Social Security Administration
Retirement, Survivors and Disability Insurance
Important Information
100 East Capitol St. SE
Washington, DC 20019
Phone: (202) 555-5555
Office Hours: 8:30 a.m. until 5:00 p.m.
Date:
Claim Number: 123-00-6789A
Mrs. Jane Doe
103 Main Street
Washington, DC 20019
We are writing to you about your agreement to repay us $500 for John Doe's Supplemental
Security Income (SSI) checks you cashed after his death.
Your Agreement
You agreed to repay the money because you cashed those checks. You asked us to hold
back $100 from your Social Security benefit check each month until you repaid the
$500 back.
Since you are no longer entitled to monthly Social Security benefits, you are personally
liable for repayment of the $500. If you cannot refund the full amount now, you should
submit a partial payment. With this payment, send an explanation of your circumstances
and a definite plan for paying the balance. Your plan should show the amount you would
pay each month and the date on which you will make each payment. You should make the
initial payment within 30 days from the receipt of this letter. Please make your check
or money order payable to "Social Security Administration, Claim No. XXXX." Enclosed
is an envelope for your convenience.
If You Have Any Questions
If you have any questions, you should call, write or visit any Social Security office.
If you call or visit our office, please have this letter with you and ask for Sallie
Claims rep. The telephone number is at the top of page 1. We can answer most questions
over the phone. If you plan to visit an office, you may want to call ahead to make
an appointment. This will help us serve you more quickly.
Field Office Manager
Enclosure:
Return Envelope