NL 00703: Exhibit and Dictated Letters
TN 30 (03-96)
Document Identifier for Word Processor: E3927
A. Exhibit letter
We are writing to let you know that your entitlement to benefits ended as of (1) . We based this on information that (2) became age 16 in (3) .
| 3927A | We can pay (1) benefits only when you have (2) child in your care, under age 16 or disabled, who is entitled to Social Security benefits. |
| 3927B | We can pay (1) benefits only when you have a child in your care, under age 16 or disabled, who is entitled to benefits on (2) Social Security record. |
(If there is an overpayment, follow instructions in NL 00703.920 on what paragraphs to include.)
Other Social Security benefits
3922E
OR
3922F
Your responsibilities
When benefits are terminated during the year, you must file an annual report if you earn over $ (4) . In this report, include your earnings for the entire year both before and after your benefits were terminated.
If you disagree with the decision1
ALS020
If you want help with your appeal2
3100E
If you have any questions
3901C
1 If there is an overpayment, omit this paragraph.
2 If the person has an attorney, omit this paragraph.
B. Requesting instructions
The benefit authorizer sends to the terminated parent when the youngest child-in-care attains age 16.
Use paragraphs 3927A and 3922E when benefits to mother/father terminate because last child-in-care marries. Use paragraphs 3927B and 3922F when benefits to wife, husband, former wife, former husband terminate. Use ALS020 (except when there is an overpayment), 3100E and 3901C in all cases.
-
Refer to NL 00703.180 for ALS020 text. Refer to NL 00703.100 for 3100E text. Refer to NL 00703.005E. for 3901C text.
Fill-ins:
last month/year of entitlement e.g., May 1993
full name of child beneficiary
month/year e.g., June 1993
exempt amount for year of termination
|
3927A |
|
|
|
|
3927B |
|
|
C. Typing instructions
Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573.