We are trying to contact (1) about a Social Security matter. Our records show that this person worked for you. Please provide (2) most recent telephone number and address in your records.

 

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Telephone Number .           

 

If this information is not available, please check here: .          

 

Authorized Signature .          

 

Title and Date .                

 

Enclosure:

Return Envelope

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  The debtor contact representative will send this notice to a debtor's last known employer to obtain address data.

   

Fill-ins:

1. (1) 

   name of debtor

2. (2) 

   name of debtor, possessive

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  Use Form SSA-L2000-C2 for title II debtors.

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  Use Form SSA-L8166-U2 for title XVI debtors.