We are writing to let you know that we are stopping (1) Social Security benefits in
(2) . This is the check you would normally receive on (3) .
(4) benefits are stopping because you have not returned the form, (5) . We need the information requested on this form to decide if (6) can receive benefits again.
What You Need To Do
We have enclosed another copy of the form with this letter. Please complete this form
and return it to us in the enclosed envelope.
Once we get this information, we will let you know if (7) can still receive benefits.
If You Have Any Questions