TN 31 (02-97)

(GN 00506.140B.)

Document Identifier for Word Processor: E3770

A. EXHIBIT LETTER

We are writing to let you know that (1) has been approved to collect a fee from (2) monthly benefits for serving as (3) representative payee. They can begin collecting these fees in (4) .

What (5) Representative Payee Can Collect

(6) representative payee may collect a fee of 10 percent of (7) total monthly benefits, but no more than $ (8) each month.

If You Have Any Questions

3765C

B. REQUESTING INSTRUCTIONS

• Send this notice to inform a legally competent adult, emancipated minor, legal guardian, or parent or person standing in place of parent when the representative payee has been authorized to collect a fee.

• Show the title of the officer and the name of the institution or entity. Do not show the name of such officer.

• Refer to NL 00703.765 for 3765C text and fill-ins.

• The fee amounts for fill-in (8) will change each year beginning 1996, subject to the Consumer Price Index.

   

Fill-ins:

1. Name of representative payee

2. your, name of beneficiary (possessive)

3. your, his, her

4. month/year organization can begin collecting fees from this beneficiary

5. Your, His, Her

6. Your, first name of beneficiary (possessive)

7. your, his, her

8. maximum non-DAA amount, maximum DAamount

C. TYPING INSTRUCTIONS

This notice will be sent by the FO. It may be reproduced on FO letterhead.