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.
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.
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
If You Think You Should Not Have To Pay Us Back
If You Disagree With The Decision
If You Want Help With Your Appeal1
Information About Work and Earings
||Once 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.
If You Have Any Questions
1 If the person has an attorney, omit this paragraph.