TN 31 (02-97)

NL 00703.111 Notice to Representative Payee Who Received Overpayment On Behalf Of Beneficiary And Who Is Not Currently Receiving Benefits For Beneficiary — Adjustment Proposed Against Representative Payee Or Other Beneficiary For Whom Representative Is Receiving Benefits — Alien Tax Withholding Involved

Document Identifier for Word Processor: E3111

A. Exhibit Letter

We sent you $ (1) more in Social Security benefits for (2) than we 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

 

3111AYou should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration,” and send it to us in the enclosed envelope. Always include your claim number (as shown above) on your check or money order.
 Please send your check or money order in United States currency or in local currency equal to the United States dollars. When you pay us in local currency, we use the exchange rate in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment directly to us, please go to the nearest United States Embassy or consulate for help in making the refund.
 If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding (1) full benefit beginning with the payment (2) about (3) . We will continue withholding (4) benefit until the amount we have kept is equal to the amount owed us.

 

OR
3104B

or

3110B

 

If You Think You Should Not Have To Pay Us Back

3100C

If You Disagree With The Decision

3108B

 

Enclosures (2):
SSA-3105
Refund envelope

 

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 3111A if the overpayment exceeds the monthly benefit payable after tax withholding.

  • Use 3104B if the overpayment equals the monthly benefit payable after tax withholding.

  • Use 3110B if the overpayment is less than the monthly benefit payable after tax withholding.

  • Use 3100C and 3108B in all cases.

Refer to NL 00703.110 for 3110B text and fill-ins, NL 00703.100 for 3100C text and NL 00703.108 for 3108B text and fill-in. Refer to NL 00703.104 for 3104B text and fill-ins.

 

Fill-ins:

  1. amount of overpayment (not including taxes withheld)

  2. name(s) of beneficiary(ies)

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

  4. name(s) of beneficiary(ies)

3111A(1)your/name(s) of beneficiary(ies), possessive
 (2)you would normally receive/you would normally rec