TN 3 (05-92)
After you complete the notice:
If using the manual snap-out form, separate the original from the two pressure-sensitive
copies; if using the PC version, print two copies;
Mail the original to the overpaid individual along with an SSI payment stub (SSA-4017)
and the appropriate refund envelope (SI 02220.010 C.5); and
Document the file with the FO copy of the notice.
If the individual has a representative payee, place an SSA-L8176-U2 (NL 00803.150), representative payee cover sheet, on top of the representative payee's copy of
the notice and place the SSA-4017 and refund envelope behind the payee's copy.
If the individual has a legal guardian and/or appointed representative (who is not
the representative payee), send a photocopy of the original notice to each.