TN 17 (10-11)

NOTE: "Erroneous Death Case Notice" & "Erroneous Death Case - Third Party Contact" notices in these exhibits are available on the document processing system (DPS) under the "General" menu selection.

Exhibit 1A

 USE:

When a number holder (NH) notifies us that our records incorrectly show him or her as being deceased; use this language to obtain his or her consent to notify third parties that we gave incorrect information and ask them to change their records.

 LANGUAGE:

 We are responding to your request that we correct our records. We removed incorrect information from our records that showed you as deceased. If you want us to ask (organization's name and address) to correct their records, please sign the tear-off portion of this letter and return it to us at the address shown above.

We are sorry for any inconvenience this incorrect information may have caused you.

I give the Social Security Administration my consent to use my Social Security number to let the (organization's name and address) know that I am not deceased. My Social Security number is (Social Security number).

Signature                  Date           

Exhibit 1B

USE:

 Use when an NH alleges that our records incorrectly show him or her as deceased but our records are correct. We will notify the agency that used the information that the individual is alive if the individual gives his or her consent.

LANGUAGE:

We are responding to your request that we correct our records. Our records are correct and do not show you as deceased. However, if you want us to ask (organization's name and address) to correct their records, please sign the tear-off portion of this letter and return it to us at the address shown above.

We are sorry for any inconvenience this may have caused you.

I give the Social Security Administration my consent to use my Social Security number to let the (organization's name and address) know that I am not deceased. My Social Security number is (Social Security number).

Signature                 Date           

 Exhibit 2A

USE:

Do not use this notice until we have the NHs consent. Use this language to notify third parties that we gave erroneous information and ask them to change their records.

LANGUAGE:

 We are writing to let you know about a correction in our records for (NHs full name), whose Social Security number is (Social Security number). Our records incorrectly showed (him or her) as deceased. However, we have since found that (he or she) is alive.

Please change your records to show the correct information. We are sorry for any inconvenience the incorrect information may have caused you.

cc: (NHs Name)

Exhibit 2B

USE:

Do not use this notice until we have the NHs consent. Use this language when our records are correct but the NH says a third party's records show him as deceased. Use to notify the third party that the NH is alive and to ask them to change their records.

 LANGUAGE:

We are writing to let you know that (NHs full name), whose Social Security number is (Social Security number), is alive. (NHs full name) has informed us that your records show (he or she) is deceased.

Please change your records to show the correct information. We are sorry for any inconvenience this may have caused you.

cc: (NH's Name)