TN 30 (03-96)

NL 00703.152 Initial Government Pension Offset (GPO) Advance Notice —Suspense/Deferred Status

Document Identifier for Word Processor: E3152

A. Exhibit Letter

We are writing to tell you about a change in (1) Social Security benefit amount. Although (2) not receiving regular monthly benefits now, (3) will receive a reduced amount if (4) benefits start again. This is because the amount of (5) government pension affects (6) Social Security benefit amount. Based on the information we have, we should have reduced (7) benefits beginning (8) .


The Information We Have

When we matched computer records with the Office of Personnel Management, we learned the following information about (9) pension.

Monthly Amount(s)
$ (10) (11)

Please read the enclosed fact sheet, “Government Pension Offset.” This fact sheet will give you more information about how (12) benefits may change.


What You Can Do

We cannot use this information to change (13) Social Security benefits until we give you time to check it. Certain information could change our plan to reduce (14) benefits. Please let us know right away if:

  • Any of the information we have about (15) government pension is wrong.

  • (16) eligible for a government pension before December 1982, even if (17) did not receive any payments before December 1982.

  • (18) eligible for a government pension before July 1983 AND (19) receiving one-half of (20) financial support from (21) at the time (22) retired, became disabled or died.

  • (23) paying Social Security (FICA) taxes on (24) federal salary before (25) retired.


If We Do Not Hear From You

If we do not hear from you within 30 days from the date of this letter, we will assume the information in this letter is correct and use it to reduce (26) Social Security benefits.

We will send another letter at that time. It will explain the change in the benefits, the amount of any overpayment, and how to appeal our decision.

  • You will have 60 days to ask for an appeal.

  • The 60 days will start the day after you receive the next letter.


If You Have Any Questions

3901C - Domestic

3901D - Foreign



SSA Pub. No. 05-10007

B. Requesting Instructions

The PC will send this notice to a beneficiary in current pay status whose benefit will be reduced because of receipt of a government pension.


Refer to NL 00703.005E. for 3901C and 3901D text and fill-ins.



  1. (1) 

    your/full name of auxiliary beneficiary, possessive

  2. (2) 

    you are/(beneficiary title and surname) is

  3. (3) 


  4. (4) 


  5. (5) 

    your/beneficiary title and surname, possessive

  6. (6) 


  7. (7) 

    your/beneficiary title and surname, possessive

  8. (8) 

    effective month and year of reduction

  9. (9) 

    your/beneficiary title and surname

  10. (10) 

    amount(s) of government pension

  11. (11) 

    effective month(s) and year(s) of government pension

  12. (12) 


  13. (13) 

    your/beneficiary title and surname, possessive

  14. (14) 


  15. (15) 


  16. (16) 

    You were/He was/She was

  17. (17) 


  18. (18) 

    You were/He was/She was

  19. (19) 

    you were/he was/she was

  20. (20) 


  21. (21) 

    your spouse/your former spouse/his spouse/his former spouse/ her spouse/her former spouse

  22. (22) 


  23. (23) 

    You were/He was/She was

  24. (24) 


  25. (25) 


  26. (26) 

    your/beneficiary title and surname, possessive

C. Typing Instructions

Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573.

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NL 00703.152 - Initial Government Pension Offset (GPO) Advance Notice —Suspense/Deferred Status - 03/04/1996
Batch run: 06/01/2018