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 in (2) . Your benefits are stopping because (3) is working more than 45 hours per month.

In another letter, we explained that we would continue to pay you benefits even though you were 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 you are no longer working more than 45 hours per month. We need this information so that we can pay you the right amount of benefits.

 

If You Have Any Questions

If you have any questions, you should contact (4) . You may also write to the Social Security Administration, P.O. Box 17769, Baltimore, Maryland 21235, U.S.A. Please be sure to include your claim number if you do write. However, if you visit an office, please take this letter. It will help the people there answer your questions.

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 is working more than 45 hours per month.

Show the information for this notice on Form SSA-573.

 

Fill-ins:

1. (1) 

   month/year; e.g., July 1992

2. (2) 

   month/year; e.g., August 1992

3. (3) 

   first and last name of the other beneficiary who submitted the work report.

4. (4) 

   See NL 00703.005E for fill-in.

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