TN 14 (03-97)

GN 02280.849 Sample Guide — Partial Waiver Denial (Waiver Only Requested) -Adjustment Proposed - RSI Cases

Name

Address

Dear

 

We are writing about your request that we waive the collection of your Social Security overpayment. Based on the facts we have, we will waive the collection of part of your Social Security overpayment of    $(1)    . You will not have to pay back    $(2)    of this overpayment. However, this means that you still have to pay back    $(3)    of this overpayment.

Below, we explain why we cannot waive all of your overpayment.

 

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.

 

(4)

 

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.

 

(5)

 

Therefore, based on the facts we have, we cannot waive the collection of     (6)    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 $    (7)    . Make your check or money order out to the Social Seurity Administration. Be sure to put your claim number (8) on it. Please use the enclosed envelope to mail the check or money order to us.

If we do not receive your refund within 30 days, we will collect your overpayment from your monthly Social Security payments. You will receive another letter that will explain when we will start collecting your overpayment and the amount we will withhold.

 

Do You Think We Are Wrong?

 

(If waiver was denied because the person declined the conference or failed to appear for it include:)

If you think we are wrong, you have the right to appeal. We will correct any mistakes. We will look at any new facts you have. Then a person who did not make the first decision will decide your case again.

  • You have 60 days to ask for an appeal.

  • 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 an appeal.

     

(If waiver is denied after a personal conference include:)

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 Admnistrative 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 hearng 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

         Field Officer Manager

 

Enclosure

Refund Envelope

 

Fill-ins

1 ) amount for which the person is liable minus any amoun