TN 31 (02-97)
NL 00703.109 Notice To Representative Payee Who Received Overpayment On Behalf Of Beneficiary And Who is Currently Receiving Benefits For Beneficiary — Refund Requested And Adjustment Proposed — Alien Tax Withholding Involved
Document Identifier for Word Processor: E3109
A. Exhibit Letter
We sent you $ (1) more in Social Security benefits for (2) than we should have.
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
If You Think You Should Not Have To Pay Us Back
If You Disagree With The Decision
1 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 3108B in all cases.
Refer to NL 00703.102 for 3102B text and fill-ins and NL 00703.103 for 3103A text and fill-ins. Refer to NL 00703.100 for 3100C text and fill-ins. Refer to NL 00703.108 for 3108B text. Refer to NL 00703.104 for 3104B text and fill-ins.
amount of the overpayment (not including taxes withheld)
names of beneficiary(ies)
narrative overpayment explanation - A chart may be included following the explanation.
name(s) of beneficiary(ies)
C. Typing Instructions
Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Information for this notice will be shown on Form SSA-573.