TN 31 (02-97)

(GN 00506.300B.)

Document Identifier for Word Processor: E3950

DPS

A. EXHIBIT LETTER

We recently selected your organization as representative payee for (1) , claim number (2) . If you haven't received the letter telling you of this selection, it should arrive soon.

When you filed to be representative payee, you requested authorization to collect a fee for your services as representative payee. After reviewing your relationship as the beneficiary's creditor, we have decided that your organization (3) collect fees for acting as this person's representative payee.

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 creditor organization advising them whether they are authorized to collect representative payee fees.

If the organization may not collect a fee, include a reason at the end of the sentence that contains fill-in (3).

Fill-ins:

1. Name of beneficiary

2. Claim number

3. may/may not

C. TYPING INSTRUCTIONS

The FO will send on FO letterhead.