TN 31 (02-97)

NL 00703.167 Waiver Denial Only — Refund Requested — Title II

Document Identifier for Aurora: E3167

DPS Notice: Waiver Denial

A. Exhibit Letter

We are writing about your request that we waive the collection of your Social Security overpayment. Based on the facts we have, we cannot waive the collection of your overpayment of $ (1) .

The Reason For Our Decision

For us to waive the collection of your overpayment, two things have to 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.

Based on the facts we have, you do not meet both of these rules. The following will tell you why.

(2)

We apply three tests when we decide if you are at fault in causing an overpayment. The first is whether you made an incorrect statement or a statement which you knew or should have known was incorrect. The second is whether you failed to give us timely information which you knew or should have known was important. The third is whether you accepted payments which you either knew or could have been expected to know were incorrect.

(3)

Therefore, based on the facts we have, we cannot waive the collection of this overpayment. This means that you must pay this money back.

How To Pay Us Back

You should refund this overpayment within 30 days. You can send us a check or money order for the full amount of your overpayment of $ (4) . Make your check or money order out to the Social Security Administration. Be sure to put your claim number, (5) , on it. Please use the enclosed envelope to mail the check or money order to us.

If you cannot pay us the full amount now, send as much as you can. Then contact any Social Security office. You can pay the rest of the money you owe by making monthly payments.

If You Disagree With This Decision

(6)

If You Want Help With Your Appeal

3100E

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

Enclosure:

Refund Envelope

B. Requesting Instructions

Fill-ins:

  1. amount of overpayment

  2. narrative explanation of the overpayment

  3. narrative explanation of reasons for denying waiver

  4. amount of overpayment

  5. Social Security number and BIC

  6. IF PERSONAL CONFERENCE HELD:

    If you disagree with this decision, you have the right to appeal. A person who has not seen your case before will look at it. That person will be an administrtive law judge. The administrative law judge will review your case and look at any new facts you have before deciding your case. We call this a hearing.

You have 60 days to ask for a hearing. The 60 days 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 will have to have a good reason for waiting more than 60 days to ask for a hearing.

You have to ask for a hearing in writing. We will ask you to sign an SSA form HA-501, called "Request for Hearing." Contact one of our offices if you want help.

IF PERSONAL CONFERENCE NOT HELD:

If you disagree with this decision, you have the right to appeal. We will review your case and look at any new facts you have. Then, a person who did not make the first decision will decide your case.

You have 60 days to ask for an appeal.

The 60 days 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 will have to have a good reason for waiting 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.

Refer to NL 00703.100 for 3100E text and fill-ins.

C. Typing Instructions

Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards for cases processed in the PC. Because the requested fill-ins and paragraph may vary according to the different situations, follow the requester's instructions carefully. There is a refund envelope enclosure. Include a “refund envelope” with the letter and type the claim number on the inside of the envelope below the flap. Place the envelope lengthwise on the left-hand side of the notice and staple in the upper left-hand corner.


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