Social Security Administration
Retirement, Survivors and Disability Insurance
Notice of Change in Benefits
Mid-America Program Service Center
601 East Twelfth Street
Kansas City, Missouri 64106-285
Claim Number: XXX-XX-XXXXA
In an earlier letter, we told you that you were entitled to Social Security but that
we were holding back benefits for July 2003 through October 2004. We withheld $XX,XXX.xx
in Social Security benefits.
We did this because our records showed you could have been getting Supplemental Security
Income (SSI) when we started paying you Social Security benefits. And Social Security
benefits can lower the amount of SSI payments you can receive.
What We Will Pay And When
You will receive $XX,XXX.xx around December 13, 2004.
This is the additional money you are due for July 2003 through October 2004.
After that, you will receive $XXX.xx on or about the third of each month.
What We Found
When we considered your Social Security and refigured your SSI, we found we should
have paid you $X,XXX.xx less in SSI money. We will take this from the Social Security
benefits we held.
Social Security Benefits Can Affect SSI Payments
The Social Security benefits you receive count as income and resources and can lower
the amount of SSI payments you can receive. When a person receives SSI money for a
month and later becomes entitled to Social Security for the same month, we have to
refigure the SSI payment. We hold back some of the Social Security benefits while
we do this, so the person doesn't owe if we've paid too much SSI.
Reduction to Collect Your SSI Overpayment
When you/he/she received Supplemental Security Income (SSI) payments in the past,
you/he/she received more than you/he/she should have. Our records show that you still
owe us $XXXX.xx. Congress passed a law that permits us to collect SSI overpayments by withholding
from your/his/her Social Security benefits. We have withheld $XXXX.xx from the Social Security benefits you were underpaid to collect the $XXXX.xx that you owe.
Do You Think That You Do Not Owe This Money?
You may ask us to review our finding that you still owe the money. You may have evidence
to show that you already paid some or all of the money or that we previously waived
collection of it. If so, give us this evidence when you ask for review. We will review
the evidence you give us and the information we have. We will send you a letter with
our decision. If we find that you do not owe us this amount, then we will correct
For more information on requesting review, see “If You Disagree With The Decision”
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 won’t have to pay us back. For us to waive the collection of the overpayment,
two things have to be true.
It wasn’t your fault that you got too much SSI money.
Paying us back would mean you can’t 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 office. You can
ask for waiver at any time by completing the waiver form and returning it to us. The
form is called Request for Waiver of Recovery or Change in Repayment Rate, Form SSA-632.
We will be happy to help you fill out the form. If you ask for waiver, we will stop
collecting the overpayment while we decide if we can waive collection.
If You Disagree With The Decision
If you disagree with our decision, you have the right to appeal. We will
review your case and consider any new facts you have. 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 get 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
You must have a good reason for waiting more than 60 days to ask an appeal.
You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2,
called "Request for Reconsideration". Contact one of our offices to get the form or
if you need help to fill it out.
If You Want Help With Your Appeal
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it. And if you hire a lawyer, we will
withhold up to 25 percent of any past due benefits to pay toward the fee.
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 409-766-3628. 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:
4918-A SEAWALL BLVD
GALVESTON TX 77551
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