We use the SSA-632 to collect pertinent information about the overpaid individual and the overpaid individual's household family members, if any, when the overpaid individual requests a waiver. The overpaid individual or an individual representing the overpaid individual can help complete the SSA-632. A technician can assist with completing the SSA-632 if the overpaid individual requests our assistance. At the top of the SSA-632, we inform the public when to complete the following forms and provide the purpose of the forms:

 

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  SSA-561, Request for Reconsideration;

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  HA,-501-US, Request for Hearing by Administrative Law Judge; and

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  SSA-634, Request for Change in Overpayment Recovery Rate

 

If the overpaid individual does not live in the United States, obtain an SSA-632-BK and ask the individual to show the value of their and any household family members' resources, monthly income, and monthly expenses in local currency. After receiving the completed form, use the Treasury Reporting Rates of Exchange tables to convert the foreign currency to U.S. dollar amounts and specify the type of currency involved. For the definition of household family members, see GN 02250.100B1.

Inform the overpaid individual or representative payee (payee) that they are responsible for providing proof of all monthly income, certain monthly household expenses, and resources, per GN 02250.255. We do not require proof for food and miscellaneous monthly household expenses, unless the expenses seem unusually high. For more information regarding monthly household expenses, see GN 02250.100D. The Access for Financial Institution (AFI) process requires the overpaid individual to provide authorization for us to obtain their financial account information. If the overpaid individual, parent, or legal guardian refuses to provide the authorization or revokes the authorization, we are unable to grant a waiver based on the defeats the purpose provision. For more information, refer to GN 02250.100E8.

The supporting documents should be no older than 3 months from the date that we receive the waiver request. If the individual notifies you that they are actively trying to obtain the supporting documents and needs additional time, allow them the additional time. If the individual has not provided the documents within 30 days or they have not notified you that they need additional time, you are unable to approve the waiver under the defeats the purpose waiver provision. If the overpaid individual does not qualify for a waiver under other waiver provisions, you cannot approve the waiver. Notify the individual with the appropriate notice found in, GN 02250.370. Process the waiver determination following the instructions in GN 02270.000 and GN 02250.315.

When interviewing the individual requesting a waiver, be alert for non-waiver related evidence that may require additional development, such as the individual has wages on the SSA-632 when we did not know the individual was working. Take the appropriate action, if necessary. Include all development on the non-waiver issue in the waiver documentation.

Fax the SSA-632 and the supporting documents into the Certified Electronic Folder (CEF) for disability claims. For non-disability claims fax the SSA-632 into the Non-Disability Repository for Evidentiary Documents (NDRed) using the Evidence Portal. You can access the Evidence Portal at View Evidence - Evidence Portal (ssa.gov).

 

Question 1

Anyone who wants to request a waiver must complete Section 1. It includes the overpaid individual’s name, SSN, and claim number. If someone else is completing the SSA-632 on behalf of the overpaid individual, we ask for the identity of the organization or individual who is assisting the overpaid individual.

Question 2

If the individual was the payee for the overpaid individual when the overpayment occurred, they must complete Section 2. Complete the questions in Section 2 as the questions apply to the payee. If we notified the payee that they are liable for the overpayment, they must request a waiver and complete the questions on the SSA-632 as the questions relate to them.

Question 3

If the individual is a contingently liable individual who received an overpayment notice for a family member’s overpayment, they must complete Section 3. The contingently liable individual’s answers will inform us if the individual was living with the family member and received any of the overpaid money, see GN 02250.150.

Questions 4 through 12

The answers to these questions may help technicians make the fault determination. The responses must thoroughly explain the overpayment situation. Findings of fault must be made separately for each overpaid individual who requests a waiver. The fault of one individual is independent of the fault of any other individual who may be liable for the overpayment.

Questions 4 through 11- The responses to questions 4 through 11 provides information about the individual’s overpayment.

Questions 12.A through 12.E - The responses to questions 12.A through 12.E may show whether the overpaid individual or payee acted in good faith or complied with reporting responsibilities. The responses to the questions will help determine if the overpaid individual understands reporting responsibilities and recognizes the events that may affect their benefits. If the overpaid individual or payee reported the change that caused the overpayment, they will describe the actions they took to report and what they did after the report. The purpose is to assist the technician with making the fault determination.

Question 12.F - Document when an overpaid individual receives Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or Department of Veterans Affairs (VA) service and non-service related disability pension. If the overpaid individual is receiving any of the these benefits at the time that we receive the waiver request and if you have determined that the overpaid individual is not at fault, the individual does not have to complete any more questions on the form because we would deem that recovery defeats the purpose of Title II of the Act, see GN 02250.110.

Questions 13 through 16

The responses to questions 13 through 16 will assist with determining if the overpaid individual had any of the overpaid funds in their possession when they received the overpayment notice. The answers to these questions will assist technicians with determining if the overpaid individual meets the defeats the purpose waiver provision, see GN 02250.105.

Question 17

Question 17.A - List the overpaid individual's household family members. For the definition of household family members, see GN 02250.100B1.

If the overpaid individual is a minor child, include only the child’s name, if the child does not help with food or household expenses and complete Sections 7, 8, and 9 with the child’s information only. A child’s ability to repay an overpayment depends on the child’s own monthly income, resources, and share of household expenses. A child’s income or resources must be in the child’s name and available for the child’s use. If the child helps with food or household expenses, list the child’s parent(s) and all other household family members. For more information, refer to GN 02250.100B2.

Question 17.B - If someone lives with the overpaid individual who is not a household family member , include any money or payments that the individual provides as income to the overpaid individual.

Questions 18 through 19

Question 18.A - Enter the cash in the overpaid individual’s and household family member’s possession.

Question 18.B - Enter a detailed description of the financial accounts owned by the overpaid individual and household family members.

Question 19.A - If the overpaid individual owns more than one vehicle, enter a description, present value, loan balance, and the main purpose of the additional vehicles for the overpaid individual and household family members. Do not include a vehicle needed for the support of the overpaid individual or household family member who uses a wheelchair or mobility devise as a resource.

Question 19.B - Enter a detailed description of any real estate that the overpaid individual and household family members own, if it is not where the overpaid individual lives.

Question 19.C - Enter a detailed description of any interest in any business, property, or valuables that the overpaid individual and household family members own.

For more information on how to apply resources for a defeats the purpose determination, see GN 02250.100E.

Questions 20 through 22

Question 20.A - Enter monthly employment information for the overpaid individual.

Question 20.B - Enter monthly employment information for the overpaid individual’s spouse.

Question 20.C - Enter the total monthly employment information for any other household family member.

Question 21 - Enter the support or contributions from any individual, agency, or organization that the overpaid individual and household family members receive.

Question 22 – Enter unearned monthly income for the overpaid individual and household family members.

For more information regarding monthly household income, refer to GN 02250.100C.

Question 23

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, child support, alimony, wage garnishments, etc.

When reviewing the monthly household bills do not double count the expenses if the overpaid individual uses a credit card for paying bills and making purchases. If the overpaid individual pays expenses by credit card, only list it as a credit card expense instead of a another expense for clothing, phone, gas for a vehicle, or etc.

For more information regarding monthly household expenses, see GN 02250.100D.

Questions 24 through 25

Section 10 totals the monthly household expenses from the total monthly household income to determine if the overpaid individual has money to pay the overpayment. Monthly household expenses usually have some unbudgeted or unaccountable expenses; therefore, we allow a margin of $55 to cover those expenses. We use the $55 to establish “adjusted household expenses” and compare it to household income when deciding if overpayment recovery defeats the purpose, see GN 02250.100D4.

Question 26

Question 26.A - Requires the overpaid individual to let us know if they expect to receive an inheritance within 6 months of requesting the waiver to determine if the individual’s resources may increase.

Question 26.B - This question totals the overpaid individual and the family members’ resources to determine if recovery reduces the resources below the amount listed in GN 02250.100B.

Question 26.C - This question determines if the overpaid individual has any resources that they cannot convert to cash to repay the overpayment.