TN 31 (02-97)

NL 00703.759 Request to Financial Institution for Correct Beneficiary Address

Document Identifier for Word Processor: E3759


Financial Institution Claim Number:
Street Address Bank Account No.:
City/State/Zip Code

We are writing to ask for some information about (1) , who has direct deposit of (2) Social Security benefit payment with you. We are unable to locate (3) at the address we have in our records:


If we are unable to obtain a current address for (5) , we will stop (6) checks.


What We Need

Please provide the mailing address you have for (7) , (8) , in the space below, and return this letter in the enclosed envelope.


Customer's Current Mailing Address is:








Right To Financial Privacy

A financial institution can provide the Social Security Administration with address information for a title II beneficiary without the person's consent. This conforms with the Right to Financial Privacy Act (12 U.S.C 3414 k.1).


If You Have Any Questions

If you have any questions, or do not have this information please let us know right away. Please include the Social Security claim number shown above in any letter you send us.



Return Envelope


  • The FO or PC should send this letter to the Financial Institution where the beneficiary has a direct deposit when the beneficiary cannot be located.


  • Fill-ins:

    1. (1) 

      name of beneficiary

    2. (2) 

      “his” or “her”

    3. (3) 

      “him” or “her”

    4. (4) 

      address shown in SSA records

    5. (5) 

      same as (1)

    6. (6) 

      same as (2)

    7. (7) 

      same as (1)

    8. (8) 

      claim number


The FO or PC should use FO or PC letterhead. Be sure to enclose a return envelope and include all eight fill-ins.

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NL 00703.759 - Request to Financial Institution for Correct Beneficiary Address - 02/28/2011
Batch run: 02/28/2011