We are writing to tell you that we are reducing the Social Security benefits which you receive (1) to $ (2) beginning (3) because (4) entitled to a pension from the Department of Veterans Affairs (VA) in that month. We will reduce the checks beginning with the check you would normally receive around (5) .

Why We Are Reducing Your Checks

The amount of (6) Social Security checks is partly based on (7)   (8) military service in World War II. We cannot use this service to figure benefit amounts if the VA uses it to pay a pension. Beginning (9) , the VA is using this military service to pay a pension, so we must reduce the Social Security checks.

If You Disagree With The Decision

3180A - Domestic

3180B - Foreign

If You Want Help With Your Appeal¹

3100E

Your Responsibilities

Please let us know if any other Federal agency (except the VA) pays a benefit based on this military service. Any other Federal benefit paid to the family could affect the amount of the family's Social Security checks.

If You Have Any Questions

3901C - Domestic

3901D - Foreign

¹ If the person lives outside the U.S. or has an Attorney, omit this paragraph.

• •

  This letter is sent when a widow(er)'s and child's/children's benefits are being adjusted because VA payments have been awarded and MS credits based on Sec. 217(b) can no longer be used in the RSI benefit computation.

   

  Fill-ins:

  1. (1) 

     for beneficiary(ies) full name(s); null, if sent to beneficiary

  2. (2) 

     benefit amount

  3. (3) 

     first month for which reduced payment is due, e.g. “June 1992”

  4. (4) 

     you were, he was, she was, they were

  5. (5) 

     month/day/year of first reduced check

  6. (6) 

     Name(s) of beneficiary(ies), possessive case, your

  7. (7) 

     his, her, their, your

  8. (8) 

     husband's, wife's, father's, mother's

  9. (9) 

     month/year of reduction

      

  Optional Paragraph 3365A:

  1. (1) 

     COM when the action was taken, e.g. “June 1992”

  2. (2) 

     month of reduction through month before COM in which action taken, in format “March through June,” unless period spans 2 calendar years, in which case format is “May 1991 through June 1992”

  3. (3) 

     total amount of overpayment

• •

  Refer to NL 00703.005E. for 3901C and 3901D text fill-ins. Refer to NL 00703.180 for 3180A and 3180B text. Refer to NL 00703.100 for 3100E text.

• •

  Use optional paragraph 3365A when an overpayment is caused by untimely processing. If this paragraph is selected, the standard overpayment paragraphs and appeals information must also be used in the notice.

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