TN 30 (03-96)
NL 00703.706 Withdrawal Notice to RRB — Withdrawal Approved — No Entitlement Under SSA
Document Identifier for Word Processor: E3706
Use SSA Letterhead Stationery
A. EXHIBIT LETTER
|U.S. Railroad Retirement Board|
Bureau of Retirement Claims
844 Rush Street
Chicago, Illinois 60611
|(Name of W/E)|| |
We have approved the subject beneficiary's request for withdrawal of (1) application for Social Security benefits.
The approval of a withdrawal request results in the complete nullification of the beneficiary's application and any award of benefits made on the basis of such application. Since the beneficiary has filed no other application for benefits, (2) is not entitled to Social Security payments.
|(Optional) || |
|3706A||We have recovered all benefits certified to date. |
|(Optional) || |
| || |
|3706B||Before we approved (1) request for withdrawal, the beneficiary received $ (2) which must now be repaid. Please withhold this sum from the benefits payable under the Railroad Retirement Act. Credit this sum to the (3) Insurance Trust Fund. Please send us a copy of your adjustment letter to the annuitant.|
B. REQUESTING INSTRUCTIONS
This letter will be requested by the claims authorizer on Form SSA-573 or SSA-559 and should be typed on SSA letterhead. The claims authorizer will furnish all the information for completing the letter.
Include Optional Paragraph 3706A if repayment has been made.
Include Optional Paragraph 3706B if the RR annuitant wants to repay the SSA benefits through adjustment.
“Copy of Approved Request for Withdrawal” if paragraph 3706A or 3706B is used. Otherwise, NULL.
“Applicant's Request to RRB to Withhold SSA Overpayment” if paragraph 3706B is used. Otherwise, NULL.
amount of benefits received
Old Age and Survivors/Disability