TN 36 (03-99)
NL 00703.924 Termination Letter to Representative Payee When Beneficiary Dies — Domestic or Foreign
Document Identifier for Word Processor: E3924
A. Exhibit letter
We are writing to let you know that (1) entitlement to benefits ended as of (2) . We based this on information that (3) died (4) .
|3924B||We could not stop (1) 's (2) payment, which you should receive on (3) . Since this payment was not due, you will have to pay back the money. This overpayment totals $ (4) .|
(If there is an overpayment, follow instructions in NL 00703.920 on what paragraphs to include.)
If you have saved any money
You may have saved some (1) money for (2) . Any money that you have saved, plus any interest on that money, belongs to (3) estate.
What you need to do
You need to do one of these things:
| || |
| || |
If you disagree with the decision1
3180A - Domestic
3180B - Foreign
If you want help with your appeal2
If you have any questions
3901C - Domestic
3901D - Foreign
1 If there is an overpayment, omit this paragraph.
2 If the person lives outside the U.S. or has an attorney, omit this paragraph.
B. Requesting instructions
Send when a beneficiary with a representative payee dies.
Include 3924B when a late death input will result in an overpayment for the month of death.
Include 3924A if payee has conserved funds for the deceased beneficiary.
full name of beneficiary, possessive format
last month/year of entitlement e.g., May 1993
month/year e.g., June 1993
name of deceased beneficiary (Mr./Ms. and surname, if adult; first name, if child)
month and year of overpayment
expected receipt date of overpayment
amount of overpayment
Social Security, Black Lung
First name of beneficiary, if child; if adult, “Mr.” or “Ms.” last name of beneficiary
See NL 00703.005E. for 3901C and 3901D text and fill-ins.
Use 3180A in all cases, except when there is an overpayment.
Refer to NL 00703.180 for 3180A text.
Refer to NL 00703.100 for 3100E text.
C. Typing instructions
Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573.