Although you never asked us to withhold any money from (1) Social Security benefits for voluntary Federal tax withholding, we withheld $ (2) . (3) We are sorry if our error caused you any inconvenience.

If You Have Any Questions

3901C

Fill-ins:

1. (1) 

   your; beneficiary's name, possessive in format

2. (2) 

   amount we withheld

3. (3) 

   Choice 1 - We are refunding this amount to you. (When the error is in the current year.)

   Choice 2 - To receive the money we withheld, you must contact the Internal Revenue Service. (When the error is in the prior year.)

   Choice 3 - We are refunding $ (a) to you that we withheld for the current year. To receive the $ (b) we withheld for the previous year, you must contact the Internal Revenue Service.

   (a)

   amount refunded

   (b)

   IRS amount

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

Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Because the requested fill-ins and paragraphs may vary according to different situations, follow the requester's instructions carefully.