1 PCOC: 1 ATTN: OPERATIONS ANALYSIS STAFF
MBR ALERT (MMDDYY)
NOTICE OF NUMBER HOLDER'S REMOVAL (DEPORTATION)
SSN: XXX-XX-XXXX BCIS NAME:
DOB: MMDDYYYY ALIAS:
MBR NAME:
DATE REMOVED: MMDDYYYY DATE SSA NOTIFIED: MMDDYYYY
IMPORTANT INFORMATION: SSA HAS RECEIVED NOTICE THAT THE NUMBER HOLDER ON THIS RECORD
WAS REMOVED FROM THE U.S. SUSPENSION OF RSDI BENEFITS MAY BE REQUIRED UNDER SECTION
202(N) OF THE SOCIAL SECURITY ACT.
INSTRUCTIONS: SEE POMS RS 02635.000.