TN 14 (03-97)
GN 02280.842 Sample Guide — Waiver Denial (Combined Overpayment Reconsideration and Waiver Request)
- Refund Requested - RSI Cases
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
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
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
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.
Field Officer Manager
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.