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
3901D - Foreign