TN 31 (02-97)
Document Identifier for Word Processor: E3771
We are writing to let you know that (1) can no longer collect a fee from (2) monthly benefits for serving as (3) representative payee. If they were collecting a fee, they must stop doing so after
If You Have Any Questions
The FO will send this notice when the representative payee's authorization to collect
a fee has been revoked.
Show the title of the officer and the name of the institution or entity. Do not show
the name of such officer.
Refer to NL 00703.765 for 3765C text and fill-ins.
name of representative payee
your, name of beneficiary (possessive)
your, his, her
the last month/year in which the organization is permitted to collect a fee from this
The FO will send this notice. It may be reproduced on FO letterhead.