We are writing to tell you that we will still pay you the same monthly check even though (1) working and expect(s) to earn $ (2) this year.

 

The Reason For Our Decision

Because of the money (3) earning, (4) not due checks (5) . However, if we stopped these checks we would have to pay the amount we hold back from (6) to other members of the family. Since the total amount we pay the family would not change, we will keep paying you the same benefit amount.

Please remember that the checks you receive (7) while (8) working are really for the other family members. These checks should be used only for their needs.

 

Things to Remember

Please let us know right away if any of the following things happen:

• •

  The amount of money which (9) to make changes, or

• •

  Another family member starts working, or

• •

  A family member moves out of your household.

The way we pay benefits could change if any of these things happen.

 

If You Have Any Questions

3901C

Use this notice when an estimate of earnings is received that would not normally permit reinstatement during the current taxable year; however, due to the “family maximum provisions” (see GN 02603.075) the beneficiary will continue to receive the same monthly benefit rate. Show the information for this notice on Form SSA-573.

 

Fill-ins:

1. (1) 

   name of beneficiary is; you are

2. (2) 

   estimated earnings

3. (3) 

   name of beneficiary is; you are

4. (4) 

   he/she is; you are

1. (6) 

   him, her, you

2. (7) 

   for name of beneficiary; null

3. (8) 

   he/she is; you are

4. (9) 

   name of beneficiary expects; you expect

Refer to NL 00703.005E. for 3901C text

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