We have considered your application for (1) benefits on (2) 's Social Security record. You are not entitled to benefits now because (3) did not work long enough under Social Security.

 

Why we can not pay you

 

Other Social Security benefits

3901E

 

If you disagree with the decision

ALS020

 

New application

3900A

 

If you want help with your appeal¹

3100E

 

If you have any questions

3901C - Domestic

3901D - Foreign

 

Enclosure:

SSA Pub. No. 05-10072

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

• •

  Send this notice to the survivor of a deceased N/H who was not insured.

• •

  Use 3907A if fill-in 1 is “lump-sum death,” “child's,” “mother's,” or “father's.” Use 3907B if fill-in 1 is “widow's,” “widower's,” or “parent's.”

• •

  Use 3901E, ALS020 and 3900A in all cases. Refer to NL 00703.901 for 3901E text. Refer to NL 00703.900 for ALS020 and 3900A text and NL 00703.100 for 3100E text.

• •

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

Fill-ins:

1. (1) 

   type of benefit: “lump-sum death”/“child's”/“mother's”/ “father's” or “widow's” /“widower's”/“parent's.”

2. (2) 

   NH's name

3. (3) 

   he or she

4. (4) 

   NH's name

5. (5) 

   NH's name

6. (6) 

   number of quarters

7. (7) 

   he or she

8. (8) 

   number of quarters

9. (9) 

   number of quarters

Use Form SSA-L2000-C2 (Universal Notice). Refer to Form SSA-3428-U2, Determination of Disallowance Coding Sheet, “Name and Address Information” field in block 2 for completing the name and address. Because the fill-ins may vary according to the different situations, follow the requester's typing instructions carefully.