We are writing to let you know that (1) entitlement to benefits ended as of (2) . We based this on information that (3) (4) in (5) .
||(To Be Used When Last Child-In-Care Marries)
||We can pay (1) benefits only when you have a child in your care, under age 16 or disabled, who is
entitled to Social Security benefits.
(If there is an overpayment, follow instructions in NL 00703.920 on what paragraphs to include.)
Other Social Security benefits
When benefits are terminated during the year, you must file an annual report if you
earn over $ (6) . In this report include your earnings for the entire year both before and after
your benefits were terminated.
If you disagree with the decision1
If you want help with your appeal2
If you have any questions
1 If there is an overpayment, omit this paragraph.
2 If the person has an attorney, omit this paragraph