Basic (06-81)

GN 02280.910 Sample Guide — Notice To Overpaid Person In Current Pay Status With Title XVIII Overpayment - Adjustment Proposed - No Waiver Offered

As you were previously informed you have been overpaid $        by the Medicare Program. The Social Security law requires that we recover the overpayment by withholding the amount from your social security benefits. We plan to withhold $        each month beginning with the benefit you will receive in ( month/year ). This will reduce the payment you receive to $        a month. We will continue to withhold your benefit each month until the overpayment has been fully recovered.

Please call, write or visit any social security office if (1) you cannot afford the planned reduction of your benefit and you would like to request that less of your monthly benefit withheld so that the overpayment can be paid back sooner; or (3) you prefer to make full refund of the overpayment so that no withholding of your benefit is necessary. Please take this letter with you if you do visit a social security office. Unless we hear from you within 30 days, we will reduce your benefits as shown above.