TN 14 (03-97)

GN 02280.842 Sample Guide — Waiver Denial (Combined Overpayment Reconsideration and Waiver Request) - Refund Requested - RSI Cases

Name

Address

Dear

 

We are writing about your request that we reconsider and waive the collection of your Social Security overpayment. Based on the facts we have, our decision that you are overpaid is correct and we cannot waive the collection of your overpayment of    $(1)    .

 

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

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

  (2)

   

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.

(3)

 

Therefore, based on the facts we have, we cannot waive the collection 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    $(4)    . Make your check or money order out to the Social Security Administration. Be sure to put your claim number (5) on it. Please use the enclosed envelope to mail the check or money order to us.(6)

 

Do You Think We Are Wrong?

 

If you think we are wrong, 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 correct any mistakes and look at any new facts you have before deciding your case. We call this a hearing.

• •

  You have 60 days to ask for a hearing

• •

  The 60 days start the day after you get this letter.

• •

  You will have to have a good reason for waiting more than 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-U5, called “Request for Hearning.” Contact one of our offices if you want help.

 

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.

 

         Sincerely          

         Name          

         Field Officer Manager

 

Enclosure

Refund Envelope

¹ ) amount for which the person is liable minus any amount repaid to date

² ) narrative explanation of how the overpayment occurred

³ ) narrative explanation

⁴ ) same as fill in (1)

⁵ ) Social Security number and BIC

⁶ ) If a repayment agreement was reached at the personal conference, include it here.