TN 31 (02-97)

NL 00703.202 Misuse Not Established — Notice to Beneficiary or Representative Payee

(GN 00604.040)

Document Identifier for Word Processor: E3202


We are writing to you about the benefits we (1) to (2) on (3) behalf. We looked at how this person used the benefits and found that the money was used for (4) needs.


How We Reached Our Decision



Information About Replacement of Benefits

A representative payee must use any benefits we pay for (6) needs. If the payee misuses the money, we will ask him or her to pay it back. If the money is not repaid, you may be able to collect it from us. We will replace the benefits if we were at fault by selecting an unsuitable payee or not monitoring the payee correctly. This only applies to cases where a payee misuses the benefits.

Since this payee used the benefits properly, we have decided that (7) not qualify for replacement of benefits.


If You Think (8) For Replacement of Benefits

If you think that (9) for replacement of benefits, you have the right to ask us to look at the case again. We will review this case again and consider any new facts you have.

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you receive this letter.

  • You must have a good reason if you wait more than 60 days to ask for an appeal.

  • To appeal, you must fill out a form called "Request for Reconsideration. The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out this form.




If You Want Help With Your Appeal



If You Have Any Questions

3901C -Domestic
3901D - Foreign


The FO will send this notice to the beneficiary and/or the representative payee when misuse is not found.

  • Use 3100E if the beneficiary lives in the U.S.

  • Refer to NL 00703.100 for 3100E text.

  • Refer to NL 00703.005E. for 3901C and 3901D text and fill-ins.



  1. (1) 

    are sending/sent

  2. (2) 

    (payee name)

  3. (3) 

    your/(beneficiary name, possessive)

  4. (4) 

    your/(beneficiary title and surname, possessive)

  5. (5) 

    narrative explanation of the misuse decision

  6. (6) 

    your/(beneficiary title and surname, possessive)

  7. (7) 

    you do/(beneficiary title and surname) does

  8. (8) 

    You Qualify/He Qualifies/She Qualifies

  9. (9) 

    you qualify/he qualifies/she qualifies

To Link to this section - Use this URL:
NL 00703.202 - Misuse Not Established — Notice to Beneficiary or Representative Payee - 02/19/2015
Batch run: 04/25/2016