TN 30 (03-96)

NL 00703.769 Representative Payee Advance Notice to Legal Guardian, Parent or Person Standing in Place of Parent — If Not Proposed Payee

(GN 00503.100)

Document Identifier for Word Processor: E3769

A. Exhibit Letter

3769AWe are writing to tell you that we have information that shows (1) needs help managing (2) money and meeting (3) needs. Because of this information, we plan to send (4) (5) money to (6) as representative payee.


The Representative Payee's Duties

It is the representative payee's duty to manage (7) (8) money. The representative payee must report changes that can affect (9) benefits and act in (10) best interest. We will ask (11) to show us how the money was used.


If You Disagree With This Decision

If you think someone else should help manage these benefits, you have the right to appeal. You have the right to review the facts in the file and to submit additional evidence. We will review the case and consider any new facts you have. Then, a person who didn't make the first decision will decide the 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.


How To Appeal

3769CThere are two ways to appeal. You can pick the way you want. If you meet with us in person, it may help us decide your case.
  • Case review - You have a right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case.

  • Informal Conference - You'll meet with the person who decides your case. You can tell that person why you think you're right. You have the right to review the facts in your file. You can give us more facts to help prove you are right. You can bring other people to help explain your case.


If You Want Help With Your Appeal


If You Have Any Questions




B. Requesting Instructions

The FO (or, on rare occasions, the PSC) should send this advance notice to a non-selected legal guardian of a legally incompetent adult or a child, parent, or person standing in for the parent when we plan to make someone else the representative payee. Send separate notices in concurrent cases unless both are adjudicated simultaneously. If so, a dictated paragraph may be added so that one notice is released. If an application has been filed by the officer of an institution, or entity, show the title of the officer and the name of the institution or entity. Do not show the name of such officer.

  • 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.

  • Use 3769A for title II and title XVI.

  • Use 3769C if title XVI is involved.



3769A(1)name of beneficiary
 (2)his, her
 (3)his, her