We are writing to tell you that the Social Security check you receive for (1) will stay the same even though (2) expects to earn $ (3) or less this year.

 

The Reason For Our Decision

We did not stop the check while (4) was earning more money because it would not have changed the total amount we paid to the family. Because we did not stop the checks before, we do not need to change the check amount now that (5) is making a different amount of money.

 

Your Responsibilities

Please let us know right away if (6) again plans to earn more than $ (7) . This will help us make sure that we pay the right amount.

 

If You Have Any Questions

3901C

Send this notice to the representative payee. Refer to NL 00703.502 (E3502) for requesting instructions.

 

Fill-ins:

1. (1) 

   beneficiary name

2. (2) 

   he, she

3. (3) 

   current annual exempt amount for the beneficiary

4. (4) 

   beneficiary name

5. (5) 

   he, she

6. (6) 

   beneficiary name

7. (7) 

   current annual exempt amount for the beneficiary

Refer to NL 00703.005E. for 3901C text.

Use SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this letter will be shown on form SSA-573.