As we told you in an earlier letter, we have chosen (1) to be your representative payee. Your representative payee will get your checks each month and will use this money for your needs.

Information About Your Checks

If You Have Any Questions

3901C - Domestic

3901D - Foreign

• •

  In title II cases, the FO is responsible for designating this notice. When a copy of the award notice will be sent to the competent adult, the FO will designate optional paragraph 3822C to be included in the notice. The PC is responsible for providing all necessary fill-ins. In title XVI the FO is responsible for the entire notice.

• •

  Select paragraph 3822B when the first payment is different from the regular ongoing payment. Otherwise, select 3822A.

• •

  Use optional paragraph 3822C in Title II cases whenever we are sending a copy of the award notice to the beneficiary.

• •

  See NL 00703.005E for 3901C and 3901D text and fill-in.

ALERT: Since no advance notice is sent to beneficiaries living in foreign countries, the final notice must include appeal rights.

Fill-in:

1. (1) 

   Name of representative payee or name of institution or entity

3822A

1. (1) 

   We will begin, We began

2. (2) 

   monthly payment amount

3. (3) 

   name of payee

4. (4) 

   month, day, year change is effective

3822B

1. (1) 

   sent, will send

2. (2) 

   amount of first payment

3. (3) 

   name of payee

4. (4) 

   month, day, year payment is due

5. (5) 

   ongoing monthly benefit amount

6. (6) 

   him, her, them

7. (7) 

   month, day, year regular monthly check will be received

In title II cases use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573. For title XVI cases, use the Form SSA-L8025-U2 (Supplemental Security Income Payment Decision), or Form SSA-8166-U2 (Supplemental Security Income Notice) as appropriate.