TN 31 (02-97)

NL 00703.108 Notice to Representative Payee Who Received Overpayment on Behalf of Beneficiary and Who is Currently Receiving Benefits for Beneficiary — Refund Requested or Adjustment Proposed

Document Identifier for Aurora: E3108

DPS Notice: Notice Of Overpayment (Rep Payee) SSA-L8176

A. Exhibit Letter

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

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 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.

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.

 

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.

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
01/84   
02/84   
etc.   
Total   
  • Use 3102A 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 in all cases.

  • Use 3108A and 3901C if the person lives in the U.S.

  • Use 3108B and 3100FC if the person lives outside the U.S.

     

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

  1. amount of overpayment

  2. name(s) of beneficiary(ies)

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

  4. name(s) of beneficiary(ies)

     

3108B(1)Use a fill-in from paragraph 3901D in NL 00703.005E.

 

Refer to NL 00703.102 for 3102A, 3102B text and fill-ins. Refer to NL 00703.100 for 3100C, 3100E and 3100FC text and fill-ins. Refer to NL 00703.104 for 3104B text and fill-ins.

C. Typing Instructions

Because the fill-ins may vary according to the different situations, follow the requester's typing instructions carefully.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900703108
NL 00703.108 - Notice to Representative Payee Who Received Overpayment on Behalf of Beneficiary and Who is Currently Receiving Benefits for Beneficiary -- Refund Requested or Adjustment Proposed - 08/19/2016
Batch run: 08/19/2016
Rev:08/19/2016