TN 31 (02-97)
NL 00703.101 Notice To Overpaid Person In Current Pay Status — Adjustment Proposed — Alien Tax Withholding Involved
Document Identifier for Word Processor: E3101
A. Exhibit Letter
We sent you $ (1) more in Social Security benefits than we should have.
How To Pay Us Back
|3101A||You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Always include your claim number (as shown above) on the check or money order.|
| ||Please send your check or money order in United States currency or in local currency equal to the United States dollars. When you pay us in local currency, we use the exchange rate in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment directly to us, please go to the nearest United States Embassy or consulate for help in making the refund.1|
| ||If we do not receive your refund within 30 days, we plan to recover the full overpayment by withholding your full benefit beginning with the payment you would normally receive about (1) . We will continue withholding your benefit until the amount we have kept is equal to the amount owed us.|
|We plan to recover the overpayment from the payment you would normally receive about (1) . The reduced payment will be $ (2) , and you will again receive your regular monthly payment starting about (3) .|
If You Think You Should Not Have To Pay Us Back
If You Disagree With The Decision
If you disagree with the decision, you have the right to appeal. A person who did not make the first decision will decide your case. We will review your case again and consider any new facts you have.
You have 60 days to ask for an appeal. If you ask in the next 30 days, you will not have to pay us back until we decide your case.
Both the 30- and 60-day periods start the day after you receive this letter.
You must have a good reason if you wait more than 60 days to ask for an appeal.
You have to ask for an appeal in writing.
We are enclosing a pamphlet called “Important Information About Your Appeal and Waiver Rights.” Please be sure to read it.
Even if you do not want to request reconsideration or waiver, please call, write or visit any Social Security office2 if (1) withholding of your monthly payment will cause hardship; or (2) you would rather pay the full amount of the overpayment so that no withholding of your benefit is necessary. Please take this letter with you if you do visit an office. Unless we hear from you within 30 days, we will withhold your benefit as shown above.
1 If the person lives outside the U.S., substitute a fill-in from paragraph 3901D in NL 00703.005 E.
2 If the overpayment is less than the monthly payment, omit the refund envelope.
B. Requesting Instructions
The person who determines the overpayment (generally the benefit authorizer) is responsible for requesting this notice and providing the appropriate fill-ins.
Use 3101A if the overpayment exceeds the monthly benefit payable after tax withholding.
Use 3104B if the overpayment equals the monthly benefit payable after tax withholding.
Use 3101B if the overpayment is less than the monthly benefit payable after tax withholding.
Use 3100C and 3101C in all cases.
Refer to NL 00703.100 for 3100C text. Refer to NL 00703.104 for 3104B text and fill-ins.
amount of the overpayment (not including taxes withheld)
narrative overpayment explanation - A chart may be included following the explanation.
|3101A||(1) month/day/year payment would have been received|
|3101B||(1) month/day/year benefit will be received|
| ||(2) amount of payment|
| ||(3) month/day/year payment will be received|
C. Typing Instructions
Use Form SSA-2000-C2 (Universal Notice) and follow notice standards. Information for this notice will be shown on Form SSA-573.