Security Envelope

Form Approved

SOCIAL SECURITY ADMINISTRATION OMB No. 09600105

"ADVANCE NOTICE OF TERMINATION OF CHILD'S BENEFITS

***-**.**** **

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EDDIE PHUNG FOR :

THOMAS PHUNG THOMAS PHUNG

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Apr Gane Da CTT AAR :

EVERETT WA 98208-7166 zl i

July 2020

YOUR BENEFITS WILL AUTOMATICALLY STOP AT AGE 18 UNLES!

© You are a full-time student at an elementary or secondary school (a

secondary school is a school at or below the high school level), or

¢ You qualify for childhood disability benefits.

Your benefits will end sth the payment for the month before the month in which you attain age 18

You attain age 18 on the day before your 18th birthday. This is imprortant when your birthday t= on

the Grst day of the month. For example, if your 18th birthday is June I, you attain that age on May

31. Ifyou are neither a fulltime student nor disabled in May. benefits would not be payable for May.

‘The Inst henefit check to which you would be entitled would be the one received in May, whieh

represents your payment for April.

FOR YOU TO RECEIVE STUDENT BENEFITS AFTER AGE 18,YOU MUS1

1. Complete the form, STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE

(page 2).

2. Take the form to the school for a school official to certify on page 3 the information

you provide on page 2

3. Leave page 4, NOTICE OF

page 5 with the school official.

4, Bring pages 2 (STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE) and

3 (CERTIFICATION BY SCHOOL OFFICIAL) to a Social Security office or return

them in the enclozed envelop (fold page 2 so the address on back shows through

window envelope) prior to the age 18 attainment month shown above.

5. For Direct Deposit, bring or mail a voided check or a copy of a bank statement. Your

name must be on the account

SATION OF FULL-TIME SCHOOL ATTENDANCE, and

‘TO RECEIVE CHILDHOOD DISABILITY BENEFITS, YOU MUST CONTACT ANY SOCIAL

SECURITY OFFICE AND HAVE THE FOLLOWING INFORMATION:

1. A history of the disabling condition, including names and addresses of medical record

sources (such az doctors and hospitals) and schools attended. If you have worked, you

‘must also furnish your work history.

2 Your Social Security Number.

Please keep the attached shect, INFORMATION ABOUT BENEFITS PAST AGE 18 (page 6), for your

records. It contains important information about eligibility for student benefits and reporting

responsibilities.

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