We are writing to tell you that (1) not have to pay a penalty for reporting (2) (3) earnings late.

 

Your Responsibilities

As soon as you know that (4) will earn more than $ (5) in (6) , please let us know. If you do not do this, we may have to hold back a penalty from the checks. You may also need to report earnings for future years. We will let you know each year how much (7) can earn before you have to report to us.

 

If You Have Any Questions

3901C

Send this notice when “good cause” has been established for the late filing of an annual report of earnings after beneficiary was notified that an “additional” penalty deduction would be made because he/she failed to report within the prescribed time limit .

 

Fill-ins:

1. (1) 

   you do, (Name of Beneficiary) does

2. (2) 

   your/his/her

3. (3) 

   year

4. (4) 

   you, Name of Beneficiary

5. (5) 

   annual exempt amount for current taxable year

6. (6) 

   current taxable year

7. (7) 

   you, Name of Beneficiary

Refer to NL 00703.005E. for 3901C text.

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