TN 113 (07-24)

NL 00703.101 Notice To Overpaid Person In Current Pay Status — Adjustment Proposed — Alien Tax Withholding Involved

Document Identifier for Word Processor: E3101

A. Exhibit Letter

We sent you $ (1) more in Social Security benefits than we should have.

(2) .

 

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 *F1 Social Security claim number on the check or money order.  

Please send your check or money order in United States currency or in local currency equal to the United States dollars. When you pay us in local currency, we use the exchange rate in effect at the time we receive 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 directly to us, please go to your Federal Benefit Unit for help in making the refund. Visit www.socialsecurity.gov/foreign.htm for a list of Federal Benefits Units.  

If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding 10 percent of your total monthly benefit or $10 (whichever is more) beginning with the payment you will receive on or about *F2. If the total benefit is less than $10, we will withhold the entire benefit. We will continue withholding benefits until the amount we have kept is equal to the amount owed us. (3101A)

Or

To recover the overpayment, we will withhold 10 percent of the payment you will receive *F1 until we recover the overpayment. We will do this starting with the payment *F2 will receive on or about *F3. (3104B)  

Or

We plan to recover the overpayment from the payment you would normally receive about (1) . The reduced payment will be $ (2) , and you will again receive your regular monthly payment starting about (3) . (3101B)

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.

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

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, please call, write or visit any Social Security office if (1) withholding of your monthly payment will cause hardship; or (2) you would rather pay the full amount of the overpayment so that no withholding of your benefit is necessary. Please take this letter with you if you do visit an office. Unless we hear from you within 30 days, we will withhold your benefit as shown above. (3101C)

If You Want Help With Your Appeal (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)

If You Have Any Questions (REFC01)

Need more help?

1. Visit www.ssa.gov for fast, simple, and secure online service.

2. If you are in the United States, American Samoa, Guam, Northern Mariana Islands, Puerto Rico, or the U.S. Virgin Islands, call us at 1-800-772-1213. If you are deaf or hard of hearing, call TTY 1-800-325-0778.

3. You may also call your local Social Security office.

  • If you are in Canada, visit *F1 to find the office that services your area.

  • Contact your nearest Federal Benefits Unit (FBU). Visit *F2 for a list of FBUs.

  • Write to the Social Security Administration at:

    P.O. Box 17769

    Baltimore, Maryland, 21235-7769

    USA

If you contact us, please refer to this letter. It will help us answer your questions.

How are we doing? Go to www.ssa.gov/feedback to tell us. (REF197)

Or

Suspect Social Security Fraud? Please visit Office of the Inspector General or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Any Questions

Need more help?

1. Visit www.ssa.gov for fast, simple, and secure online service.

2. Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm. If you are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention this letter when you call.

3. You may also call your local office at 1- *F1- *F2- *F3.

(Field Office General Inquiry Line phone number).

*F4

*F5

*F6

*F7 *F8- *F9

How are we doing? Go to www.ssa.gov/feedback to tell us. (CTDO Domestic)

Enclosures (2):

Form SSA-3105

Refund envelope

B. Requesting Instructions

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

  • Use 3101A if the overpayment exceeds the monthly benefit payable after tax withholding.

  • Use 3104B if the overpayment equals the monthly benefit payable after tax withholding.

  • Use 3101B if the overpayment is less than the monthly benefit payable after tax withholding.

  • Use 3100C and 3101C in all cases.

Fill-ins:

  1. (1) 

    amount of the overpayment (not including taxes withheld)

  2. (2) 

    narrative overpayment explanation - A chart may be included following the explanation.

3101A:

*F1-1 your

*F1-2 his

*F1-3 her

*F2-1 MM/DD/CCYY date payment would have been received

3104B:

*F1-1 for him

*F1-2 for her

*F1-3 null

*F2-1 you

*F2-2 he

*F2-3 she

*F3-1 MM/DD/CCYY

3101B:

*F1-1 MM/DD/CCYY date payment will be received

*F2-1 $$ amount of payment

*F3-1 MM/DD/CCYY date payment will be received

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 FBU

REF197 Fill-Ins:

*F1-1 http://www.socialsecurity.gov/foreign/canada.htm

*F2-1 http://www.socialsecurity.gov/foreign/foreign.htm

CTDO (Domestic) Fill-Ins:

*F1-1 Telephone Area Code

*F2-1 Phone Exchange

*F3-1 Phone Number

*F4-1 Local Office Address Line #1

*F5-1 Local Office Address Line #2

*F6-1 Local Office Address Line #3

*F7-1 City & State of Local Office

*F8-1 Local Office Zip code *

F9-1 Zip+4 of Local Office


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900703101
NL 00703.101 - Notice To Overpaid Person In Current Pay Status — Adjustment Proposed — Alien Tax Withholding Involved - 07/10/2024
Batch run: 07/10/2024
Rev:07/10/2024