TN 31 (02-97)

(GN 00506.400A.1.)

Document Identifier for Word Processor: E3949

A. Exhibit Letter

We are writing to tell you that your organization must stop chrging and collecting fees for providing representative payee services to Social Security and Supplemental Security Income beneficiaries. This is effective beginning with any payments you receive after
(1) .

The Reason For Our Action

Your organization may no longer collect these fees for the following reason(s):

(2)

If You Disagree

If you disagree, you have 20 days from the date of this letter to ask for a review. However, even if you request a review, you must stop collecting fees for representative payee services after the date shown above. If we review and change our decision, your organization can then collect the fees for payments received after the date shown above.

If you want us to review our decision, you should send your written request to us at the address shown above.

• Your request should say that you are requesting a review of our decision that you can no longer collect fees for providing representative payee services.

• You should give the reason(s) you disagree with our decision and include any other information you feel is important.

Individuals who did not make the earlier decision will review your request and make a decision based on their review. Please allow 30 days for a response to your request.

If You Have Any Questions

If you have any questions, you should contact our office at the telephone number or address shown above.

B. Requesting Instructions

The FO will send this notice to inform an organization that it is no longer qualified to collect a fee for its payee services.

Fill-ins:

1. Month/day/year (Last day of the month the decision is made).

2. Reasons(s) the organization is no longer qualified (from the SSA-553). See GN 00506.400 for instructions on completing the SSA-553.

C. Typing Instructions

The FO will send on FO letterhead.