This is a very important letter in connection with your organization’s status as a
“Fee-for-Service” representative payee. We must re-certify all fee for service organizations
periodically to ensure they continue to be in compliance with statutory requirements
to act in that capacity. Our records show that (1) is now scheduled for the re-certification.
Optional Paragraph 1
For site visit certifications:
We have set up an appointment to visit your office on (2)
between the hours of (3). During this visit, we will be reviewing the following documentation to ensure that
you continue to qualify as a Fee-for-Service organizational payee:
(4)
Please have these documents available for our review.
Fill-Ins
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(1)
Name of organizational payee
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(3)
Hours of appointment, format “time and time”
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(4)
List of items needed such as bond, license, list of beneficiaries served, and any
other documentation the reviewers may deem necessary to perform the review.
Optional Paragraph 2
For mail-in certifications:
We need the following information from you in order to conduct this review. Please
mail all the items listed below, as of (1)
Things we need:
(2)
We must see the original document(s) or a certified copy of this item(s). We cannot
accept photocopies. We will return these items to you.
We must receive the above documentation in this office no later than (3). If we do not receive the aforementioned information by the due date, we may have
to cancel your authorization to collect a fee for payee services.
Fill-ins
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(1)
Date showing period of review or date of last certification
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(2)
List of items needed such as bond, license, list of beneficiaries served, and any
other documentation the reviewers may deem necessary to perform the review
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If you have any questions or any scheduling conflicts, please contact us at the address
and phone number listed above, and ask for (Name of reviewer).
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Signature,
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District Manager,