You received $*F1 more in *F2 benefits *F3 than *F4 due.
*F5 (OPT188)
You must repay the money overpaid to *F1 unless you spent the
money for *F2 benefit and the overpayment was not your fault. (OPT189)
How To Pay Us Back
Please refund this overpayment within 30 days. Make your check or money order payable
to "Social Security Administration." Include the claim number shown above on the check
or money order, and send it to us in the enclosed envelope. If you cannot refund the
full $*F1 now, please submit (a) a partial payment; (b) an explanation of your financial
situation; and (c) a definite plan to repay the balance.
*F2 (3106E)
(Use the UTI below only when the beneficiary is receiving other program benefits)
Instead of sending us a refund, we can withhold part or all of your overpayment from
your *F1. This method of repayment is voluntary. You may stop the withholding at any
time. We will not change your *F2 if you do not choose this method of repayment. If
you want us to withhold the overpayment from your *F3, please get in touch with us
right away. (3106A)
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 your
overpayment, two things must be true.
-
•
It was not your fault that you 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 office1. 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.
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.
(3106B)
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 you think you are not liable for repayment or if you have any questions. (3112A 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.
-
•
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 *F1 if you think you are not liable for repayment or have any questions or need
more information. Please take this letter with you if you do visit an office. (3112B Foreign)
If You Want Help With Your Appeal2 (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
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
questions, you should contact *F1. You may also write to the Social Security Administration,
P.O. Box 17769 Baltimore, Maryland 21235, U.S.A. Please be sure to include your claim
number if you do write. However, if you visit an office, please take this letter.
It will help the people there answer your questions. (3901D Foreign)
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)
Enclosures (2):
Refund envelope
SSA-3105
1If the person lives outside the U.S., substitute a fill-in from paragraph 3901D in
NL 00703.005 E.
2If the person lives outside the U.S., or has an attorney omit this paragraph.