(1) disability benefits have been stopped because (2) . We are withholding further benefits until we can study the facts and decide whether (3) is still entitled to disability benefits. We will let you know when this decision has been made and will tell you then whether benefits can be started again.

3901C

This notice is used to notify the representative payee of a CDB that benefits are being suspended for one of the following reasons:

1. 1. 

   he/she has gone to work or,

2. 2. 

   his/her condition has improved or,

3. 3. 

   we have been unable to locate him/her or,

4. 4. 

   we have not received the information requested

    

Fill-ins:

1. (1) 

   name of the beneficiary, possessive

1. (3) 

   “he” or “she” as appropriate

Refer to NL 00703.005E. for 3901C text.

Information for this letter will be shown on Form SSA-573. The name and address, if not given, can be taken from the latest Form SSA-3926-EP in file.