TN 31 (02-97)

NL 00703.195 Partial Waiver Approval with Personal Conference — Refund Requested

Document Identifier for Aurora: E3195

DPS Notice: Partial Waiver Approval (Per Conference Decision)


We are writing about your request that we waive the collection of your Social Security overpayment. Based on the facts we have, we will waive the collection of part of your Social Security overpayment of $ (1) . You will not have to pay back $ (2) of this overpayment. However, this means that you still have to pay back $ (3) of this overpayment.

Below, we explain why we cannot waive all of your overpayment.

The Reason for Our Decision

For us to waive the collection of your overpayment, two things have to be true.

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


  • 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.

Based on the facts we have, you do not meet both of these rules. The following will tell you why.


We apply three tests when we decide if you are at fault in causing an overpayment. The first is whether you made an incorrect statement or a statement which you knew or should have known was incorrect. The second is whether you failed to give us timely information which you knew or should have known was important. The third is whether you accepted payments which you either knew or could have been expected to know were incorrect.


Therefore, based on the facts we have, we cannot waive the collection of $ (6) of this overpayment. This means that you must pay this money back.


How To Pay Us Back


You should refund this overpayment within 30 days. You can send us a check or money order for the full amount of your overpayment of $ (7) . Make your check or money order out to the Social Security Administration. Be sure to put your claim number, (8) , on it. Please use the enclosed envelope to mail the check or money order to us.

If you cannot send the full amount now, send as much as you can. Then contact any Social Security office. You can pay the rest of the money you owe by making monthly payments.


If You Disagree With The Decision


If you disagree with this decision, you have the right to appeal. Your appeal can cover both your reconsideration and waiver denial. A person who has not seen your case before will look at it. That person will be an administrative law judge. The administrative law judge will review your case and look at any new facts you have before deciding your case.


You have 60 days to ask for a hearing.


The 60 days start the day after you get 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 will have to have a good reason for waiting more than the 60 days to ask for a hearing.

You have to ask for a hearing in writing. We will ask you to sign an SSA form HA-501, called "Request for Hearing." Contact one of our offices if you want help.


If You Want Help With Your Appeal




If You Have Any Questions


If you have any questions, you should call, write, or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.




Refund Envelope



  1. (1) 

    amount of overpayment

  2. (2) 

    amount of overpayment waived

  3. (3) 

    overpayment refund amount

  4. (4) 

    narrative explanation why overpayment cannot be waived

  5. (5) 

    narrative explanation for denying without fault

  6. (6) 

    overpayment refund amount

  7. (7) 

    overpayment refund amount

  8. (8) 

    claim number


Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards for cases processed in the PC. Because the requested fill-ins and paragraph may vary according to the different situations, follow the requester's instructions carefully. There is a refund envelope enclosure. Include a “refund enevelope” with the letter and type the claim number on the inside of the envelope below the flap. Place the envelope lengthwise on the left-hand side of the notice and staple in the upper left-hand corner.

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NL 00703.195 - Partial Waiver Approval with Personal Conference — Refund Requested - 08/19/2016
Batch run: 08/19/2016