TN 30 (03-96)
NL 00703.356 Conserved Benefits — Monthly Installments Paid To New Representative Payee
Document Identifier for Word Processor: E3356
A. EXHIBIT LETTER
We are writing to tell you about extra money we are sending you for (1) .
What We Will Pay and When
(2) is due $(3) . This is the money that the last representative payee saved for (4) and returned to us.
You will get this money over a period of months.
We will send you $(5) each month in addition to the regular check you already get for (6) .
These checks will start (7) and end when all of the extra money is paid to you.
|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 conserved amount returned by the former payee is paid to the new representative payee in monthly installments.
Full name of beneficiary in the format, Joan Sands
First name of beneficiary if child; if adult, “Mr.” or “Ms.” last name of beneficiary
amount returned by the former payee
amount of each monthly installment
him or her
month, day, year the first installment will be paid in the format, August 10, 1992
Optional Paragraph 3350A:
Beneficiary's 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.
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.