TN 30 (03-96)
NL 00703.357 Conserved Benefits — Monthly Installments Paid to the Beneficiary
(GN 00603.070 and GN 00603.085)
Document Identifier for Word Processor: E3357
A. EXHIBIT LETTER
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 to us.
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.
B. REQUESTING INSTRUCTIONS
Send when the conserved amount returned by the former payee is paid to the beneficiary in monthly installments.
amount returned by the former payee
amount of each monthly installment
month, day, year the first installment will be paid in the format, August 10, 1992
See NL 00703.180 for 3180A and 3180B text. See NL 00703.100 for 3100E text.
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.