We are writing to let you know that (1) entitlement to benefits ended as of (2) . We based this on information that (3) (4) in (5) .
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(To Be Used When Last Child-In-Care Marries) |
3925A |
We can pay (1) benefits only when you have a child in your care, under age 16 or disabled, who is
entitled to Social Security benefits.
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(If there is an overpayment, follow instructions in NL 00703.920 on what paragraphs to include.)
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Other Social Security benefits
3923A
OR
3923B
If you disagree with the decision1
ALS020
If you have any questions
3901D
1 If there is an overpayment, omit this paragraph.