TN 31 (02-97)

NL 00703.203 Notice of Misuse Negligence Determination

(GN 00604.055)

Document Identifier for Word Processor: E3203

DPS

A. EXHIBIT LETTER

We are writing to let you know that we made a decision in the misuse case involving (1) former representative payee, (2) .

 

How We Reached Our Decision

3203AWe reviewed the facts in this case and decided that benefits were misused. We didn't follow our rules for choosing the most qualified person to manage (1) benefits. As a result, we are sending you the misused benefits of $ (2) . You should receive this money soon.
3203BWe reviewed the facts in this case and decided that benefits were misused. We didn't look at (1) use of benefits as closely as we should have. As a result, we are sending you the misused benefits of $ (2) . You should receive this money soon.
3203CWe reviewed the facts in this case and decided that benefits were misused. We didn't follow our rules for choosing the most qualified person to manage (1) benefits. We also didn't look at (2) use of benefits as closely as we should have. As a result, we are sending you the misused benefits $ (3) . You should receive this money soon.
3203DWe carefully reviewed the facts in this case and decided that we are not at fault in the misuse of benefits. We selected the proper payee for (1) based on our rules for choosing representative payees and the facts we had. And, we followed all our rules for monitoring the payee's use of benefits. We have asked (2) to pay us back the misused benefits of $ (3) . Any money returned will be sent to you.

B. REQUESTING INSTRUCTIONS

  • Send this notice to new representative payee or the beneficiary when a former representative payee has misused benefits and a negligence determination is made.

  • Select paragraph 3203A if there is misuse which resulted because we were negligent in our selection investigation of the representative payee.

  • Select paragraph 3203B if there is misuse which resulted because we were negligent in monitoring the representative payee's use of funds.

  • Select paragraph 3203C if there is misuse which resulted because we were negligent in both our selection investigation and monitoring of the representative payee's use of funds.

  • Select paragraph 3203D if we were not at fault.

     

Fill-ins:

  1. your/beneficiary's name, possessive

  2. former payee's name

3203A(1)your beneficiary's surname, possessive, in format, Mrs. Smith's
 (2)money amount
3203B(1)former payee's surname, possessive, in format, Mr. Doe's
 (2)money amount
3203C(1)your/beneficiary's surname, possessive, in format, Mrs. Smith's
 (2)former payee's surname, possessive, in format, Mr. Doe's
 (3)money amount
3203D(1)you/beneficiary's surname, in format, Mrs. Smith
 (2)former payee's surname, in format, Mr. Doe
 (3)money