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 checks you cashed after his death.
Your Agreement
You agreed to repay $100 each month until you repaid us the total amount of $500.
What Our Records Show
We have not received the $100 payment that was due by December 1, 2000. If you cannot
send us the payment by December 31, 2000, please get in touch with us. If you have
already sent this payment, please disregard this request.
If We Do Not Hear From You
If you do not pay us or get in touch with us about this by XX/XX/XX, we will consider
sending this case to the Office of the Inspector General or the United States Secret
Service for possible prosecution.
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