TN 54 (06-09)

(RS 00207.025)

Document Processing System (DPS) Identifier SSA-4111/L7 - Cover Notice for Certificate of Election (Survivor) located in Cover letter folder

A. Exhibit letter –cover notice for the SSA 4111

(1)

We recently talked with you about getting permanently reduced (2) benefits.

What You Need To Do

To get these permanently reduced benefits you need to complete the enclosed Certificate of Election and return it in the envelope provided. The benefit rate is reduced by a specified percentage for each month you are entitled before full retirement age (FRA). For example, if you were born between 1945 and1956, the benefit reduction would be about 0.396 percent for each month you are entitled before your FRA. If the deceased worker received retirement benefits before FRA, the maximum survivor’s benefit is limited to the higher amount that the deceased worker would have received if still alive or 82.5 percent of the deceased worker’s unreduced benefit.

Because of this limit, delaying receipt of reduced (3) benefits will not necessarily increase the monthly benefit amount payable. We will review your election in item 3 of the Certificate of Election to make sure that the month selected maximizes your benefit amount.

Please call the number shown above if you need help completing the Certificate of Election.

Other Social Security Benefits

• If the deceased worker’s death occurred prior to FRA or prior to one year past FRA and he/she could not work due to disability before death, you may be able to get higher benefits on the deceased worker’s record. You have to file a separate application for the higher benefits within 3 months after the month the worker died.

• If you were married before, you may be able to get a higher benefit on your prior spouse's record. Please file an application to determine if you are eligible for these benefits.

If You Have Any Questions

3901C

3901D

OPTIONAL:

UTI: REF061 (TSC use)

UTI: REF120 (TSC use)

Enclosures:

SSA-4111

Preaddressed Envelope

B. Procedure - when to Use

The FO or TSC sends the cover letter with the SSA-4111 if they receive the report of death.

C. Procedure - FO/TSC typing instructions

The FO will use FO letterhead.

See NL 00703.005E. for 3901C and 3901D text or UTI: REF038 and APT054.

Fill - ins:

1. We are sorry to learn of your loss. Please accept our sincere sympathy.                             (Request fill-in (1) if notice is going to the widow(er) UTI= LIS020)

2. widow’s or widower’s or surviving divorced spouse’s

3. widow’s or widower’s or surviving divorced spouse’s

   NOTE: The TSC will request the optional referral paragraphs (UTI REF061 and REF120).

   A Spanish language version of the cover notice is available in DPS.