TN 30 (03-96)
NL 00703.354 Conserved Benefits — Entire Amount Paid to New Representative Payee or to the Beneficiary
Document Identifier for Word Processor: E3354
A. EXHIBIT LETTER
We are writing to tell you about a check we are sending you (1) .
What We Will Pay and When
|3350A||It Is Important To Keep Track of This Money |
| ||You will need to keep track of how you use all of the money we send you for (1) . That is because every year we will ask you to report on how you used the money. We call this a representative payee accounting.|
If You Have Any Questions
3901C - Domestic
3901D - Foreign
B. REQUESTING INSTRUCTIONS
Send when the entire amount of conserved benefits returned by the former representative payee is being paid to the new payee or to the beneficiary.
Leave blank in direct pay cases. Otherwise, show:
“for name of beneficiary” in the format, for John Davies
Amount of conserved fund payment
month, day, year payment is due in the format of July 3, 1992
your, beneficiary first name, possessive in the format, John's, if child; if adult, “Mr.” or “Ms.” last name, possessive, in format Mr. Davis'
you, him, her
Optional Paragraph 3350A:
Beneficiary's first name, if child; “Mr.” or “Ms.” last name if adult.
Use paragraph 3350A only when we pay the conserved benefits to a representative payee and the type of payee code (TYP) is not SLM.
See NL 00703.005E. for 3901C and D text and fill-in.
C. TYPING INSTRUCTIONS
Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573.