We have considered your application for (1) benefits (2) 's Social Security record, and decided that you are not entitled to benefits at this time.

 

Why we can not pay you

You can not get benefits because (3) is not now entitled to retirement or disability benefits. If (4) becomes entitled in the future, you will need to apply again.

 

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 

• •

  Send in notice when a auxiliary cannot be entitled because the primary beneficiary has been denied.

• •

  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 claim (e.g., “wife's”)

  2. (2) 

     first and last name of number holder

  3. (3) 

     same as #2

  4. (4) 

     he or she

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. If the disability examiner indicates Form SSA-L833-C3 or the SSA-831-U3, and word processor notice E3911 is not shown, return to claim authorizer for required fill-ins for E3911.