We are writing to let you know that we are stopping your Social Security benefits
(1) . This is the check you would normally get in (2) . Your benefits are stopped because (3) became age 16 in (4) .
How We Can Pay You
We can only continue your benefits if you have a child in your care, under age 16
or disabled, who is entitled to Social Security benefits.
We are now considering (5) claim for disability benefits. After we decide if (6) is disabled, we will let you know if you can get benefits again.
If You Disagree With The Decision
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.