We are writing to you about the (1) benefits we sent to (2) on (3) behalf. We looked at how this payee used the benefits and found (4) used the money for (5).
How We Reached Our Determination
Information About Replacement of Benefits
A representative payee must use any benefits we pay for (7). If the payee misuses the money, we will ask them to pay it back. This only applies to cases where a
payee misuses the benefits.
Since this payee used the benefits for (8), (9) not qualify for replacement of benefits.
If You Disagree With Our Determination
Please contact us within 30 days of the date you received this letter if you disagree
with our determination that (10) payee used the benefits for (11). We assume you got this letter 5 days after the date on it. Please present any new
facts and the reason you think our determination is wrong. We will close the case
in 35 days if we do not receive a request for review from you. We will treat any new
facts received after 35 days as a new case.
If You Have Any Questions
3901D - Foreign