Question 1.A - Enter the overpaid individual’s name, SSN, and claim number.

Question 1.B - Enter the individual's name and relationship to the overpaid individual, if someone else is completing the SSA-632 on their behalf.

Questions 2 through 5

Question 2 - Select yes, and follow the instructions that apply, if the overpayment amount the individual is asking us to waive is $2,000 or less. Select no if the overpayment is more than $2,000. Do not continue if the individual selects yes.

Enter the reason(s) the individual is requesting a waiver from the available list. Enter an explanation for the selected choice(s).

Question 3 - Enter the date of the overpayment notice for the overpayment the individual is requesting us to waive.

Question 4 - Select yes, if the individual is requesting us to waive the entire overpayment amount or select no if they do not want their entire overpayment waived.

If the individual is not requesting that we waive the entire overpayment, is the individual requesting we waive the remaining amount of money they owe us? Select yes or no.

Question 5 - Enter the reason(s) why the individual thinks the overpayment may have happened.

Question 6 - Select yes if the overpaid individual or any dependent household family member currently receives any of the needs based assistance listed in this section. If yes, select the items that apply. Do not complete any more questions on the form and have them sign, date, and provide the information requested on page 9.

Select no if the overpaid individual or dependent household family member does not receive needs based assistance and continue with the rest of the questions on the form.

Question 7

Question 7.A - If the overpaid individual is an adult, enter the names, ages, and relationship of their spouse and dependent household family members.

If the overpaid individual is a minor child, select yes or no to indicate if the minor child’s income and assets help with food and household items. If the individual selects yes, enter the child's parents' and the parents' dependents' names, ages, and relationship to the child in the box provided. If the individual selects no, do not enter any information in the box; instead complete Sections 5, 6, and 7 with the child’s information only.

Question 7.B - If someone lives with the overpaid individual who is not a dependent, enter any money or payments they provide for rent or household bills or expenses.

Questions 8 and 9

Question 8.A - If the overpaid individual, their spouse, or dependents have any cash in their possession, enter the total amount.

Question 8.B - If the overpaid individual, their spouse, or dependents own financial accounts, enter the type of account, name and address of the institution, name on account, balance or value, monthly interest or dividend, and account numbers.

Question 9.A - If the overpaid individual, their spouse, or dependents own more than two vehicles, select yes and enter the owner, a description, present value, loan balance, and the main purpose or use for each vehicle. To determine which vehicles are excluded as a resource for a waiver determination, refer to GN 02250.100E.

Question 9.B - If the overpaid individual co-owns any real estate with anyone other than their spouse or dependent family member, select yes and enter the owner, description, market value, loan balance, and income amount.

Question 9.C - If the overpaid individual, their spouse, or dependents own or have an interest in any business, property, or valuables, select yes and enter the owner, description, market value, loan balance, and income amount.

Question 9.D - Select the appropriate box to indicate whether the overpaid individual can sell or liquidate any of the resources identified in this section and enter the overpaid individual's explanation in the space provided.

Questions 10 and 11

Question 10.A - If the overpaid individual is employed, select yes and enter the employer's information and monthly take home pay or earnings from self-employment.

Question 10.B - If the overpaid individual's spouse is employed, select yes and enter the employer's information and monthly take home pay or earnings from self-employment.

Question 10.C - If the overpaid individual's dependents are employed or self-employed, select yes and enter the dependents' names and monthly take home pay.

Question 11 - If the overpaid individual, their spouse, or any dependents receive income, enter the income in the specific columns.

Question 12 - Enter the monthly household expenses. Write the amounts in whole dollars and round any cents to the nearest dollar. Do not list an expense withheld from the individual’s paycheck, such as medical insurance, child support, alimony, wage garnishments, etc.