We told you in an earlier letter that we would let you know when we made a final decision about (1) (2) . Based on the information in your file, we will continue to use (3) to figure your payments. This decision does not change (4) .

 

If You Disagree With The Decision

3180A

 

If You Want Help With Your Appeal¹

3100E

 

If You Have Any Questions

3901 C- Domestic

3901 D- Foreign

¹ If the person lives outside the U.S. or has an attorney, omit this paragraph.

• •

  Send this notice as a followup to the partial award after development has been completed on the unresolved issues. The notice explains that our decision does not affect benefits and/or the month of entitlement.

• •

  Refer to NL 00703.005E. for 3901C and 3901D text and fill-ins. Refer to NL 00703.180 for 3180A text. Refer to NL 00703.100 for 3100E text.

   

Fill-ins:

1. (1) 

   “your,” (full name of claimant or number holder), possessive

2. (2) 

   issue that was being developed, e.g.: “date of birth,” “wages,” “date of marriage”

3. (3) 

   findings, e.g.:“a date of birth of (month/day/year)”, “wages of $$$¢¢ for (year)” , “a date of marriage of (month/day/year)”

4. (4) 

   “the amount we can pay (4A) ,” OR “the month when (4B) first entitled to benefits or the amount we can pay (4C)

   (4A)

   “you,” “him,” “her”

   (4B)

   “you were,” “he was,” “she was”

   (4C)

   “you,” “him,” “her”

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