*F1 received $*F2 more than *F3 should have on *F4 record for *F5. *F6 has not repaid
the money. When a person receives too much money and does not pay us back, the law
allows us to recover the money from other benefits payable on the same record. (E3104.1A)
How To Pay Us Back
We will withhold 10 percent of *F1 payments until we recover the money. We will do
this starting with the payment *F2 will receive on or about *F3. (3104A)
Or
To recover the overpayment, we will withhold 10 percent of the payment you will receive
*F1 until we recover the overpayment. We will do this starting with the payment *F2
will receive on or about *F3. (3104B)
Or
We will recover the overpayment from the payment you would receive about *F1. The
reduced payment will be $*F2. You will receive your regular monthly payment about
*F3. (3100B)
If You Think You Should Not Have To Pay Us Back
You may not have to pay us back. Sometimes we can waive the collection of an overpayment,
which means you will not have to pay us back. For us to waive the collection of the
overpayment, two things must be true.
-
•
It was not your fault that the overpaid individual got too much Social Security money.
AND
-
•
Paying us back would mean you cannot pay your bills for food, clothing, housing, medical
care, or other necessary expenses, or it would be unfair for some other reason.
If you think these are true about you, contact any Social Security office. You can ask for waiver at any time by filling out the waiver form. The form number
is SSA-632-BK. We will not collect the overpayment while we decide if we can waive
collection. If you ask for waiver in the next 30 days, we will not withhold benefits
until we decide if we can waive collection.
You may need to show us proof of your monthly income, expenses, and assets. Examples
are pay stubs, pension records, rent receipts, utility bills and bank statements.
(WAV702)
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. We assume
you got this letter 5-days after the date on it, unless you show us that you did not
get it within the 5-day period.
-
•
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 will ask you to sign a form called “Request
for Reconsideration.” The form number is SSA-561-U2. To get this form, contact one
of our offices. We can help you fill out the form. 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, call us at 1-800-772-1213
if withholding of the monthly payment will cause hardship. Unless we hear from you
within 30 days, we will withhold the benefit as shown above. (3100D Domestic)
Or
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.
-
•
Your request must be in writing. The fastest and easiest way to file an appeal is
to visit *F1 online.
We are enclosing a pamphlet called “Important Information About Your Appeal and Waiver
Rights.” Please be sure to read it.
If withholding of the monthly payment will cause hardship, please contact *F2.
You can contact us even if you do not want to request reconsideration or waiver. Please
take this letter with you if you do visit an office. Unless we hear from you within
30 days, we will withhold the benefit as shown above. (3100F Foreign)
If You Want Help With Your
Appeal1 (REPC01)
You may choose to have a representative help you. We will work with this person just
as we would work with you. If you decide to have a representative, you should find
one quickly so that person can start preparing your case. Many representatives charge
a fee only if you receive benefits. Others may represent you for free. Usually, your
representative may not charge a fee unless we approve it. Your local Social Security
office can give you a list of groups that can help you find a representative. If you
get a representative, you or that person must notify us in writing. You may use our
Form SSA-1696 "Appointment of Representative." Any local Social Security office can
give you this form. (REP002)
If You Have Any Questions (REFC01)
Need more help?
1. Visit www.ssa.gov for fast, simple, and secure online service.
2. If you are in the United States, American Samoa, Guam, Northern Mariana Islands,
Puerto Rico, or the U.S. Virgin Islands, call us at 1-800-772-1213. If you are deaf
or hard of hearing, call TTY 1-800-325-0778.
3. You may also call your local Social Security office.
-
•
If you are in Canada, visit *F1 to find the office that services your area.
-
•
Contact your nearest Federal Benefits Unit (FBU). Visit *F2 for a list of FBUs.
-
•
Write to the Social Security Administration at:
P.O. Box 17769
Baltimore, Maryland, 21235-7769
USA
If you contact us, please refer to this letter. It will help us answer your questions.
How are we doing? Go to www.ssa.gov/feedback to tell us. (REF197)
Or
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 Any Questions
We invite you to visit our website at www.socialsecurity.gov on the Internet to find
general information about Social Security. If you have any specific questions, you
may call us toll-free at 1-800-772-1213, or call your local Social Security office
at 1-*F3- *F4- *F5. We can answer most questions over the phone. If you are deaf or
hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or
visit any Social Security office. The office that serves your area is located at:
*F6
*F7
*F8
*F9 *F10- *F11
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly when you arrive at
the office. (CTDO
Domestic)
Enclosure:
SSA-3105