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.
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•
It was not your fault that you got too much Social Security money.
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•
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.
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•
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.
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•
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.
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•
You must have a good reason if you wait more than 60 days to ask for an appeal.
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•
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.
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•
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.
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•
Both the 30- and 60-day periods start the day after you receive this letter.
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•
You must have a good reason if you wait more than 60 days to ask for an appeal.
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•
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.