they are former payees; or if they are unsuccessful payee applicants. Also send to an unsuccessful attorney applicant. For title XVI cases the FO should refer to GN 00503.130 on when the notice is system generated.
Select paragraph 3824B when the first payment to the new payee is different from the regular ongoing monthly benefit (retroactive benefits are due, a cost-of-living increase will occur the month after the payee change). Otherwise, select paragraph 3824A.
Select paragraph 3821A (If You Have Saved Any Money and How To Pay Us Back) if a refund of conserved funds is required.
Select paragraph 3100FC as the second paragraph in the section, “How To Pay Us Back” if refund of conserved funds is requested and the address is a foreign one. See NL 00703.100 for text.
ALERT: Since no advance notice is sent to beneficiaries living in foreign countries, the final notice must include appeal rights.
Select paragraph 3821B if a final accounting is requested.
Select 3824C in title II cases when a copy of the Award Notice is being sent to the parent, person standing in place of parent, or legal guardian.
See NL 00703.005E. for 3901C and 3901D text and fill-in.
Fill-ins:
Full name of beneficiary
name of payee
his, her
Social Security, Supplemental Security Income, Social Security and Supplemental Security Income.
First name of beneficiary, if child; if adult, “Mr.” or “Ms.” last name
his, her
-
If paragraph 3821A is requested:
Enclosure:
Return envelopeIf paragraph 3821B is requested:
Enclosures:
Return envelope
SSA-623-OCR-SM (for domestic cases) or SSA-7161-OCR-SM (for foreign cases)
3824A
We will begin, We began
first name of beneficiary, possessive, if child; if adult, “Mrs.” or “Ms.” last name, possessive
monthly payment amount
name of payee
month, day, year change is effective, in the format of January 3, 1991
3824B
sent, will send
amount of first payment
name of payee
first name of beneficiary, if child; if adult, “Mr.” or “Ms.” last name
month, day, year payment is due in the format, June 3, 1991
will begin/began
first name of beneficiary, possessive, if child; if adult, “Mr.” or “Ms.” last name, possessive
ongoing monthly benefit amount
name of payee
month, day and year regular monthly benefit check will first be received by the payee
3821A
first name of beneficiary, possessive, if child; if adult, “Mrs.” or “Ms.” last name, possessive
him, her
name of beneficiary
Show the actual claim number (Title II cases) or Social Security number (Title XVI cases), as appropriate.
3824C
first name of beneficiary, possessive, if child; if adult, “Mr.” or “Ms.” last name, possessive
C. Typing Instructions
In title II cases use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be on the Form SSA-573. In title XVI cases use the SSA-L8025-U2 (Supplemental Security Income Payment Decision), or SSA-L8166-U2 (Supplemental Security Income Notice) as appropriate. In concurrent SSA/SSI cases use SSA letterhead.