We are writing to let you know that we are stopping your Social Security benefits in

(1) . This is the check you would normally get about (2) . Your benefits are stopping because you told us that you are working and plan to earn $ (3) during the year.

 

Information We Need From You

Let us know right away if the amount of money you expect to earn changes. We need this information so that we can pay you the right amount of benefits.

Also, please read the enclosed pamphlet, “When You Get Social Security Retirement or Survivors Benefits...What You Need To Know.” It explains the kinds of things you need to tell us.

 

If You Have Any Questions

3901C

 

Enclosure:

SSA Pub. No. 05-10077

This notice is used when a child beneficiary submits an estimate of earnings and a change of address. The amount of the estimate does not permit reinstatement during the current calendar year. Development of a proper payee has been deferred until a notice is received that the child is no longer working and has not returned to the payee's care. The notice is sent to the child at his/her new address.

 

Fill-ins:

1. (1) 

   month/year; e.g. July 1992

2. (2) 

   month/day/year; e.g., August 3, 1992

3. (3) 

   dollar amount of estimate

Refer to NL 00703.005E. for 3901C text.

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