NL: Notices, Letters and Paragraphs
TN 34 (05-98)
(See GN 00503.130)
Document Identifier for Word Processor: E3828
A. EXHIBIT LETTER
We have decided that it is best for (1) to have (2) (3) checks paid directly to (4) .
Check Information
| 3828A |
(1) sending (2) regular monthly check of $ (3) to (4) about (5) . |
| OR 3828B |
We (1) $ (2) to (3) around (4) . We (5) sending (6) regular monthly check of $ (7) to (8) around (9) . |
If You Disagree With the Decision
If you disagree with the decision, you have the right to appeal. We will review your case again and consider any new facts you have. (5) Then a person who did not make the first decision will decide your case again.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5 day period.1
You will have to have a good reason for waiting more than 60 days to ask for an appeal.
To appeal, you must fill out a form called “Request for Reconsideration.” The form number is SSA-561-U2. To get this form, contact one of our offices. We can help you fill out the form.
3828C |
We are enclosing a copy of a letter that we sent to (1) . Please be sure to read it. If we are wrong about anything in that letter, you can ask for an appeal. |
(Optional) |
How To Appeal |
There are two ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide (1) case. |
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(Optional)
If You Want Help With Your Appeal
3215E
If You Have Any Questions
3901C - Domestic
3901D - Foreign
Enclosure:
Pamphlet No. SSA-05-10058
1 Delete this sentence for foreign claims.
B. REQUESTING INSTRUCTIONS
In title II cases, the FO is responsible for designating this notice. When a copy of the award notice will be sent to the parent or legal guardian, the FO will designate optional paragraph 3828A to be included in the notice. The PC is responsible for providing all necessary fill-ins. In title XVI cases, the FO is responsible for the entire notice.
Select paragraph 3828B when the first payment to the beneficiary is different than 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 3828A.
Use paragraph 3826D and 3215E in title XVI cases.
Use Optional paragraph 3828C in title II cases whenever we are sending a copy of the Notice of Award to the beneficiary.
Fill-ins:
name of beneficiary
his, her
Social Security, Supplemental Security Income.
him, her
Include this sentence only in title II cases.
3828A
We will begin, we began
first name of beneficiary, possessive case
monthly payment amount
him, her
month, day year change is effective, in the format of January 3, 1992.
3828B
sent, will send
amount of first payment
first name of beneficiary
month, day, year payment is due in the format of June 3, 1992
will begin/began
his, her
ongoing monthly benefit amount
him, her
month, day and year regular monthly benefit check will first be received by the beneficiary.
3828C
first name of minor child or incompetent beneficiary.
3828D
first name of minor child or incompetent beneficiary, possessive case
his, her
his, her
his, her
his, her
See NL 00703.005E. for 3901C and 3901D text and fill-in.
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 Form SSA-L8025-U2 (Supplemental Security Income Payment Decision) or SSA-L8166-U2 (Supplemental Security Income Notice) as appropriate. Refer to NL 00801.015C.