TN 30 (03-96)

NL 00703.418 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 Current Or Deferred Status

Document Identifier for Word Processor: E3418

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 to Social Security benefits.

(Optional)

3417C

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 that 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

 

Information About Work and Earnings

3417B

 

Your Responsibilities

3413D

 

If You Have Any Questions

3901C

 

Enclosures:

Form 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.

 

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 3100A if the overpayment exceeds the monthly benefits. 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 00703.417 for 3417C and 3417B text and fill-ins.

    • Refer to NL 00703.005E. for 3901C 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 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/0900703418
NL 00703.418 - 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 Current Or Deferred Status - 05/01/1999
Batch run: 01/27/2009
Rev:05/01/1999