TN 30 (03-96)

NL 00703.414 Notice of Overpayment Due to Posted Earnings - Beneficiary Did Not File Work Report Or Filed Work Report Showing No Earnings — Beneficiary In Current Or Deferred Status

Document Identifier for Work Processor: E3414

A. EXHIBIT LETTER

Our records show that you earned (1) .

If you disagree with (2) and you can show (3) wrong, please get in touch with any Social Security office and we will correct our records.

(Optional)

A50

 

(Optional)

A52

 

Based on the earnings on our records, $ (4) should have been withheld from your benefits for (5) .

Based on this, you received $ (6) more in Social Security benefits than you were due.

 

How to Pay Us Back

3100A
or
3100B
or
3100G

If You Think You Should Not Have To Pay Us Back

3100C

 

If You Disagree With the Decision

3100D

 

If You Want Help With Your Appeal1

3100E

 

Your Responsibilities

3413D

 

If You Have Any Questions

3901C

 

Enclosures:

SSA-3105

Refund Envelope

 

1 If the person has an attorney, omit this paragraph.

B. REQUESTING INSTRUCTIONS

The person who determines the overpayment (generally the benefit authorizer) is responsible for requesting the notice and providing appropriate fill-ins. Listed below are the fill-ins which are generally required:

(1)A=$ (1) in (2)
   (1) amount of posted earnings
   (2) year of earnings
 B=$ (1) in (2) and $ (3) in (4)
   (1) amount of posted earnings
   (2) year of earnings
   (3) amount of posted earnings
   (4) year of earnings
 C=$ (1) in (2) ,
   $ (3) in (4) , and
   $ (5) in (6)
   (1) amount of posted earnings
   (2) year of earnings
   (3) amount of posted earnings
   (4) year of earnings
   (5) amount of posted earnings
   (6) year of earnings
 D=$ (1) in (2) ,
   $ (3) in (4) ,
   $ (5) in (6) , and
   $ (7) in (8)
   (1) amount of posted earnings
   (2) amount of earnings
   (3) amount of posted earnings
   (4) year of earnings
   (5) amount of posted earnings
   (6) year of earnings
   (7) amount of posted earnings
   (8) year of earnings
(2)A=this amount
 B=any of these amounts
(3)A=it is
 B=they are
  1. amount of deductions (based on earnings in (1) A above)

(5)A=year (Same as in 1A above)
 B=year, and $ (1) for (2)
   (1) amount of deductions
   (2) year
 C=year
   $ (1) for (2) , and
   $ (3) for (4)
   (1) amount of deductions
   (2) year
   (3) amount of deductions
   (4) year
 D=year
   $ (1) for (2) , and
   $ (3) for (4) and
   $ (5) for (6)
   (1) amount of deductions
   (2) year
   (3) amount of deductions
   (4) year
   (5) amount of deductions
   (6) year
  1. total amount of overpayment

     

NOTE: Insert any applicable ARF or DRC paragraphs after fill-in (6). If necessary, include a paragraph to give the new overpayment balance as a result of the ARF or DRC.

  • Use 3100A if the overpayment exceeds the monthly benefit. Use 3100B if the overpayment is less than the monthly payment. Use 3100G if the overpayment equals the monthly payment.

  • Use A50 if there is a month of entitlement change and the election was before age 65. Use A52 if the month of entitlement is being confirmed.

  • Use 3100C, 3100D, 3413D and 3901C in all cases.

  • Refer to NL 00703.100 for 3100A, 3100B, 3100C, 3100D, 3100E and 3100G text.

  • Refer to NL 00703.413 for 3413D text and fill-in.

  • Refer to NL 00703.005E. for 3901C text.

C. TYPING INSTRUCITONS

The individual's name and address, if not shown, can be taken from the latest Form SSA-3916-EP.

Because the fill-ins may vary according to the different situations, follow the requester's typing instructions carefully.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900703414
NL 00703.414 - Notice of Overpayment Due to Posted Earnings - Beneficiary Did Not File Work Report Or Filed Work Report Showing No Earnings -- Beneficiary In Current Or Deferred Status - 03/11/1996
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