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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
![](https://webarchive.library.unt.edu/eot2008/20090512193339im_/http://plainlanguage.gov/graphics/medYellowDot.gif)