We are writing to let you know that we are stopping your Social Security benefits in

(1) . This is the check you would normally get about (2) . Your benefits are stopping because (3) expects to earn more than $ (4) during the year.

In another letter, we explained that we would continue to pay you benefits even though you are working. We also said that the benefits we paid to you were for the non-working people in your house.

The benefits we are stopping are the benefits you were paid for other people in your house. Since they are now working, they are not due any benefits at this time.

 

Information We Need From You

Let us know right away if the amount of money you expect to earn changes. We need this information to make sure we pay you the right amount of benefits.

 

If You Have Any Questions.

3901C

This notice is used only for survivor cases. Send this notice when a beneficiary who is already working but receiving a reduced benefit is now having his/her benefit stopped because another beneficiary has submitted an estimate of earnings in excess of the current yearly earnings limitation.

Show the information for this notice on Form SSA-573. The name and address can be taken from the latest Form SSA-3926-EP in file.

 

Fill-ins:

1. (1) 

   month/year; e.g., July 1992

2. (2) 

   month/day/year; e.g., August 3, 1992

3. (3) 

   first and last name of the other beneficiary who submitted an estimate of earnings.

4. (4) 

   dollar amount (current yearly earnings limitations)

Refer to NL 00703.005E. for 3901C text.

Use SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on SSA-573.