We are writing to let you know that (1) entitlement to benefits ended as of (2) . We based this on information that (3) became (4) in (5) .
We can pay benefits to (6) only if (7) age 18 and a full-time student in an elementary of secondary school or disabled.
(If there is an overpayment, follow instructions in NL 00703.920 on what paragraphs to include.)
||When benefits are terminated during the year, you must file an annual report if you
earn over $ (1) . 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
3901C - Domestic
3901D - Foreign
1 If there is an overpayment, omit this paragraph.
2 If the person lives outside the U.S. or has a representative, omit this paragraph.