We are writing to tell you about extra money we are sending you.
What We Will Pay and When
You are due $(1) . This is the money that the last representative payee saved for you and returned
You will get this money over a period of months.
We will send you $(2) each month in addition to the regular check you already get.
These checks will start (3) and end when all of the extra money is paid to you.
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 person lives outside the U.S. or has an attorney, omit this paragraph.