TN 1 (01-10)

NL 00713.007 Remittance Reminder Notice

A. Exhibit of Remittance Reminder Notice

Social Security Administration

Retirement, Survivors and Disability Insurance

Important Information

                                                                           Program Center Name

                                                                           Street Address

                                                                           City, State ZIP

                                                                           Date: Month DD, YYYY

                                                                           Claim Number: 123-00-6789

JANE G. BENEFICIARY

101 MAIN STREET

MY CITY, ST 00000

We are writing to you about the overpayment of Social Security benefits paid to you. We have not received a refund.

Please pay the $1,200.00 due now. If you cannot afford to pay the entire amount now, please contact us to arrange repayment.

If you have recently mailed your payment, please disregard this letter.

If You Have Any Questions

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at [FO phone]. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

                                                   FIELD OFFICE NAME

                                                     STREET ADDRESS

                                                       CITY STATE ZIP

If you do call or visit an office, please have this letter with you. It will help us answer your

questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

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