We are writing to let you know that (1) entitlement to benefits ended as of (2) . We based this on information that (3) died (4) .
(Optional)
3924B |
We could not stop (1) 's (2) payment, which you should receive on (3) . Since this payment was not due, you will have to pay back the money. This overpayment
totals $ (4) .
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(If there is an overpayment, follow instructions in NL 00703.920 on what paragraphs to include.)
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If you have saved any money
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(Optional)
3924A
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You may have saved some (1) money for (2) . Any money that you have saved, plus any interest on that money, belongs to (3) estate.
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What you need to do
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You need to do one of these things:
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-
•
Give this money to the legal representative of the estate.
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OR
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-
•
If there is no legal representative, contact the State probate court or the authorities
who control the estate's money. They will be able to tell you what to do with the
money.
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If you disagree with the decision1
3180A - Domestic
3180B - Foreign
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 an attorney, omit this paragraph.