TN 34 (05-98)

(See GN 00503.130)

Document Identifier for Word Processor: E3823

A. Exhibit Letter

We have chosen (1) to be your representative payee. Your payee will get your checks each month and will use this money for your needs.

If You Have Any Questions

3901C - Domestic

3901D - Foreign

B. Requesting Instructions

• Send to any legally incompetent adult for whom a payee is being appointed, or to a child under age 18 who has been receiving his/her own benefits but will now have a representative payee. In title II and Black Lung cases the FO is responsible for designating the notice; the PC is responsible for preparing and releasing the notice and providing the fill-ins. In title XVI cases, the FO is responsible for preparing and releasing the notice.

• See NL 00703.005E for 3901C and 3901D text and fill-in.

   

Fill-in:

1. name of new payee

C. Typing Instructions

In title II and Black Lung cases use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be on the SSA-573. In title XVI cases, refer to NL 00801.015C.

Use the SSA-L8025-U2 (Supplemental Security Income Payment Decision), or SSA-L8166-U2 (Supplemental Security Income Notice) as appropriate.