TN 3 (05-92)

PROCEDURE

1. General

After you complete the notice:

• If using the manual snap-out form, separate the original from the two pressure-sensitive copies, if using the PC version, print two copies.

• Include the SSA-4017 (SSI payment stub) and the appropriate refund envelope (SI 02220.010 C.5) unless there is a representative payee; and

• Mail the notice and enclosures to the individual and document the file with the FO copy of the notice.

2. Representative Payee Involvement

If the overpaid individual has a representative payee send the payee's copy with the SSA-4017 and the return envelope.

3. Legal Guardian or Appointed Representative

If the overpaid individual has a legal guardian and/or appointed representative who is not the representative payee, send a photocopy of the notice to each.