TN 2 (09-11)

NL 00720.080 CFD Conserved Funds

CFD003 REQUEST FOR CONSERVED FUNDS (T13)

(Requested/Generated)

Caption: If You Saved Any Money

While you were  (1)  payee, you may have saved some money for  (2)  . If you have, you should return it to us unless you have already made other plans with us for handling it. The money you will need to return includes:

  • Saved and invested benefits.

  • Interest earned from these savings and investments.

  • Money you have left over from any checks we sent you.

  • Any checks you might receive after the date of this letter.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Beneficiary's Name

Fill-in (2) - Systems Generated

Choice 1: him

Choice 2: her

CFD004 RETURN CONSERVED FUNDS

(Generated)

Caption: How To Pay Us Back

To do this, you can write us a check or money order. Make it out to the Social Security Administration. Be sure to write "Conserved Funds for  (1)  ,  (2)  on that check or money order. Please mail it in the enclosed envelope.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Full Name

Fill-in (2) - Systems Generated

Choice 1: Claim Number and BIC (XXX-XX-XXXX HA)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720080
NL 00720.080 - CFD Conserved Funds - 06/04/2013
Batch run: 06/04/2013
Rev:06/04/2013