TN 8 (08-12)
NL 00715.205 Cross Program Recovery Paragraphs/Captions
Reduction to Collect Your SSI Overpayment
We paid (1) more in Supplemental Security Income (SSI) payments in the past than (2) due. Our records show that (3) us (4) in SSI payments. By law, we can collect SSI overpayments from the Social Security
benefits that (5). We withheld (6) from (7) Social Security benefits to collect (8) the SSI payments that (9).
beneficiary's first and last name/you
he still owes/she still owes/you still owe
Total T16 overpayment amount ($,$$$,$$$.¢¢)
he receives/she receives/you receive
amount in $$$,$$$.¢¢ format
he owes/she owes/ you owe
Do You Think That You Do Not Owe This Money?
You may ask us to review our finding that you still owe the money. You may have evidence
to show that you already paid some or all of the money or that we previously waived
collection of it. If so, give us this evidence when you ask for review. We will review
the evidence you give us and the information we have. We will send you a letter with
our decision. If we find that you do not owe us this amount, then we will correct
For more information on requesting review, see “If You Disagree With The Decision” below.
If You Think You Should Not Have To Pay Us Back
You may not have to pay us back. Sometimes we can waive the collection of an overpayment,
which means you won't have to pay us back. For us to waive the collection of the overpayment,
two things have to be true.
It wasn't your fault that you got too much SSI money.
Paying us back would mean you can't pay (1) bills for food, clothing, housing, medical care or other necessary expenses, or it
would be unfair for some other reason.
If you think these are true about you, contact any Social Security office. You can
ask for waiver at any time by completing the waiver form and returning it to us. The
form is called Request for Waiver of Recovery or Change in Repayment Rate, Form SSA-632.
We will be happy to help you fill out the form. If you ask for waiver after that time,
we will stop collecting the overpayment while we decide if we can waive collection.
your/his/her (beneficiary's first name)' (apostrophe only)/(beneficiary's first name)'s