We are writing to tell you about a change in (1) Social Security benefits. Beginning
(2) , we have refigured your benefits (3) .
You still will not receive regular monthly checks because (4) . If we can send you money in the future, (5) new monthly payment will be $ (6) .
If You Disagree With The Decision
3180A - Domestic
3180B - Foreign
If You Want Help with Your Appeal1
If You Have Any Questions
3901C - Domestic
3901D - Foreign
1 If the beneficiary has an attorney or lives outside the U.S. omit this paragraph.