TN 31 (02-97)

NL 00703.113 Notice to Overpaid Person in Railroad Board Certification Cases — Adjustment Proposed

Document Identifier for Word Processor: E3113

A. Exhibit Letter

We have determined that you received $ (1) more in Social Security benefits than you were due. (2) .

 

How To Pay Us Back

You 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. (3) . Always include your claim number (as shown above) on your check or money order.

If we do not receive your refund within 30 days, we shall instruct the Railroad Retirement Board to withhold your Social Security benefits until the overpayment is recovered. The Railroad Retirement Board will advise you when the withholding will begin and for how long. However, you will be given at least 30 days before the withholding begins.

 

If You Think You Should Not Have to Pay Us Back

3100C

 

If You Disagree With The Decision

3113A

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 withholding of the monthly payment will cause hardship. Unless we hear from you within 30 days, we will request the Railroad Retirement Board to withhold your benefits as stated above.

or
3113B

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 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 request the Railroad Retirement Board to withhold your benefits as stated above.

 

If You Want Help With Your Appeal1

3100E

 

If You Have Any Questions

3901C

 

Enclosures (2):

SSA-3105

Refund envelope

 

1 If the person lives outside the U.S. or has an attorney, omit this paragraph.

B. Requesting Instructions

This notice is to be used in overpayment cases when the Social Security benefits are certified to the Railroad Retirement Board for payment and adjustment of the Social Security benefits is proposed.

The person who determines the overpayment (generally the benefit authorizer) is responsible for requesting this not