TN 34 (05-98)

NL 00703.828 Notice to Parent, Person Standing in Place of Parent, or Legal Guardian of a Minor Beneficiary That the Beneficiary's Benefits Will Be Paid Directly to the Minor, Rather Than a Representative Payee

(See GN 00503.130)

Document Identifier for Word Processor: E3828


We have decided that it is best for (1) to have (2) (3) checks paid directly to (4) .

Check Information

3828A (1) sending (2) regular monthly check of $ (3) to (4) about
(5) .
We (1) $ (2) to (3) around (4) . We (5) sending (6) regular monthly check of $ (7) to (8) around (9) .

If You Disagree With the Decision

If you disagree with the decision, you have the right to appeal. We will review your case again and consider any new facts you have. (5) Then a person who did not make the first decision will decide your case again.

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you get 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.1

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

  • To appeal, you must fill out a form called “Request for Reconsideration.” The form number is SSA-561-U2. To get this form, contact one of our offices. We can help you fill out the form.


We are enclosing a copy of a letter that we sent to (1) . Please be sure to read it. If we are wrong about anything in that letter, you can ask for an appeal.


How To Appeal


There are two ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide (1) case.

  • Case Review. You have a right to review the facts in (2) file. You can give us more facts to add to (3) file. Then we will decide (4) case again. You will not meet with the person who decides (5) case.

  • Informal Conference. You will meet with the person who decides (6) case. You can tell that person why you think you are right. You can give us more facts to help prove you are right. You can bring other people to help explain (7) case.


If You Want Help With Your Appeal


If You Have Any Questions

3901C - Domestic

3901D - Foreign


Pamphlet No. SSA-05-10058

1 Delete this sentence for foreign claims.


  • In title II cases, the FO is responsible for designating this notice. When a copy of the award notice will be sent to the parent or legal guardian, the FO will designate optional paragraph 3828A to be included in the notice. The PC is responsible for providing all necessary fill-ins. In title XVI cases, the FO is responsible for the entire notice.

  • Select paragraph 3828B when the first payment to the beneficiary is different than the regular ongoing monthly benefit (retroactive benefits are due, a cost-of-living increase will occur the month after the payee change.) Otherwise, select