We received the new information you sent us about [1] checks(s) dated [2] totaling
            $[3]. You asked us to consider these new facts and look again at our decision not
            to replace the check(s). We are reviewing the information and will write to you again
            when we finish.
         
         If you have any questions, call us toll free at 1-800-772-1213 [4]. We can answer
            most questions over the phone. You can also write or visit any Social Security office.
         
         The office that serves your area is:
         
            - 
               
                  • 
                     District Office Address City, State Zip 
 
 
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 should call ahead to
            make an appointment. This will help us serve you more quickly.
         
         
            
               
                  
                  
                  
               
               
                  
                  
                     
                     | Fill-ins: |  |  | 
               
               
                  
                  
                     
                     | [1] | Choice 1 -Choice 2 -
 | yourperson's name, possessive, in format: John Smith's
 | 
                  
                     
                     | [2] |   | Date of check(s), in format: May 3, 2011 | 
                  
                     
                     | [3] |   | Amount of check(s) | 
                  
                     
                     | [4] |   | or call your local Social Security office at (field office phone number is taken from
                           the DOORS).
                         |