We have reviewed the overpayment determination and, based on the information now available, find that the overpayment determination was (1) . We have explained our reasons for this finding in the enclosed Form SSA-662.

 

How To Pay Us Back

3106E

3106A (Optional)

 

If you believe that the reconsideration determination is not correct, you may request a hearing before an administrative law judge of the Office of Disability Adjudication and Review. If you want a hearing you must request it not later than 60 days from the date you receive this notice. You should make your request through any Social Security office.

You also have the right to request a determination concerning the need to recover the overpayment. This is called waiver. You may request waiver anytime. A request for waiver will be approved if both of the following are true:

1. 1. 

   The overpayment was not your fault in any way, and

2. 2. 

   You could not meet your necessary living expenses if we recovered the overpayment, or recovery would be unfair for some other reason.

If you request waiver, we may need a statement of your assets and monthly income and expenses.

If you request waiver within 30 days, you will not have to refund the overpayment unless you are denied waiver after you have had an opportunity for a personal conference. If you request waiver and after reviewing your request we cannot approve it, we will notify you in writing of our reasons.¹ A personal conference with a Social Security employee will then be scheduled for you so that you can explain why you do not believe your waiver request should be denied. More information about the personal conference is given in the notice if we cannot waive recovery of your overpayment.

If You Want Help With Your Appeal

REPC01, REP002

3118A

or

3118B

 

If You Have Any Questions

3901C

 

Enclosures (3)

SSA Pub. No.-70-10281

SSA-662

Refund envelope

 

¹ If the person lives outside the U.S. or has an attorney, omit the next two sentences.

² If the person lives outside the U.S., or has an attorney, omit this paragraph.

The reconsideration reviewer is responsible for requesting this notice and providing appropriate fill-ins.

• •

  Use 3106E in all cases.

• •

  Use fill-in 3106A if the liable individual is receiving other program benefits (e.g., Black Lung or title XVI payments).

• •

  Use 3118A and 3901C in domestic case.

• •

  Use 3118B if the beneficiary lives outside the U.S.

   

Refer to NL 00703.100 for 3100E text. Refer to NL 00703.106 for 3106E text.

 

Fill-ins:

 

Use Form SSA-L2000-C2 (Universal Notice) with “Notice of Reconsideration” displayed under heading.