TN 36 (03-99)

NL 00703.924 Termination Letter to Representative Payee When Beneficiary Dies — Domestic or Foreign

Document Identifier for Word Processor: E3924

A. Exhibit letter

We are writing to let you know that (1) entitlement to benefits ended as of (2) . We based this on information that (3) died (4) .


3924B We could not stop (1) 's (2) payment, which you should receive on (3) . Since this payment was not due, you will have to pay back the money. This overpayment totals $ (4) .

(If there is an overpayment, follow instructions in NL 00703.920 on what paragraphs to include.)


If you have saved any money



You may have saved some (1) money for (2) . Any money that you have saved, plus any interest on that money, belongs to (3) estate.



What you need to do


You need to do one of these things:

  • Give this money to the legal representative of the estate.




  • If there is no legal representative, contact the State probate court or the authorities who control the estate's money. They will be able to tell you what to do with the money.


If you disagree with the decision1

3180A - Domestic

3180B - Foreign


If you want help with your appeal2


If you have any questions

3901C - Domestic

3901D - Foreign

1 If there is an overpayment, omit this paragraph.

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

B. Requesting instructions

  • Send when a beneficiary with a representative payee dies.

  • Include 3924B when a late death input will result in an overpayment for the month of death.

  • Include 3924A if payee has conserved funds for the deceased beneficiary.



    1. (1) 

      full name of beneficiary, possessive format

    2. (2) 

      last month/year of entitlement e.g., May 1993

    3. (3) 


    4. (4) 

      month/year e.g., June 1993


    1. (1) 

      name of deceased beneficiary (Mr./Ms. and surname, if adult; first name, if child)

    2. (2) 

      month and year of overpayment

    3. (3) 

      expected receipt date of overpayment

    4. (4) 

      amount of overpayment


    1. (1) 

      Social Security, Black Lung

    2. (2) 

      First name of beneficiary, if child; if adult, “Mr.” or “Ms.” last name of beneficiary

    3. (3) 


  • See NL 00703.005E. for 3901C and 3901D text and fill-ins.

  • Use 3180A in all cases, except when there is an overpayment.

  • Refer to NL 00703.180 for 3180A text.

  • Refer to NL 00703.100 for 3100E text.

C. Typing instructions

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

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NL 00703.924 - Termination Letter to Representative Payee When Beneficiary Dies — Domestic or Foreign - 05/01/1999
Batch run: 01/30/2024