|U.S. Railroad Retirement Board
Bureau of Retirement Claims
844 Rush Street
Chicago, Illinois 60611
|(Name of W/E)
We have approved the subject beneficiary's request for withdrawal of (1) application for Social Security benefits.
The approval of a withdrawal request results in the complete nullification of the
beneficiary's application and any award of benefits made on the basis of such application.
Since the beneficiary has filed no other application for benefits, (2) is not entitled to Social Security payments.
||We have recovered all benefits certified to date.
||Before we approved (1) request for withdrawal, the beneficiary received $ (2) which must now be repaid. Please withhold this sum from the benefits payable under
the Railroad Retirement Act. Credit this sum to the (3) Insurance Trust Fund. Please send us a copy of your adjustment letter to the annuitant.