Your last report of how you used (1) (2) checks showed that you saved money for

them. Even though you are no longer their payee, we have decided that you may continue to manage these savings.

It Is Important to Keep Track of This Money

We may ask you to tell us how you are managing this money. For that reason, you will need to keep track of how you use the savings.

Your Responsibilities

Please let the new payee know when there is a change in your address. This is so that you can be reached quickly when (3) needs the money you have saved. If you move, be sure to give us your new address, too. The payee is (4) . They can be reached at (5) . We are also sending them a copy of this letter.

If You Have Any Questions

3901C - Domestic

3901D - Foreign

CC: (6)

Send to former payee when we decide to let him administer the funds he has saved.

Fill-ins:

1. (1) 

   Full name of beneficiary, possessive

2. (2) 

   Social Security, Supplemental Security Income, Black Lung (or any combination of these)

3. (3) 

   first and last name of beneficiary, if child or adult.

4. (4) 

   name of current payee

5. (5) 

   address of current payee

6. (6) 

   current payee name

Use paragraph 3901D when the former payee lives outside the U.S. Otherwise, use paragraph 3901C. See NL 00703.005E. for 3901C and 3901D text and fill-in.

Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards for SSA and BL. Information for this notice will be shown on Form SSA-573. For title XVI, use FO letterhead.