You asked us not to hold back your full monthly benefit for (1) . Instead, you asked us to hold back only $ (2) from your Social Security check each month from (3) . We cannot do what you asked because (4) .

Because of your work, we have to hold back your full benefits until (5) .

What We Will Pay And When

• •

  You will receive $ (6) around (7) . This is the money you will be due for (8) .

• •

  After that, you will receive $ (9) each month.

   

If You Have Any Questions

3901C

If the reviewing office has disapproved the beneficiary's request to have his /her work suspensions prorated or deferred, send this letter to explain the reason for disapproval. Because such a rejection is not an initial determination and carries no appeal rights, no reconsideration paragraph will be included in this notice. Furnish all information for this notice on a Form SSA-573

Fill-ins:

1. (1) 

   month/year through month/year (of full withholding) e.g. January 1992 through May 1992

2. (2) 

   amount of denied withholding

3. (3) 

   month/year through month/year (of requested pro-rated withholding), e.g. January 1992 through November 1992

1. (5) 

   last month/year of full withholding, e.g. May 1992

2. (6) 

   amount of next payment

3. (7) 

   month/day/year of next payment, e.g. July 3, 1992

4. (8) 

   month and year for which payment will be due, e.g. June 1992

5. (9) 

   continuing MPA

Refer to NL 00703.005E. for 3901C text.

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