TN 31 (02-97)

Document Identifier for Word Processor: E3771

A. Exhibit Letter

We are writing to let you know that (1) can no longer collect a fee from (2) monthly benefits for serving as (3) representative payee. If they were collecting a fee, they must stop doing so after (4) .

If You Have Any Questions

3765C

B. Requesting Instructions

• The FO will send this notice when the representative payee's authorization to collect a fee has been revoked.

• 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.

   

Fill-ins:

1. name of representative payee

2. your, name of beneficiary (possessive)

3. your, his, her

4. the last month/year in which the organization is permitted to collect a fee from this beneficiary.

C. Typing Instructions

The FO will send this notice. It may be reproduced on FO letterhead.