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Get Omb No 0960 0369

Te 2 Address City, State ZIP4 Date: July 24, 2010 Claim Number: AccountNumber BIC I am writing to ask your help in making sure that we are paying you the correct amount of Social Security benefits. We need you to give us current information about your work for TaxYear. The enclosed form has some questions about your work for TaxYear. After you complete it, please mail it in the enclosed envelope. If we do not receive this information within 30 days, we will assume that you worked all months in.

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