TN 31 (02-97)

NL 00703.104 Notice to Other Beneficiary — Recovery From Overpaid Person Not Possible

Document Identifier for Word Processor: E3104

A. Exhibit Letter

Our records show that (1) received $ (2) more in Social Security1 benefits than (3) due. (4) .

When an overpayment is not recovered from the person overpaid, the overpayment may be withheld from any other benefits payable on the same Social Security record.

3104ATo recover the overpayment, we plan to withhold your full benefit beginning with the payment you would normally receive about
(1) . We will continue to withhold your benefit until the overpayment has been fully recovered.
or
3104B
We plan to recover the overpayment by withholding the payment you would normally receive about (1) . You will receive your monthly payment again about (2) .
or
3100B
 

 

If You Think You Should Not Have To Pay Us Back

3100C

 

If You Disagree With The Decision

3100D
  or
3100F

 

If You Want Help With Your Appeal2

3100E

 

If You Have Any Questions

3901C

Enclosure:

SSA-3105

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.

If the overpayment computation is too complex for a simple narrative explanation, use a chart such as the following:

Month/YearAmount PaidAmount PayableDifference
01/85   
02/85   
etc.   
Total   
  • Use 3104A if the overpayment exceeds the monthly payment.

  • Use 3104B if the overpayment equals the monthly payment.

  • Use 3100B if the overpayment is less than the monthly payment.

  • Use 3100C in all cases.

  • Use 3100D and 3901C if the person lives in the U.S.

  • Use 3100F if the person lives outside the U.S.

Listed below are the fill-ins which are generally required:

  1. overpaid person's name

  2. the amount of the overpayment

  3. he was, she was, they were

  4. a narrative overpayment explanation - A chart may be included following the explanation.

3104A(1) month/day/year payment would have been received
3104B(1) month/day/year payment would have been received
 (2) month/day/year payment will be received
3100B(1) month/day/year payment will be received
 (2) amount of payment
 (3) month/day/year payment will be received

Refer to NL 00703.100 for 3100C, 3100D, 3100E and 3100F text and fill-ins.

Because the fill-ins may vary