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
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
If You Think You Should Not Have To Pay Us Back
If You Disagree With the Decision
If You Want Help With Your Appeal1
If You Have Any Questions
1 If the person has an attorney, omit this paragraph.