TN 31 (02-97)
NL 00703.103 Notice To Overpaid Person In Nonpay Status But Receiving Benefits For Other Beneficiary In Same Household — Refund Requested And Adjustment Proposed — Alien Tax Withholding Involved
Document Identifier for Word Processor: E3103
A. Exhibit Letter
We sent you $ (1) more in Social Security benefits than we should have.
How To Pay Us Back
|3103A||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. If you cannot refund the $ (1) now, you should give us: (a) a partial payment; (b) an explanation of your assets and income and expenses; and (c) a definite plan for repaying the rest of the money.|
| ||Please send your check or money order in United States (U.S.) 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 U.S. 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 overpayment by withholding (2) full benefit beginning with the payment you would normally receive for (3) about (4) . We will continue withholding the benefit you receive for (5) until the amount we have kept is equal to the amount owed us.|
If You Think You Should Not Have To Pay Us Back
If You Disagree With The Decision
1 If the person lives in the Philippines, substitute “the U.S. Veterans Affairs Regional Office, SSA Division, 1131 Roxas Boulevard, Manila.
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 3103A if the overpayment exceeds the monthly payment.
Use 3104B if the overpayment equals the monthly payment.
Use 3102B if the overpayment is less than the monthly payment.
Use 3100C and 3100F in all cases.
Refer to NL 00703.100 for 3100C and 3100F text and fill-in.
Refer to NL 00703.102 for 3102B text and fill-ins. 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.
|3103A||(1) amount of overpayment (not including taxes withheld)|
| ||(2) name(s) of beneficiary(ies), possessive|
| ||(3) him/her/them|
| ||(4) month/day/year payment would have been received|