We are writing to tell you that we have not received the form, Report to United States Social Security Administration, which we sent you to complete. We need the information on the form to decide if you should still receive checks.

 

How You Can Give Us This Information

If you still have the form we sent you, please answer the questions on it and mail it back to us. Let us know if you need any help in answering the questions. Once we have the form, we will let you know if you can still receive benefits.

 

What We Plan To Do

Also, please let us know right away if you did not receive the form or if you lost it.

If we do not hear from you within 15 days of the date of this letter, we will stop your checks. This is because we do not have the information we need to show that you can still receive checks.

 

If You Have Any Questions

3901D - Foreign

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  Send follow-up notice to any beneficiary who has not returned the SSA-7162-OCR-SM (Report to United States Social Security Administration) or SSA-7161-OCR-SM (Report to United States Social Security Administration by Person Receiving Benefits for a Child or an Adult Unable to Handle Funds) before suspension action.

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  Use paragraph 3901D referral paragraph. Text and fill-ins may be found in NL 00703.005E.

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