You offered to settle (1) $ (2) (3) overpayment by paying us $ (4) . We are writing to tell you that we will accept your offer as long as you send us
the money by (5) . If you are late with your payment, you will have to pay back the full $ (6) .
How To Pay Us Back
To pay us back, send us a check or money order for $ (7) . Make your check or money order out to the Social Security Administration. Be sure
to put (8) (9) , (10) on it. Please use the enclosed envelope to mail your check or money order to us.
3100FC (Foreign Cases Only):
If You Have Any Questions
3901C - Domestic
3901D - Foreign