Attention: [Entity's POC Name] (Entity POC)

Our records show that [Entity Name] ([Entity EIN]) received [Amount Received] for services [Rep Name] provided to [Claimant or Aux Beneficiary Name] on their claim for [Type of Benefit]. However, [Entity Name] should have received [Correct Amount]. Because of this error, [Entity Name] received [Erroneous Amount] in excess fees.

As a result, [Entity Name] must refund [Erroneous Amount] to us within 20 days from the date of this notice. Please make the refund check payable to: Social Security Administration. Include the entity’s EIN, the Representative ID of the representative who assigned direct payment of the fee to [Entity Name], and the claimant or auxiliary beneficiary’s full name and Social Security Number on the refund check. Submit the payment to the address at the top of this notice.

If [Entity Name] fails to refund the excess fees received, we may deem [Entity Name] ineligible to receive direct payment. Once an entity loses eligibility to receive direct payment of fees, we will not honor any assignments made by a representative to the entity until the entity takes necessary action to restore eligibility.

Suspect Social Security Fraud?

If you suspect Social Security fraud, please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Questions

Please visit our Representing Claimants website at www.ssa.gov/representation for general information.  

If you have questions, please call us at 1-800-772-6270. If you are deaf or hard of hearing, you can call the TTY number, 1-800-325-0778 between 7:00 a.m. and 5:30 p.m. Eastern time, Monday through Friday. When you call, please have this letter with you to help us answer your questions.

If you have questions about reporting income or Form 1099-MISC, please contact the Internal Revenue Service.

Attention: [Entity's POC Name] (Entity POC)

We previously wrote to inform [Entity Name] ([Entity EIN]) on [Date of 1st Contact], that it received [Erroneous Amount] in error for services [Rep Name] provided in the claim(s) of [Claimant or Aux Beneficiary Name].

In our previous correspondence, we asked that [Entity Name] refund the erroneous amount and provided instructions on how to do so. To date, the error has not been corrected despite our previous correspondence. This is our final attempt to recover the excess fees [Entity Name] received in error for services [Rep Name] provided on the claim(s) of [Claimant or Aux Beneficiary Name].

Please make the refund check payable to: Social Security Administration.

Include the entity’s EIN, the Representative ID of the representative who assigned direct payment of the fee to [Entity Name], and the claimant or auxiliary beneficiary’s full name and Social Security Number on the refund check. Submit the payment to the address at the top of this notice.

If [Entity Name] fails to refund excess fees received within 20 days of the date of this notice, we may deem [Entity Name] ineligible to receive direct payment. Once an entity loses eligibility to receive direct payment of fees, we will not honor any assignments made by a representative to the entity until the entity takes necessary action to restore eligibility.

Suspect Social Security Fraud?

If you suspect Social Security fraud, please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Questions

Please visit our Representing Claimants website at www.ssa.gov/representation for general information.  

If you have questions, please call us at 1-800-772-6270. If you are deaf or hard of hearing, you can call the TTY number, 1-800-325-0778 between 7:00 a.m. and 5:30 p.m. Eastern time, Monday through Friday. When you call, please have this letter with you to help us answer your questions.

If you have questions about reporting income or Form 1099-MISC, please contact the Internal Revenue Service.

Attention: [Entity's POC Name] (Entity POC)

We previously wrote to inform [Entity Name] ([Entity EIN]) that it received [Erroneous Amount] in error for services provided in the claim(s) of [Claimant Name or Aux Beneficiary Name].

In our previous correspondence, we asked that [Entity Name] refund the erroneous amount and provided instructions on how to submit the refund to us. To date, the error has not been corrected.

Since [Entity Name] has not returned the excess fee, effective immediately, [Entity Name] is ineligible to receive direct payment of authorized fees. This means that we will no longer honor any assignment of direct payment of fees to [Entity Name]. The entity will remain ineligible to receive direct payment of authorized fees until we receive a full refund of the excess fees.

Suspect Social Security Fraud?

If you suspect Social Security fraud, please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Questions

Please visit our Representing Claimants website at www.ssa.gov/representation for general information.  

If you have questions, please call us at 1-800-772-6270. If you are deaf or hard of hearing, you can call the TTY number, 1-800-325-0778 between 7:00 a.m. and 5:30 p.m. Eastern time, Monday through Friday. When you call, please have this letter with you to help us answer your questions.

If you have questions about reporting income or Form 1099-MISC, please contact the Internal Revenue Service.