Social Security Administration
Retirement, Survivors and Disability Insurance
Important Information
Miscellaneous Program Service Center
600 West Madison Street
Chicago, IL 60661-2474
Date:
Claim Number: 123-00-6789A
Mrs. Jane Doe
103 Main Street
Washington, DC 20019
If you do not pay us or get in touch with us about this matter by XX/XX/XX, we will
consider sending this case to the Department of Justice.
We are writing to you about your agreement to repay us $500 for John Doe's Social
Security checks you cashed after his death.
Your Agreement
You agreed to repay the money because you cashed those checks. You asked us to hold
back $100 from your Social Security benefit check each month until you have repaid
the $500.
What You Should Do
Since you are no longer entitled to monthly Social Security benefits, you are personally
liable for repayment of the $500. We have written to you about this before, but you
have not settled this matter. You should repay this money now, or contact us about
how you will pay us back.
If We Do Not Hear From You
If you do not pay us or get in touch with us about this by XX/XX/XX, we will consider
sending this case to the Office of the Inspector General or the United States Secret
Service for possible prosecution.
If You Have Any Questions
If you have any questions, you may call us at 1-800-772-1213, or call your local Social
Security office at XXX-XXXX. We can answer most questions over the phone. You may
also write or visit any Social Security office. The office that serves your area is:
611 E 6th
Baltimore, MD 21200
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. If you plan to visit an office, you may want to call ahead
to make an appointment. This will help us serve you more quickly when you arrive at
the office.
Name
Assistant Regional Commissioner
Processing Center Operations
Enclosure:
Return Envelope