TN 85 (04-22)
Document Identifier for Word Processor: E3702
Letterhead - Social Security Benefit Information
The request for this letter may be made on Form SSA-573 or SSA-559 by the claims authorizer.
The claims authorizer will furnish all information and, if necessary, any additional
paragraphs that may be needed.
A(retirement benefits)/B(disability benefits)/C(survivor's benefits)/D(retirement
benefits and Medicare)/E(disability benefits and Medicare)/F(survivor's benefits and
you repay/he repays/she repays
total amount to be repaid
you still want/he still wants/she still wants
Use SSA-L2000-C2. The typist should enclose a self-addressed envelope with the notice
and the claim number should be written on the inside of the envelope below the flap.