TN 30 (03-96)

NL 00703.417 Notice of Overpayment Due to Posted Earnings — Beneficiary Did Not File Work Report Or Filed Work Report Showing No Earnings - Monthly Earnings Test Applies — Beneficiary In Suspense Or Terminated Status

Document Identifier for Word Processor: E3417

A. EXHIBIT LETTER

Our records show that you earned (1) in (2) . We assume that you worked in all months in (3) after you became entitled the Social Security benefits.

(Optional)

3417C (Optional) Also, our records show that you earned $ (1) .

If you disagree with (4) and you can show (5) wrong, or if you did little or no work in (6) after you became entitled to Social Security benefits, please get in touch with any Social Security office and we will correct our records.

 

(Optional)

A50

 

(Optional)

A52

 

Based on the information we have now, $ (7) should have been withheld from your benefits for (8) .

Based on this, you received $ (9) more in Social Security benefits than you were due.

 

How To Pay Us Back

3106E

3106A (Optional)

 

If You Think You Should Not Have To Pay Us Back

3106B

 

If You Disagree With The Decision

3106C

 

If You Want Help With Your Appeal1

3100E

 

Information About Work and Earings

3417BOnce a person becomes eligible for benefits there is a special rule that applies only in the first year with little or no earnings for one or more months. In that year, you can get a full benefit for any month your wages do not exceed $ (1) and you are not active in self-employment. This special monthly rule applies only in one year. In all other years, benefits for people under 70 are withheld solely on their total annual earnings.

 

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 this notice and providing appropriate fill-ins.

  • (1) amount of posted earnings

    (2) monthly test year

    (3) monthly test year

    3417C (1)

 A=$ (1) in (2)
   (1) amount of earnings
   (2) year of earnings
 B=$ (1) in (2) and $ (3) in (4)
   (1) amount of earnings
   (2) year of earnings
   (3) amount
   (4) year
 C=$ (1) in (2) ,
   $ (3) in (4) , and
   $ (5) in (6)
   (1) amount of earnings
   (2) year of earnings
   (3) amount
   (4) year
   (5) amount
   (6) year
(4)A=this amount
 B=any of these amounts
(5)A=it is
 B=they are
  1. monthly test year

  2. amount of deductions for monthly test year

(8)A=monthly test year
 B=monthly test year and $ (1) for (2)
   (1) amount of deductions
   (2) year
 C=monthly test year,
   $ (1) for (2) , and
   $ (3) for (4)
   (1) amount of deductions
   (2) year
   (3) amount of deductions
   (4) year
 D=monthly test year,
   $ (1) for (2) ,
   $ (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

3417B (1) monthly exempt amount

 

NOTE: Insert any applicable ARF or DRC paragraphs after fill-in (9). If necessary, include a paragraph to give the new overpayment balance as a result of the ARF or DRC.

  • Use 3417C if more than one year is enforced.

  • Use 3106A if the liable individual is receiving other program payments (e.g., a person liable for repayment of title II overpayment receives Black Lung or title XVI payments).

  • 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 3106E, 3106B, 3106C, 3417B, 3413D and 3901C in all cases.

  • Refer to NL 00703.106 for 3106A, 3106B and 3106C text.

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

  • Refer to NL 00703.100 for 3100E text.

C. TYPING INSTRUCTIONS

The individual's name and address, if not shown, can be taken from the latest Form SSA-3926-EP.

Because the fill-ins may very 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/0900703417
NL 00703.417 - Notice of Overpayment Due to Posted Earnings -- Beneficiary Did Not File Work Report Or Filed Work Report Showing No Earnings - Monthly Earnings Test Applies -- Beneficiary In Suspense Or Terminated Status - 03/04/1996
Batch run: 01/27/2009
Rev:03/04/1996