TN 30 (03-96)
NL 00703.208 Notice to Former Representative Payee to Continue to Administer Conserved Funds
Document Identifier for Word Processor: E3208
A. EXHIBIT LETTER
Your last report of how you used (1) (2) checks showed that you saved money for
(3) . Even though you no longer (4) payee, we have decided that you may continue to manage these savings.
It Is Important To Keep Track of This Money
We may ask you to tell us how you are managing this money. For that reason, you will need to keep track of how you use the savings.
Please let the new payee know when there is a change in your address. This is so that you can be reached quickly when (5) needs the money you have saved. If you move, be sure to give us your new address, too. The payee is (6) . (7) can be reached at (8) . We are also sending (9) a copy of this letter.
If You Have Any Questions
3901C - Domestic
3901D - Foreign
B. REQUESTING INSTRUCTIONS
Send to former payee when we decide to let him administer the funds he has saved.
Full name of beneficiary, possessive
Social Security, Supplemental Security Income, Black Lung (or any combination of these)
first name of beneficiary, if child; if adult, “Mr.” or “Ms.” last name
name of current payee
He, She, They
address of current payee
him, her, them
current payee name
Use paragraph 3901D when the former payee lives outside the U.S. Otherwise, use paragraph 3901C. See NL 00703.005E. for 3901C and 3901D text and fill-in.
C. TYPING INSTRUCTIONS
Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards for SSA and BL. Information for this notice will be shown on Form SSA-573. For title XVI, use FO letterhead.