TN 34 (05-98)
NL 00703.822 Final Notice to Legally Competent Adult or Emancipated Minor of Payee Selection
(See GN 00503.130)
Document Identifier for Word Processor: E3822
A. Exhibit Letter
As we told you in an earlier letter, we have chosen (1) to be your representative payee. Your representative payee will get your checks each month and will use this money for your needs.
Information About Your Checks
|3822A|| (1) sending your regular monthly check of $ (2) to (3) around (4) .|
|We (1) $ (2) to (3) for you around (4) . We will begin sending your regular monthly check of $ (5) to (6) around (7) .|
|We are enclosing a copy of a letter that we sent to your representative payee. Please be sure to read it. If you disagree with anything in this letter, you can ask for an appeal. If you want to request an appeal, please contact one of our offices. We can help you complete the required form.|
If You Have Any Questions
3901C - Domestic
3901D - Foreign
B. Requesting Instructions
In title II cases, the FO is responsible for designating this notice. When a copy of the award notice will be sent to the competent adult, the FO will designate optional paragraph 3822C to be included in the notice. The PC is responsible for providing all necessary fill-ins. In title XVI the FO is responsible for the entire notice.
Select paragraph 3822B when the first payment is different from the regular ongoing payment. Otherwise, select 3822A.
Use optional paragraph 3822C in Title II cases whenever we are sending a copy of the award notice to the beneficiary.
See NL 00703.005E for 3901C and 3901D text and fill-in.
ALERT: Since no advance notice is sent to beneficiaries living in foreign countries, the final notice must include appeal rights.
Name of representative payee or name of institution or entity
We will begin, We began
monthly payment amount
name of payee
month, day, year change is effective
sent, will send
amount of first payment
name of payee
month, day, year payment is due
ongoing monthly benefit amount
him, her, them
month, day, year regular monthly check will be received
C. Typing Instructions
In title II cases use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573. For title XVI cases, use the Form SSA-L8025-U2 (Supplemental Security Income Payment Decision), or Form SSA-8166-U2 (Supplemental Security Income Notice) as appropriate.