TN 30 (03-96)

NL 00703.768 Representative Payee Advance Notice for Title II Postentitlement Situations

(GN 00503.100)

Document Identifier for Word Processor: E3768

DPS

A. EXHIBIT LETTER

3768AWe are writing to tell you that we have information that shows you need help managing your money and meeting your needs. Because of this information, we plan to send your Social Security benefits to (1) . We will call this (2) your representative payee.
3768BWe are writing to tell you that we plan to select (1) as your new representative payee. We have information that shows you still need help managing your money and meeting your needs.

 

Your Representative Payee's Duties

It is your representative payee's duty to manage your Social Security money. The representative payee must report changes that can affect your benefits and act in your best interest. We will ask your representative payee to show us how the money was used for you.

 

If You Disagree With This Decision

If you think you should get your own benefits or that someone else should help you manage your benefits, you have the right to appeal. You have the right to review the facts in your file. You can give us more facts to add to your file. We will review your case and consider any new facts you have. Then, a person who didn't make the first decision will decide your case.

  • You have 60 days to ask for an appeal. However, unless we hear from you within 10 days, we will select the representative payee named above.

  • The 10 days and 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason for waiting more than 60 days to ask for an appeal.

  • You have to ask for an appeal in writing. We will ask you to fill out Form SSA-561-U2, called “Request for Reconsideration.” To get this form, contact one of our offices. We can help you fill out the form.

     

If You Want Help With Your Appeal

3215E

 

If You Have Any Questions

3765C

OR

3901C

B. REQUESTING INSTRUCTIONS

  • The FO (or, on rare occasions, the PSC) sends this to a legally competent adult SSA beneficiary or emancipated minor.

  • Use 3768A if action is from direct payment to representative payment.

     

    Fill-ins:

    1. Name of representative payee (if the payee is an officer of an institution or entity, show the title of the officer or name of the institution or entity not the name of the officer).

    2. person, organization

  • Use 3768B if action is from one representative payee to another.

     

  • Fill-in:

    1. Name of New Representative Payee

Use 3765C if the notice is sent by the FO. Use 3901C if the notice is sent by the PSC. Refer to NL 00703.215 for 3215E text. Refer to NL 00703.005E. for 3901C text. Refer to NL 00703.765 for 3765C text and fill-ins.

C. TYPING INSTRUCTIONS

This notice will usually be sent by the FO. It may be reproduced on FO letterhead. On the rare occasions when the PSC sends the letter, use Form SSA-L2000-C2 (Universal Notice) and follow the new notice standards. Information for this notice will be shown on Form SSA-573.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900703768
NL 00703.768 - Representative Payee Advance Notice for Title II Postentitlement Situations - 09/15/2008
Batch run: 01/27/2009
Rev:09/15/2008