We are writing to you about the claim you filed on (1) Social Security record. We need information from you about the Civil Service pension you receive on (2) , because this pension could affect your claim.

Your Civil Service Pension

The Office of Personnel Management (OPM) pays you a Civil Service pension on (3) record. The OPM told us that they used (4) military service when they figured your Civil Service pension. Military service can only be used to figure one Federal benefit. Since the OPM used the military service, we cannot use it to pay you a Social Security benefit.

Without the military service, (5) does not have enough credit for you to receive Social Security benefits.

What You Can Do

If ou want, you can decide to stop receiving the Civil Service pension. If you decide to do this, we can then use the military service to pay you a monthly Social Security benefit of $ (6) . You can only receive this Social Security benefit if we use the military service.

If you decide to stop receiving the Civil Service pension, please let us know within 15 days of the date of this letter. If we do not hear from you, we will assume that you want to continue to receive the pension. Then we will send you another letter explaining why you cannot receive Social Security benefits.

If You Have Any Questions

3901C - Domestic

3901D - Foreign

• •

  If there is no insured status without MS tell the surviving spouse by letter that action will be delayed by 15 days. (If the information is available when the surviving spouse is interviewed, the letter may be given to him or her then.) Include a copy of the letter in the claims folder.

   

  Fill-ins:

  1. (1) 

     name of number holder, possessive

  2. (2) 

     his, her

  3. (3) 

     name of number holder, possessive

  4. (4) 

     his, her

  5. (5) 

     name of number holder

  6. (6) 

     amount

• •

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

Use Form SSA-2000-C2 (Universal Notice) and follow new notice standards. Information for this letter will be shown on Form SSA-573.