TN 1 (01-10)
NL 00713.007 Remittance Reminder Notice
A. Exhibit of Remittance Reminder Notice
Social Security Administration
Retirement, Survivors and Disability Insurance
Program Center Name
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
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.