We are writing to tell you that we can pay you some Social Security checks. We still need to get some more facts about your application before we make a final decision. However, you have given us enough information so that we can send you some checks while we finish work on your application.

What We Will Pay And When

In a few days, we will send you a special check for $(1) . You can receive up to three of these special checks. After that, if we do not receive the facts we need or if we find that you are not eligible for benefits, we will stop sending the checks.

How We Will Complete Your Application

We will make a final decision as soon as we have the facts we need. If we decide you can receive regular checks, we will send you another letter explaining the check amounts. If you are not eligible for benefits, we will ask you to pay back any money you received from the special checks.

Things To Remember

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  We will get in touch with you later if we need your help in getting the facts to finish work on your application.

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  If you are eligible for benefits, we will start to pay you regular monthly checks as soon as we finish our work.

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  Please let us know if you receive more than one check for the same month.

   

If You Have Any Questions

3901C - Domestic

3901D - Foreign

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  Section 205(q)(3) of the Social Security Act provides that in certain cases a claimant may receive preliminary payment if she/he has submitted the minimum evidence on his/her claim even though additional evidence may be required before a final determination can be made.

   

  Fill-in:

  1. (1) 

     amount

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  Refer to NL 00703.005E. for 3901C and 3901D text and fill-ins.

Use Form SSA-2000-C2 (Universal Notice) and follow new notice standards. Information for this letter will be shown on Form SSA-573.