TN 105 (09-23)

NL 00703.356 Conserved Benefits — Monthly Installments Paid To New Representative Payee

(GN 00603.085)

Document Identifier for Word Processor: E3356


We are writing to tell you about extra money we are sending you for (1) .


What We Will Pay and When

  • (2) is due $(3) . This is the money that the last representative payee saved for them and returned to us.

  • You will get this money over a period of months.

  • We will send you $(4) each month in addition to the regular check you already get for them.

  • These checks will start (5) and end when all of the extra money is paid to you.



3350A It Is Important To Keep Track of This Money
You will need to keep track of how you use all of the money we send you for (1) . That is because every year we will ask you to report on how you used the money. We call this a representative payee accounting.


If You Have Any Questions

3901C - Domestic

3901D - Foreign


Send when the conserved amount returned by the former payee is paid to the new representative payee in monthly installments.



  1. (1) 

    Full name of beneficiary in the format, Joan Sands

  2. (2) 

    First and last name of beneficiary

  3. (3) 

    amount returned by the former payee

  4. (4) 

    amount of each monthly installment

  5. (5) 

    month, day, year the first installment will be paid in the format, August 10, 1992.

Optional Paragraph 3350A:

  1. (1) 

    Beneficiary's first name, if child or adult, with last name

Use paragraph 3350A when the type of payee code (TYP) is not SLM.

See NL 00703.005E. for 3901C and D text and fill-in.


Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573.

To Link to this section - Use this URL:
NL 00703.356 - Conserved Benefits — Monthly Installments Paid To New Representative Payee - 09/21/2023
Batch run: 01/30/2024