We have determined that you received $ (1) more in Social Security 1 benefits on behalf of (2) than you should have. (3) .
As representative payee, you are personally liable for repayment unless you used the
overpaid funds for the benefit of (4) and the overpayment was made through no fault of your own.
How To Pay Us Back
3102A
or
3104B
or
3102B
If You Think You Should Not Have To Pay Us Back
3100C
If You Disagree With The Decision
3108A
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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.
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•
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.
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•
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.
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•
You must have a good reason if you wait more than 60 days to ask for an appeal.
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•
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 you think you are not liable for repayment or 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.
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or 3108B
|
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 (1) if you think you are not liable for repayment or withholding of the monthly payment
will cause hardship. 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.
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If You Want Help With Your Appeal2
3100E
If You Have Any Questions
3901C
Enclosures (2):
SSA-3105
Refund envelope3
1 If Black Lung benefits are overpaid, substitute “Black Lung.”
2 If the person lives outside the U.S. or has an attorney, omit this paragraph.
3 If the overpayment is less than the monthly payment, omit the refund envelope.