We are writing to let you know that (1) entitlement to benefits ended as of (2) . We based this on information that (3) became (4) in (5) .

We can pay benefits to (6) only if (7) age 18 and a full-time student in an elementary of secondary school or disabled.

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

 

If you disagree with the decision¹

ALS020

 If you want help with your appeal²

3100E

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 a representative, omit this paragraph.

• •

  Send when a child's benefits terminate at age 18 or 19. This letter can be sent to a parent payee, representative payee, or the child being terminated. Do not use when child terminates when "deemed" to be age 19 per RS 00205.325B.

• •

  Use paragraph 3929A in domestic cases

• •

  See NL 00703.005E. for 3901C and 3901D text and fill-in. Use ALS020 in domestic cases and foreign cases. Refer to NL 00703.180 for ALS020 text. Refer to NL 00703.100 for 3100E text.

   

Fill-ins:

1. (1) 

   your or full name of beneficiary, possessive

2. (2) 

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

3. (3) 

   you/he/she

4. (4) 

   “Age 18” or “Age 19”

5. (5) 

   month/year, e.g., June 1993

6. (6) 

   you, first name of beneficiary

7. (7) 

   “you are” or “he is” or “she is”

3929A

1. (1) 

   exempt amount for year of termination

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