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.
Include the SSA-4017 (SSI payment stub) and the appropriate refund envelope (SI 02220.010 C.5) unless there is a representative payee; and
Mail the notice and enclosures to the individual and document the file with the FO
copy of the notice.
If the overpaid individual has a representative payee send the payee's copy with the
SSA-4017 and the return envelope.
If the overpaid individual has a legal guardian and/or appointed representative who
is not the representative payee, send a photocopy of the notice to each.