NL: Notices, Letters and Paragraphs
TN 31 (02-97)
Document Identifier for Word Processor: E3944
A. EXHIBIT LETTER
We cannot allow your organization to collect a fee for serving as representative payee for Social Security and Supplemental Security Income beneficiaries. Your organization does not qualify to collect a fee for the following reason(s):
(1)
(2)
If You Disagree
If you disagree, you have 20 days from the date of this letter to request a review.
The request must be in writing and should be sent to us at the above address.
It should state that you disagree and believe that your organization should be allowed to collect a fee for representative payee services.
It should also give the reason(s) you disagree.
Please include any additional information you feel is important.
Individuals who did not act on your first request will review this issue again. Please allow 30 days for a response.
If You Have Any Questions
3765C
B. REQUESTING INSTRUCTIONS
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The FO will send this exhibit notice to organizations which have been denied authorization to collect a fee for services. Select the fill-in choice(s) which explains the reason a fee may not be authorized.
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Fill-ins:
Use one or more of the following choices as appropriate:
| A= | It is not bonded or licensed by the State in which it serves as representative payee. |
| B= | It is not community based. |
| C= | It is not regularly serving as representative payee for at least five individuals. |
| D= | It is not a nonprofit social service agency. |
| E= | It is a creditor of the beneficiaries for whom it is representative payee and it does not meet an exception. |
| F= | Its mission is other than income maintenance, social service or health-care related activities. |
| G= | It does not have fiduciary responsibilities. |
Add any other comments that apply to explain the denial.
Refer to NL00703.765 for 3765C text and fill-ins.
C. TYPING INSTRUCTIONS
The FO will send this exhibit notice to explain the denial.