We are writing to tell you about extra money we are sending you.
What We Will Pay and When
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•
You are due $(1) . This is the money that the last representative payee saved for you and returned
to us.
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•
You will get this money over a period of months.
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•
We will send you $(2) each month in addition to the regular check you already get.
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•
These checks will start (3) and end when all of the extra money is paid to you.
If You Disagree With The Decision
3180A - Domestic
3180B - Foreign
If You Want Help With Your Appeal1
3100E
If You Have Any Questions
3901C - Domestic
3901D - Foreign
1 If the person lives outside the U.S. or has an attorney, omit this paragraph.