TN 14 (03-97)
GN 02280.779 Sample Guide — Reconsideration Affirms Overpayment Determination/Waiver Approved -
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. We have explained our decision in the enclosed Form SSA-662.
However, we are waiving the collection of your Social Security overpayment of $ (1) . This means you will not have to pay this money back.
The Reason For Our Decision
For us to waive the collection of your overpayment, two things have to be true.
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•
It was not your fault that you got too much Social Security money
AND
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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.
Based on the facts we have, we found that both of these are true about you. Therefore,
you will not have to pay us back.
Do You Think We Are Wrong?
If you think we are wrong, you have the right to appeal. 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.
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•
You have 60 days to ask for a hearing.
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The 60 days start the day after you get this letter.
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•
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 Hearing.” 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
Director, Program Center
Enclosure
SSA-662
Fill-in
1 ) amount for which the person is liable minus any amount repaid to date