NL 00701.237 Form SSA-L761 — Miscellaneous Adjustment Notice
A. Sample form
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This form is a payment notice used when none of the other form notices are applicable; e.g., reinstatement due to the attainment of age 70, cessation of foreign employment (see PEM 1200), “in-her-care” situations, cases in which the benefit payments were suspended pending the receipt of a correct address or a determination of a representative payee, etc. It may also be used as the notice of reinstatement of benefit payments to an auxiliary beneficiary whose benefits are not combined with those of the insured individual.
The appropriate standard or dictated paragraph explaining the reason the payment is being resumed must always be added to this notice. If there is an overpayment it will also be necessary to add the appropriate paragraph.
This notice requires four fill-ins:
the amount of next check.
the paid through month included in the next check.
the approximate date the check will be sent.
the regular monthly payment amount.