TN 30 (03-96)
NL 00703.702 Withdrawal — 30 Day Closeout
Document Identifier for Word Processor: E3702
Letterhead - Social Security Benefit Information
A. EXHIBIT LETTER
We have not heard from you since we informed you that we would approve your withdrawal of your claim for Social Security benefits if you repaid $ (1) of the benefits you have already received.
We will approve your request for withdrawal only if we hear from you in 30 days.
If you still want to withdraw your claim but have not paid back the money, you may mail your certified check or money order in the enclosed envelope. Be sure to write the Social Security claim number listed at the top of this notice on your check or money order.
|3702A||If you do not wish to repay or if you have any questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (FO telephone number). We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at: |
District Office Address
City, ST ZIP
| ||If you do call or visit an office, please have this letter with you. It will help us answer you questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.|
B. REQUESTING INSTRUCTIONS
The request for this letter may be made on Form SSA-573 or SSA-559 by the claims authorizer. The claims authorizer will furnish all information and, if necessary, any additional paragraphs that may be needed.
amount of benefits received
C. TYPING INSTRUCTIONS
Use SSA-L2000-C2. The typist should enclose a self-addressed envelope with the notice and the claim number should be written on the inside of the envelope below the flap.