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
||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