We have determined that you received $ *F1 more in Social Security benefits than you were due. *F2. (E3113.1)

How To Pay Us Back

You should refund this overpayment within 30 days. Please make your check or money order payable to the "Social Security Administration" and send it to us in the enclosed envelope. Always include your Social Security claim number on the check or money order.

*F1

If we do not receive your refund within 30 days, we shall instruct the Railroad Retirement Board to withhold 10 percent of your Social Security benefits until the overpayment is recovered. The Railroad Retirement Board will advise you when the withholding is expected to begin and for how long. However, you will be given at least 30 days before the withholding begins. (E3113.1A)

If You Think You Should Not Have to Pay Us Back

You may not have to pay us back. Sometimes we can waive the collection of an overpayment, which means you will not have to pay us back. For us to waive the collection of your overpayment, two things must be true.

 

• •

  It was not your fault that you got too much Social Security money.

  •  

    AND

• •

  Paying us back would mean you cannot pay your bills for food, clothing, housing, medical care, or other necessary expenses, or it would be unfair for some other reason.

You can ask for waiver at any time by filling out the waiver form. The form number is SSA-632-BK. We will not collect the overpayment while we decide if we can waive collection. If you ask for waiver in the next 30 days, we will not withhold benefits until we decide if we can waive collection.

You may need to show us proof of your monthly income, expenses, and assets. Examples are pay stubs, pension records, rent receipts, utility bills and bank statements.

If you have any questions, you may contact *F1. (3100C)

If You Disagree With The Decision

If you disagree with the decision, you have the right to appeal. A person who did not make the first decision will decide your case. We will review your case again and consider any new facts you have.

• •

  You have 60 days to ask for an appeal. If you ask in the next 30 days, you will not have to pay us back until we decide your case.

• •

  Both the 30- and 60-day periods start the day after you receive this letter. We assume you got this letter 5-days after the date on it, unless you show us that you did not get it within the 5-day period.

• •

  You must have a good reason if you wait more than 60 days to ask for an appeal.

• •

  You have to ask for an appeal in writing. We will ask you to sign a form called “Request for Reconsideration.” The form number is SSA-561-U2. To get this form, contact one of our offices. We can help you fill out the form.

We are enclosing a pamphlet called “Important Information About Your Appeal and Waiver Rights.” Please be sure to read it.

Even if you do not want to request reconsideration or waiver, call us at 1-800-772-1213 if withholding of the monthly payment will cause hardship. Unless we hear from you within 30 days, we will withhold the benefit as shown above. (3113A Domestic)

Or

If You Disagree With The Decision

If you disagree with the decision, you have the right to appeal. A person who did not make the first decision will decide your case. We will review your case again and consider any new facts you have.

• •

  You have 60 days to ask for an appeal. If you ask in the next 30 days, you will not have to pay us back until we decide your case.

• •

  Both the 30- and 60-day periods start the day after you receive this letter.

• •

  You must have a good reason if you wait more than 60 days to ask for an appeal.

• •

  Your request must be in writing. The fastest and easiest way to file an appeal is to visit *F1 online.

We are enclosing a pamphlet called “Important Information About Your Appeal and Waiver Rights.” Please be sure to read it.

If withholding the monthly payment will cause hardship, please contact *F2.

You can contact us even if you do not want to request a reconsideration or a waiver. Please take this letter with you if you do visit an office. Unless we hear from you within 30 days, we will withhold the benefit as shown above. (3100F Foreign)

If You Want Help With Your Appeal ¹(REPC01)

You may choose to have a representative help you. We will work with this person just as we would work with you. If you decide to have a representative, you should find one quickly so that person can start preparing your case.

Many representatives charge a fee only if you receive benefits. Others may represent you for free. Usually, your representative may not charge a fee unless we approve it. Your local Social Security office can give you a list of groups that can help you find a representative.

If you get a representative, you or that person must notify us in writing. You may use our Form SSA-1696 "Appointment of Representative." Any local Social Security office can give you this form. (REP002)

Suspect Social Security Fraud?

Please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Any Questions

We invite you to visit our website at www.socialsecurity.govv on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 1-*F3- *F4- *F5. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

*F6

*F7

*F8

*F9 *F10- *F11

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office. (CTDO Domestic)

Enclosures (2):

SSA-3105

Refund envelope

¹ If the person lives outside the U.S. or has an attorney, omit this paragraph.

This notice is to be used in overpayment cases when the Social Security benefits are certified to the Railroad Retirement Board for payment and adjustment of the Social Security benefits is proposed.

The person who determines the overpayment (generally the benefit authorizer) is responsible for requesting this notice and providing the appropriate fill-ins.

If the overpayment computation is too complex for a simple narrative explanation, use a chart such as the following:

 

 

 

E3113.1 Fill-Ins:

*F1-1 Amount of overpayment

*F1-2 Explanation of the overpayment

E3113.1A Fill-Ins:

*F1-1 3100FC if required for foreign cases

If you pay us by check or money order, make sure the check or money order is in United States (U.S.) dollars or in local currency equal to U.S. dollars. When you pay us in local currency, we use the exchange rates in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment to us, please contact your nearest Federal Benefits Unit (FBU). Visit www.ssa.gov/foreign/foreign.htm for a list of FBUs. If you are in Canada, visit www.ssa.gov/foreign/canada.htm to find the office that services your area. They will help you make the refund. (3100FC)

3100C Fill-Ins:

*F1-1 your nearest Social Security office

*F1-2 the Social Security office that services your area in Canada. To find which office services your area, visit www.ssa.gov/foreign/canada.htm online

*F1-3 your nearest Federal Benefits Unit (FBU). Visit www.ssa.gov/foreign/foreign.htm for a list of FBUs

3100F:

*F1-1 www.ssa.gov/benefits/disability/appeal.html

*F2-1 your nearest Social Security office

*F2-2 the Social Security office that services your area in Canada. To find which office services your area, visit www.ssa.gov/foreign/canada.htm online

*F2-3 your nearest Federal Benefits Unit (FBU). Visit www.ssa.gov/foreign/foreign.htm for a list of FBUs

CTDO (Domestic) Fill-Ins:

*F1-1 Zip code

*F2-1 Zip+4

*F2-2 DO Code

*F3-1 Telephone Area Code

*F4-1 Phone Exchange

*F5-1 Phone Number

*F6-1 Local Office Address Line #1

*F7-1 Local Office Address Line #2

*F8-1 Local Office Address Line #3

*F9-1 City & State of Local Office

*F10-1 Local Office Zip code

*F11-1 Zip+4 of Local Office

Because the fill-ins may vary according to the different situations, follow the requester's typing instructions carefully.