We are writing to tell you that we plan to stop (1) Social Security checks (2) as of (3) because (4) filed for benefits as the (5) of (6) . Here is what we were given as proof:
We plan to pay benefits to (8) . When we do this, we will stop your benefits.
If You Disagree With The Decision
Please tell us within 30 days of the date of this letter if you disagree with the
decision. You will also need to give us any proof that your benefits should not be
If you let us know within 30 days that you disagree with the decision, we will not
stop your checks. We will continue to pay you while we review the case to see if you
are right. However, if you are wrong we will ask you to pay back any money you received
that was not due.
If we do not hear from you within 30 days, we will stop your checks. We will send
you another letter at that time with more information about our action.
If You Have Any Questions
3901C - Domestic
3901D - Foreign