TN 30 (03-96)
NL 00703.500 Adjustment Notice, Combined Check Reduced — Child's Estimate of Earnings Caused Partial or Total Deductions
Document Identifier for Word Processor: E3500
A. EXHIBIT LETTER
We are writing to tell you about a change in the children's checks. We will reduce these checks beginning (1) because we were told that (2) plans to earn $ (3) this year.
What We Will Pay And When
You will receive $ (4) around (5) . This is the money due for (6) .
After that, you will receive $ (7) each month.
Your check is the combined amount due the children. The benefit amount for each child is:
Please let us know right away if there are changes in the amount of money (10) expects to earn. This will help us make sure that we are paying the correct check amounts.
If You Have Any Questions
B. REQUESTING INSTRUCTIONS
Use this notice when a combined payment is reduced because one of the children submits an estimate of earnings that cause a partial or total deduction of his /her benefits, resulting in a decrease in the total amount of the combined payment.
effective month/year of change, e.g., June 1992
full name of working child
amount of working child's earnings
amount of next check
date of next check, e.g., July 3, 1992
effective month/year of change
list names if each child
list payment amounts of each child
first name of working child
Refer to NL 00703.005E. for 3901C text.
C. TYPING INSTRUCTIONS
Use SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this letter will be shown on Form SSA-573.