The FO sends this notice when accrued benefits were withheld at the time benefits
were awarded and the withheld amount will now be paid to the representative payee
in monthly installments.
Name of beneficiary in the format, Joan Sands
First name of beneficiary, if child; if adult, “Mr.” or “Ms.” last name
Total amount of money due the beneficiary
First month and year accrued benefits were withheld in the format, May 1992
Last month and year accrued benefits were withheld
Amount to be paid in each installment
Month, day, year the first installment payment will be made in the format of
August 3, 1993
Optional Paragraph 3350A:
Beneficiary first name, if child; if adult, “Mr.” or “Ms.” with last name
Use paragraph 3350A when the type of payee code (TYP) is not SLM.
See NL 00703.005E. for 3901C and D text and fill-in.