BASIC (04-00)

Document Identifier for Word Processor: TITLE 8 LEGAL GUARD. OR UNSUCCESFUL PAYEE APP.

A. EXHIBIT LETTER

We have decided that it would be best for __(1)__ to have __(2)__ as __(3)__ representative payee for Special Veterans Benefits (SVB) payments. This payee will get the SVB payments for __(4)__ each month and will use this money for __(5)__ needs.

Payment Information

[Optional Paragraph #1—if first payment to payee is the same as the regular payment]

We __(1)__ sending __(2)__ regular monthly payment of $__(3)__ to __(4)__ on or about __(5)__.

[Optional Paragraph #2-if first payment to payee is different from the regular payment]

We __(1)__ $__(2)__ to __(3)__ for __(4)__ on or about __(5)__. We will begin sending __(6)__ regular monthly payment of $__(7)__ to __(8)__ on or about __(9)__.

[Optional Paragraph #3-if refund of conserved funds is required]

If You Have Saved Any Money

While you were __(1)__ representative payee, you may have saved some money for __(2)__. If you have, you should return it to us unless you have already made other plans with us for handling it. The money you will need to return includes:

• Saved and invested SVB payments.

• Interest earned from these savings and investments.

• Money you have left over from any SVB payments we sent you.

• Any SVB payments you might get after the date of this letter.

How To Pay Us Back

To do this, you can write us a check or money order. Make it out to the Social Security Administration. Be sure to write "Conserved Funds for __(3)__, Special Veterans Benefits" on that check or money order. Please mail it in the enclosed envelope.

[Optional Paragraph #4-if refund of conserved funds is required and the address is a foreign one]

Please send your check or money order in United States currency or in local currency equal to the United States dollars. When you pay us in local currency, we use the exchange rate in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment directly to us, please go to one of the offices shown in the last section "If You Have Questions or Need Help" for help in making the refund.

[Optional Paragraph #5-if final accounting is requested]

What You Need To Do

You should send us a final report of how you used the SVB payments you got. Use the form we are sending you to do this.

[Optional Paragraph #6-if copy of award notice is being sent to legal guardian]

We are enclosing a copy of a letter that we sent to __(1)__ representative payee. Please be sure to read it. It contains important information.

[Optional Paragraph #7-Appeals Language-no advance notice/foreign address]

Do You Disagree With The Decision?

If you think you should get __(1)__ payments or that someone else should help manage __(2)__ payments, you have the right to appeal this decision. We will review the case again and consider any new facts you have. Then a person who did not make the first decision will decide your case again.

• You have 60 days to ask for an appeal.

• You must put the request for an appeal in writing.

• The 60 days start the day after you receive this letter.

• You must have a good reason if you wait more than 60 days to ask for an appeal.

• You may make your request through any U.S. Social Security office, United States Embassy or consulate, or the U.S. Veterans Affairs Regional Office in Manila. Or, you may write to us at the address shown at the top of this letter.

Please read the enclosed leaflet, “Your Right to Question the Decision Made on Your Social Security Claim.” It contains more information about an appeal.

If You Have Questions or Need Help

• If you live in Canada, contact any U.S. Social Security office.

• If you live in Guam, Puerto Rico, Samoa or the U.S. Virgin Islands, you should contact the nearest U.S. Social Security Office.

• If you live in Mexico, contact any U.S. Social Security office or the nearest United States Embassy or consulate.

• In the Philippines, please call 523-1001 extensions 2516 or 2645 from 8:00am to 2:00p.m. or write/visit SSA Division, U.S. Department of Veteran's Affairs, 1131 Roxas Boulevard, 0930 Manila.

• In any other country, you should contact the nearest United States Embassy or consulate.

If you call or visit an office, please have this letter with you.

Notice Fill-ins:

1. (full name of beneficiary)

2. (payee name)

3. (his) or (her)

4. (Mr.,Ms.) (beneficiary's last name)

5. (his) or (her)

Optional Paragraph #1 Fill-ins:

1. (will begin) or (began)

2. (Mr.) or (Ms.) beneficiary's last name, possessive

3. (monthly payment amount)

4. (payee name)

5. (month, day, year change is effective)

Optional Paragraph #2 Fill-ins:

1. (sent) or (will send)

2. (amount of first payment)

3. (payee name)

4. (Mr., Ms.) (beneficiary's last name)

5. (month, day, year of first payment)

6. (Mr., Ms.) (beneficiary's last name, possessive)

7. (regular monthly benefit amount)

8. (him, her, them)

9. (regular monthly payment date)

Optional Paragraph #3 Fill-ins:

1. Mr., Ms. beneficiary's last name, possessive)

2. (him) or (her)

3. (full name of beneficiary)

Optional Paragraph #6 Fill-in:

1. (Mr., Ms.) (beneficiary's last name, possessive)

Optional Paragraph #7 Fill-ins:

1. (Mr., Ms.) (beneficiary's last name, possessive)

2. (his) or (her)

B. REQUESTING INSTRUCTIONS

The CPS is responsible for sending this notice.

Select Optional Paragraph #1 if first payment is the same as the regular payment or if different, select Optional Paragraph #2.

Select Optional Paragraph #3 if a refund of conserved funds is being requested. If a foreign address is involved, select Optional Paragraphs #4 and #7, and enclose Pub. 05-10058, “Your Right to Question the Decision Made on Your Social Security Claim.” If a final accounting is also being requested, select Optional Paragraph #5.

Select Optional Paragraph # 6 if a copy of the award notice is being sent.