Failure to Provide Claim Information

addressee
street:
city
state/zip

Dear addressee:

We wrote to you on [date], for information to help us with your claim for [benefits]. We've closed your file for now because we haven't received the information.

What we needed

We asked you to send us:

• A certified copy of your marriage license [example only]
• A certified copy of Ronnie's birth certificate [example only]
• Mary's and Ronnie's Social Security numbers [example only]

Time limit

We've closed your file for now, but you still have time to send in the information we need. We may be able to [paybenefits/raise your benefits] back to [date], if we receive this information by [date].

If you think we're wrong

If you think we shouldn't have turned down your claim, you should write and tell us. We've attached a form which explains your rights.

If you have any questions, you may call us toll-free by dialing 1-800-827-1000. Our TDD number for the hearing impaired is 1-800-829-4833. If you call, please have this letter with you.

Sincerely,

Enclosures:
VAF 1-4107