We are writing to let you know that your entitlement to benefits ended as of (1) . We based this on information that (2) became age 16 in (3) .

3927A

OR

3927B

 

Other Social Security benefits

3923A

OR

3923B

 

If you disagree with the decision¹

ALS020

 

If you have any questions

3901D

¹ If there is an overpayment, omit this paragraph.

• •

  Send to terminated parent when youngest child-in-care attains age 16.

• •

  Use paragraphs 3927A and 3923A when benefits to mother/father terminate. Use paragraphs 3927B and 3923B when benefits to wife, husband, former wife, former husband terminate. See NL 00703.005E. for 3901D text and fill-in. Refer to NL 00703.180 for ALS020 text. Refer to NL 00703.927 for 3927A and 3927B text and fill-ins. Refer to NL 00703.923 for 3923A and 3923B text and fill-ins.

   

Fill-ins:

1. (1) 

   last month/year of entitlement e.g., May 1993

2. (2) 

   full name of child beneficiary

3. (3) 

   month/year e.g., June 1993

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