TN 13 (09-19)

NL 00720.245 OPT Overpayment

OPT028 NEW OVERPAYMENT AMOUNT INCLUDES PRIOR OVERPAYMENT (M05)

(Requested)

Caption: Your Benefits

However, the total overpayment is  (1)  , which includes a prior overpayment of  (2)  .


Fill-in values:
Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
Total overpayment
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Current balance of prior overpayment

OPT107 OVERPAYMENT RECOVERED FROM ONE MONTH'S BENEFIT (A57)

(Requested)

Caption: Your Benefits

We will withhold  (1)   (2)   (3)   (4)  payment to recover the money we  (5)   (6)  . This is the payment you would normally receive about  (7)  .


Fill-in values:
Fill-in (1) – Systems Generated
Choice 1: null
Fill-in (2) – Systems Generated
Choice 1: null
Fill-in (3) – Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Choice 4: Beneficiary's name
Fill-in (4) – Systems Generated
month and year (MM/CCYY)
Fill-in (5) – Systems Generated
Choice 1: overpaid
Choice 2: incorrectly paid
Fill-in (6) – Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Choice 4: Beneficiary's name
Fill-in (7) – Systems Generated
month and year (MM/CCYY)

OPT122 BENEFICIARY OVERPAID DUE TO SUSPENSION/TERMINATION (M13)

(Requested)

Caption: Your Benefits

Since we did not stop  (1)  payments until  (2)  ,  (3)  paid  (4)  too much in benefits.


Fill-in values:
Fill-in (1) – Systems Generated
Choice 1: Beneficiary's Name (possessive)
Choice 2: your
Fill-in (2) – Systems Generated
MM/CCYY
Fill-in (3) – Systems Generated
Choice 1: he was
Choice 2: she was
Choice 3: you were
Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
Choice 1: Amount of overpayment

OPT127 UNDERPAYMENT USED TO REDUCE/RECOVER AN OVERPAYMENT (M03)

(Requested)

Caption: Your Benefits

We used  (1)  of  (2)  benefits to recover  (3)  of an overpayment on this record.


Fill-in values:
Fill-in (1) - Requested As A Money Amount in Format $$$$$.¢¢
Amount used for recovery
Fill-in (2) - Requested As A One Position Alpha Character or Language
Choice 1: (A) your
Choice 2: Name of Beneficiary
Fill-in (3) - Requested As A One Position Alpha Character
Choice 1: (A) all
Choice 2: (B) part

OPT132 DIRECT DEPOSIT — JOINT ACCOUNT — RECOVERY OF PAYMENTS MADE AFTER DEATH (A16)

(Requested)

Caption: Your Benefits

We paid  (1)  more in benefits than we should have. We deposited (2)  benefits for  (3)  into a bank account which  (4)  also owned. We can't pay benefits for the month of death,  (5)  , or later. Because  (6)  a joint owner of the bank account,  (7)  overpaid  (8)  .


Fill-in values:
Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
Amount of overpayment
Fill-in (2) Requested
Full name of the deceased beneficiary, possessive
Fill-in (3) Requested As A Date In Format Shown Below
Month(s) and year(s) of incorrect payment
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: Beneficiary's first name
Fill-in (5) Requested
Month(s) and year(s) of incorrect payment
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (6) Systems Generated
Choice 1: Beneficiary's name is
Choice 2: you are
Fill-in (7) Systems Generated
Choice 1: Beneficiary's name is
Choice 2: you are
Fill-in (8) Requested
Amount of overpayment

OPT148 CROSS PROGRAM RECOVERY - T16 UNDERPAYMENT USED TO RECOVER T2 OVERPAYMENT (B88)

(System Generated)

Caption: Your Benefits

We used (1)  of  (2)  SSI benefits to recover some or all of an overpayment on this record.


Fill-in values:
Fill-in (1)
Amount of SSI under payment
Fill-in (2)
Choice 1: Beneficiary's Name possessive
Choice 2: your

OPT149 CROSS PROGRAM RECOVERY - T16 UNDERPAYMENT NOT USED TO REDUCED/RECOVER A T2 OVERPAYMENT (B89)

(System Generated)

Caption: What We Will Pay

We did not use any of  (1)  SSI benefits to recover an overpayment on this record.


Fill-in values:
Fill-in (1)
Choice 1: Beneficiary's Name
Choice 2: your

OPT151 OVERPAYMENT LIABILITY INFORMATION TO A REPRESENTATIVE PAYEE FOR OVERPAID BENEFICIARY (A27)

(Requested)

Caption: Your Benefits

As representative payee, you are personally liable for repayment unless you used the overpaid funds for the benefit of  (1)  , and the overpayment was made through no fault of your own.


Fill-in values:
Fill-in (1) – Systems Generated
Name(s) of beneficiary (ies)

OPT152 REPAY BENEFITS WITHHELD - PROTEST OF OVERPAYMENT RECEIVED TIMELY (LAF D to C ) (A44)

(Requested)

Caption: Your Benefits

We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. If we later find that our decision was correct, or that we cannot waive the overpayment,  (4)  will have to pay back the  (5)  which  (6)  . Someone from the local Social Security office will contact  (7)  to discuss the overpayment.


Fill-in values:
Fill-in (1) – Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2) - Requested As A Date In Format Shown Below
Date payments resumed MM/CCYY
Fill-in (3) – Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) – Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) – Requested As A Money Amount In Format $$$$$.¢¢
Amount of overpayment
Fill-in (6) – Systems Generated
Choice 1: you owe
Choice 2: he owes
Choice 3: she owes
Fill-in (7) – Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her

OPT153 OVERPAYMENT WITHHELD FROM BENEFITS IS REPAID — PROTEST RECEIVED TIMELY (A46)

(Requested)

Caption: Your Benefits

 (1)  asked us to review our overpayment decision. While we review  (2)  case, we are sending  (3)  the money we withheld from  (4)  checks.

If we later find that our decision was correct, or that we cannot waive the overpayment,  (5)  will have to pay back the  (6)  which  (7)  . Someone from the local Social Security office will contact  (8)  to discuss the overpayment.


Fill-in values:
Fill-in (1) – Systems Generated
Choice 1: You
Choice 2: Beneficiary's Name
Fill-in (2) – Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) – Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (4) – Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) – Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
Amount of overpayment-
Fill-in (7) – Systems Generated
Choice 1: you owe
Choice 2: he owes
Choice 3: she owes
Fill-in (8) – Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her

OPT154 OVERPAYMENT PROTESTED - BENEFITS RESUMED AND WITHHELD BENEFITS REPAID - FOREIGN CLAIMS (A47)

(Requested)

Caption: Your Benefits

We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. If we later find that our decision was correct, or that we cannot waive the overpayment,  (4)  will have to pay back the  (5)  which  (6)  .


Fill-in values:
Fill-in (1) – Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) – Requested As A Date In Format Shown Below
Date payments resumed MM/CCYY
Fill-in (3) – Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) – Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) – Requested As A Money Amount In Format $$$$$.¢¢
Amount of overpayment
Fill-in (6) – Systems Generated
Choice 1: you owe
Choice 2: he owes
Choice 3: she owes

OPT155 OVERPAYMENT PROTESTED - BENEFITS RESUMED - MONEY WITHHELD NOT REPAID - FOREIGN CLAIMS (A48)

(Requested)

Caption: Your Benefits

We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. For now, we are still withholding the money which we already subtracted from  (4)  checks.

If we later find that our decision was correct, or that we cannot waive the overpayment,  (5)  will have to pay back the  (6)  which  (7)  .


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2) – Requested As A Date In Format Shown Below
Date payments resumed MM/CCYY
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the remaining overpayment
Fill-in (7) Systems Generated
Choice 1: you owe
Choice 2: he owes
Choice 3: she owes

OPT156 OVERPAYMENT PROTESTED AFTER RECOVERY COMPLETED/STOPPED - REPAY BENEFITS WITHHELD - FOREIGN CLAIMS (A49)

(Requested)

Caption: Your Benefits

 (1)  asked us to review our overpayment decision. While we review  (2)  case, we are sending  (3)  the money we withheld from  (4)  checks. If we later find that our decision was correct, or that we cannot waive the overpayment,  (5)  will have to pay back the  (6)  which  (7)  .


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's Name
Fill-in (2) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (4) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the overpayment
Fill-in (7) Systems Generated
Choice 1: you owe
Choice 2: he owes
Choice 3: she owes

OPT158 INTRODUCTORY STATEMENT FOR CAT A-A22 NOTICE WHEN OVERPAYMENT ESTABLISHED AND ALIEN TAXATION INVOLVED (ADMINISTRATIVE ADJUSTMENT) (F70)

(Requested)

Caption: None

We are writing to give  (1)  new information about the  (2)  benefits which  (3)  on this Social Security record. In the rest of this letter, we will tell  (4)  :

  • How we paid  (5)   (6)  too much in benefits; and

  • What to do if  (7)  we are wrong about the overpayment.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2) Requested As A One Position Alpha Character
Choice 1: (A) disability
Choice 2: (B) retirement
Choice 3: (C) survivor
Choice 4: (D) auxiliary
Fill-in (3) Systems Generated
Choice 1: you receive
Choice 2: he receives
Choice 3: she receives
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the overpayment
Fill-in (7) Systems Generated
Choice 1: you think
Choice 2: he thinks
Choice 3: she thinks

OPT159 A21 NOTICE OVERPAYMENT RECOVERY (G51)

(System Generated)

Caption: Your Benefits

As we told  (1)  in our previous letter, we are withholding  (2)  benefits to recover the overpayment of  (3)  .


Fill-in values:
Fill-in (1)
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2)
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3)
Amount of the overpayment

OPT161 INTRODUCTORY PARAGRAPH E31 AND E32 NOTICES (G70)

(System Generated)

Caption: None

We are writing to give  (1)  new information about the  (2)  benefits which  (3)  on this Social Security record. In the rest of this letter, we will tell  (4)  :

  • How we paid  (5)   (6)  too much in benefits; and

  • What to do if  (7)  we are wrong about the overpayment.


Fill-in values:
Fill-in (1)
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2)
Choice 1: disability
Choice 2: retirement
Choice 3: survivor
Fill-in (3)
Choice 1: you receive
Choice 2: he receives
Choice 3: she receives
Fill-in (4)
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5)
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (6)
Amount of the overpayment
Fill-in (7)
Choice 1: you think
Choice 2: he thinks
Choice 3: she thinks

OPT162 E31 AND E34 NOTICES MBP GREATER THAN OVERPAYMENT (G71)

(System Generated)

Caption: Your Benefits

We plan to collect the overpayment from the check which  (1)  will receive around  (2)  . We will reduce  (3)  check to  (4)  . We will send  (5)   (6)  regular monthly benefit amount again beginning  (7)  .


Fill-in values:
Fill-in (1)
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (2)
MM/DD/CCYY
Fill-in (3)
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4)
Amount of the check
Fill-in (5)
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (6)
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7)
MM/CCYY

OPT163 E34 NOTICE INTRODUCTORY PARAGRAPH (G72)

(System Generated)

Caption: None

We are writing to give  (1)  new information about Social Security benefits on this record. We paid  (2)   (3)  too much in Social Security benefits. In the rest of this letter, we will tell you:

  • How we paid too much in benefits, and

  • What to do if you think we are wrong about the overpayment.


Fill-in values:
Fill-in (1)
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2)
Beneficiary's name
Fill-in (3)
Amount of the Overpayment

OPT164 OVERPAYMENT RECOVERY PROPOSED AGAINST OTHER BENEFICIARY E34 NOTICE (G73)

(System Generated)

Caption: None

We cannot recover the overpayment from the person who was overpaid. For this reason, we will withhold the money from the checks of other persons who are paid on the same Social Security record.

OPT165 CHECK PARAGRAPH FUTURE WITHHOLDING OF OVERPAYMENT (G91)

(System Generated)

Caption: Your Benefits

We will pay  (1)  a monthly check of  (2)  until we start to collect the overpayment.


Fill-in values:
Fill-in (1)
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (2)
PMA or CMA in $$$$$.¢¢ format

OPT166 PREVIOUS CHECK WAS INCORRECT AMOUNT (M02)

(Requested)

Caption: Your Benefits

The check  (1)  received for  (2)  in  (3)  should have been for  (4)  . Therefore we paid  (5)   (6)  more in benefits than  (7)  due.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2) – Requested As A Money Amount In Format $$$$$.¢¢
Amount of check
Fill-in (3) Requested As A Date In Format Shown Below
MM/CCYY
Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
Amount that should have been paid
Fill-in (5) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
Amount of overpayment
Fill-in (7) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was

OPT167 OVERPAYMENT RECOVERED (M06)

(Requested)

Caption: Your Benefits

We have recovered all of the money  (1)  owed because of an overpayment.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT168 OVERPAYMENT BALANCE (M08)

(Requested)

Caption: Your Benefits

The total amount of the overpayment is  (1)  .


Fill-in values:
Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the overpayment

OPT169 INCORRECT BENEFIT CAUSED INCORRECT PAYMENT, OVERPAYMENT OR UNDERPAYMENT (M10)

(Requested)

Caption: Your Benefits

Since we paid  (1)   (2)  for  (3)  , we paid  (4)   (5)   (6)  than  (7)  due.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount paid
Fill-in (3) Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
Amount of the overpayment
Fill-in (6) - Requested As A One Position Alpha Character
Choice 1: (A) more
Choice 2: (B) less
Fill-in (7) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was

OPT170 BENEFITS DEFERRED TO RECOVER AN INCORRECT PAYMENT/OVERPAYMENT (M11)

(Requested)

Caption: Your Benefits

We are withholding all of  (1)  benefits for  (2)  and  (3)  of  (4)  benefits for  (5)  to recover the  (6)  that was not due


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2) Requested As A Date In Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (3) Requested As A Money Amount In Format $$$$$.¢¢
Amount of final adjustment
Fill-in (4) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (5) Requested As A Date In Format Shown Below
MM/CCYY of final adjustment
Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
Amount of overpayment or incorrect payment

OPT171 OTHER BENEFICIARY OVERPAID DUE TO WORK (M12)

(Requested)

Caption: Your Benefits

We paid  (1)   (2)  too much in benefits because of work and earnings in  (3)  .


Fill-in values:
Fill-in (1) - Requested As A Language
Name of overpaid beneficiary
Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
Amount of overpayment
Fill-in (3) - Requested As A Date In Format Shown Below
CCYY

OPT179 PAID VS. PAYABLE (M01)

(Requested)

Caption: Your Benefits

We paid  (1)   (2)  for  (3)  . Since we should have paid  (4)   (5)  for  (6)  , we paid  (7)   (8)   (9)  than  (10)  due.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount
Fill-in (3) Requested As A Date in Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) Requested As A Money Amount In Format $$$$$.¢¢
Correct Amount
Fill-in (6) Requested As A Date in Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (7) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (8) Requested As A Money Amount In Format $$$$$.¢¢
Amount
Fill-in (9) Systems Generated
Choice 1: more
Choice 2: less
Fill-in (10) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was

OPT180 FOREIGN REFUND REQUEST ADJUSTMENT PROPOSED OVERPAYMENT EXCEEDS MBP (F24)

(System Generated)

Caption: How To Pay Us Back

You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration” and send it to us in the enclosed envelope.

Always include  (1)  Social Security claim number on the check or money order.

Please send your check or money order in United States currency or in local currency equal to the United States dollars. When you pay us in local currency, we use the exchange rate in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment directly to us, please contact your Federal Benefits Unit for help in making the refund. Visit  (2)  for a list of Federal Benefits Units.

If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding  (3)  full benefit each month beginning with the benefit  (4)  would normally receive about  (5)  . We will continue to withhold  (6)  benefit until the overpayment is fully recovered.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: your
Choice 2: Beneficiary Name possessive
Fill-in (2) Systems Generated
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: Beneficiary Name possessive
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (5) Systems Generated
MM/DD/CCYY
Fill-in (6) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT181 (M07) DUPLICATE CHECK OVERPAYMENT

(Requested)

Caption: Your Benefits

We sent  (1)  two checks for  (2)  , both in the amount of  (3)  and both checks were cashed. Since  (4)  due only one check, we paid  (5)   (6)  too much in benefits.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: you
Choice 2: Beneficiary's name
Fill-in (2) Requested As A Date in Format Shown Below
MM/CCYY
Fill-in (3) Requested As A Money Amount In Format $$$$$.¢¢
Amount
Fill-in (4) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was
Fill-in (5) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the overpayment

OPT182 PRIOR OVERPAYMENT — WORK MONTHS PREVENTED RECOVERY (A29)

(Requested)

Caption: Your Benefits

Our records show that we paid  (1)   (2)  too much in  (3)  . In our previous letter, we told  (4)  that we would withhold benefits in  (5)  to recover  (6)  amount. But  (7)  recent report shows that  (8)  worked during  (9)  . Because of that work, no benefits were payable for that period. Since we could not use benefits for those months to recover the amount  (10)  owed,  (11)  us  (12)  .


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: Beneficiary's name
Choice 2: you
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the overpayment
Fill-in (3) Requested As A Date in Format Shown Below
Year of prior overpayment in CCYY
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (5) Requested As A Date in Format Shown Below
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY
Fill-in (6) Requested As A One Position Alpha Character
Choice 1: (A) this
Choice 2: (B) part of this
Fill-in (7) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (9) Requested As A Date in Format Shown Below
Choice 1: month and year of work MM/CCYY
Choice 2: months and years of work MM/CCYY through MM/CCYY
Fill-in (10) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (11) Systems Generated
Choice 1: you still owe
Choice 2: he still owes
Choice 3: she still owes
Fill-in (12) Requested As A Money Amount In Format $$$$$.�¢
Overpayment Amount

OPT262 OVERPAYMENT ESTABLISHED DUE TO INCORRECT COMPUTATION, A LEGALLY DEFINED OVERPAYMENT OR TO RECOVER A SKELETON DUE PROCESS OVERPAYMENT

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because the payment amount was incorrect. We corrected  (3)  record, which caused (4)  benefit amount to decrease.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT263 OVERPAYMENT ESTABLISHED DUE TO SUBVERSIVE ACTIVITY

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  convicted of a crime against the United States.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was

OPT264 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY DID NOT HAVE A CHILD IN THEIR CARE

(Requested)

Caption: Your Benefits

 (1)  received (2)  too much in benefits because  (3)  a child in  (4)  care who receives benefits from us.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you no longer have
Choice 2:he no longer has
Choice 3: she no longer has
Fill-in (4) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT265 OVERPAYMENT ESTABLISHED BECAUSE A WARRANT FOR THE BENEFICIARY'S ARREST EXISTS

(Requested)

Caption: Your Benefits

 (1)  received (2)  too much in benefits. We should not have paid  (3)  because of a warrant for  (4)  arrest.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.��
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2:him
Choice 3: her
Fill-in (4) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT266 OVERPAYMENT ESTABLISHED BECAUSE OF STATE OR FEDERAL ASSISTANCE

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because (3)  received State or Federal assistance.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT267 OVERPAYMENT CAUSED BY REPRESENTATIVE PAYEE MISUSE OF BENEFITS

(Requested)

Caption: Your Benefits

 (1)  received (2)  too much in benefits because  (3)  misused funds while acting as a representative payee.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT268 OVERPAYMENT CAUSED BY DISABILITY CESSATION

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because we cannot pay benefits after  (3)  disability ends.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Requested As A One Position Alpha Character or Wage Earner's Name for Choice 4
Choice 1: (A) your
Choice 2: (B) his
Choice 3: (C) her
Choice 4: Wage Earner's name (possessive)

OPT269 OVERPAYMENT ESTABLISHED DUE TO RECEIPT OF PROVISIONAL BENEFITS ON A CLAIM THAT WAS LATER DENIED

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  received temporary benefits while we were making a decision on  (4)  claim that we later denied.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT270 OVERPAYMENT ESTABLISHED DUE TO CROSS-BENEFIT ADJUSTMENT

(Requested)

Caption: Your Benefits

We moved  (1)  overpayment of  (2)  to  (3)  for collection.


Fill-in values:
Fill-in (1) Requested As A Alpha Character or the Beneficiary's Name
Choice 1: (A) another person's
Choice 2: Beneficiary's full name (possessive)
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: Beneficiary’s full name

OPT271 OVERPAYMENT ESTABLISHED DUE TO CHANGE IN THE AMOUNT OR COMMENCEMENT OF THE GOVERNMENT PENSION OFFSET

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because we must offset  (3)  benefit payments due to  (4)  receipt of a government pension.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT272 OVERPAYMENT ESTABLISHED DUE TO CROSS-BENEFIT ADJUSTMENT

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because (3)  received a pension based on work not covered by Social Security taxes.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Requested As A One Position Alpha Character or Wage Earner's name for Choice 4
Choice 1: (A) you
Choice 2: (B) he
Choice 3: (C) she
Choice 4: Wage Earner's name (not possessive)

OPT273 OVERPAYMENT ESTABLISHED DUE TO RECEIPT OF PAYMENTS AFTER CONFINEMENT TO A MENTAL INSTITUTION BECAUSE OF A COURT ORDER

(Requested)

Caption: Your Benefits

 (1)  received (2)  too much in benefits because  (3)  received payments after being confined to an institution because of a court order.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT274 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WAS AN ALIEN LIVING OUTSIDE THE UNITED STATES WHILE RECEIVING BENEFITS

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because (3)  not a United States citizen and  (4)  outside the country for six months in a row.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is
Fill-in (3) Systems Generated
Choice 1: you are
Choice 2: he was
Choice 3: she was

OPT275 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WORKED OUTSIDE THE US IN A JOB NOT COVERED UNDER SOCIAL SECURITY TAXES

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  worked outside the United States in a job not covered by United States Social Security taxes.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT276 OVERPAYMENT ESTABLISHED DUE TO PRISONER SUSPENSION

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of  (3)  criminal conviction and confinement in a correctional institution for more than 30 days.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT277 OVERPAYMENT ESTABLISHED DUE TO DEATH RECLAMATION, REPRESENTATIVE PAYEE ELECTRONIC FUNDS TRANSFER (EFT) AFTER DEATH OR REPRESENTATIVE PAYEE DEATH

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because we cannot pay benefits for the month of death or later.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.��
Amount of the Overpayment

OPT278 OVERPAYMENT ESTABLISHED DUE TO PERMANENT DEDUCTIONS RESULTING FROM THE ANNUAL EARNINGS TEST

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of  (3)  work and earnings.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT279 OVERPAYMENT ESTABLISHED DUE TO DEATH SUPER-ENDORSEMENT

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  signed and cashed a check for the month of death or later.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT280 OVERPAYMENT ESTABLISHED DUE TO A CHANGE IN MARITAL STATUS

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of a change in  (3)  marital status.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT281 OVERPAYMENT ESTABLISHED DUE TO ENTITLEMENT TO WORKERS' COMPENSATION, PUBLIC DISABILITY OR BOTH

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of  (3)  receipt of workers’ compensation, public disability payments, or both of these payments.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT282 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY CONTINUED TO RECEIVE BENEFITS AFTER THE AGE OF 18

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because we do not pay benefits once a student reaches age 18, unless he or she is a full-time elementary or high school student.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment

OPT283 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY CONTINUED TO RECEIVE BENEFITS AFTER AGE 19 OR 22

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because we do not pay benefits once a full-time student reaches age 19 , unless  (3)  blind or disabled, or meet(s) an exception which allows benefits to continue:

• for 2 months after a student turns 19, or;

• until the end of the school term, whichever comes first.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you are
Choice 2: he is
Choice 3: she is

OPT284 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY IS NO LONGER IN FULL-TIME SCHOOL ATTENDANCE

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because we do not pay benefits once a student stops going to school full-time.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.��
Amount of the Overpayment

OPT285 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY REFUSED TO ACCEPT VOCATIONAL REHABILITATION

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because we should not have paid benefits when (3)  refused vocational rehabilitation services.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT286 OVERPAYMENT ESTABLISHED DUE TO UNPAID ATTORNEY FEES

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of unpaid attorney's fees.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment

OPT287 OVERPAYMENT ESTABLISHED RAILROAD RETIREMENT BOARD EARNINGS WERE INCORRECTLY USED TO ESTABLISH THE BENEFICARY'S ENTITLEMENT

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  received incorrect payments from the Railroad Retirement Board.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT288 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICARY WAS NOT A UNITED STATES (U.S.) CITIZEN OR LAWFULLY PRESENT IN THE U.S.

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  received payments even though  (4)  not a United States citizen or lawfully present in the U.S.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (4) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was

OPT289 OVERPAYMENT ESTABLISHED BECAUSE THE MONTH OF ENTITLEMENT WAS INCORRECT

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of a change in the month  (3)  benefits started.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT290 OVERPAYMENT ESTABLISHED DUE TO MULTIPLE ENTITLEMENTS

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  received payments on two or more records for the same month(s).


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT291 OVERPAYMENT ESTABLISHED BECAUSE INSURED STATUS WAS NOT MET

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  worked long enough under Social Security to receive monthly benefits.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you have not
Choice 2: he has not
Choice 3: she has not

OPT292 OVERPAYMENT ESTABLISHED BECAUSE THE BENFICIARY MISUSED FUNDS WHILE SERVING AS A REPRESENTATIVE PAYEE

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  misused benefits that  (4)  received as the representative payee for another person.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT293 OVERPAYMENT CAUSED BY SUBSTANTIAL GAINFUL WORK ACTIVITY (SGA) DURING THE EXTENDED PERIOD OF ELIGIBILITY (EPE) OR DISABILITY CESSATION DUE TO SGA

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of  (3)  work activity.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Requested As A One Position Alpha Character or the Wage Earner's Name for Choice 4
Choice 1: (A) your
Choice 2:(B) his
Choice 3:(C) her
Choice 4: Wage Earmer's name (possessive)

OPT294 OVERPAYMENT ESTABLISHED VIA CROSS PROGRAM RECOVERY (CPR) TO RECOVER A TITLE VIII SPECIAL VETERANS BENEFITS (SVB) PAID IN EXCESS

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in Special Veterans Benefit (SVB) payments.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.��
Amount of the Overpayment

OPT295 OVERPAYMENT CAUSED DUE TO INCORRECT PAYMENTS FOR MEDICARE SERVICES

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of incorrect payments for Medicare services.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment

OPT296 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFCIARY WAS CONVICTED OF A CRIME OR IMPRISONED FOR MORE THAN 30 DAYS DUE TO FELONIOUS HOMICIDE

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because of (3)  criminal conviction and imprisonment for more than 30 days.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

OPT297 OVERPAYMENT CAUSED BY WINDFALL OFFSET

(Requested)

Caption: Your Benefits

 (1)  received (2)  too much in benefits because  (3)  received Supplemental Security Income (SSI) payments  (4)   (5)  .


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4) Systems Generated
Choice 1: from
Choice 2: in
Fill-in (5) Systems Generated
Choice 1: MM/CCYY through MM/CCYY
Choice 2: MM/CCYY

OPT298 OVERPAYMENT ESTABLISHED BECAUSE MORE THAN ONE PAYMENT WAS CASHED FOR THE SAME MONTH

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because we should not have paid two payments for the same month(s).


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment

OPT299 OVERPAYMENT ESTABLISHED DUE TO INVALID FAMILY RELATIONSHIPS

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  did not meet the relationship requirements to receive benefits.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT300 OVERPAYMENT ESTABLISHED BECAUSE OF INVALID ENTITLEMENT

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  did not qualify for benefits.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: he
Choice 3: she

OPT301 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WAS DEPORTED

(Requested)

Caption: Your Benefits

 (1)  received  (2)  too much in benefits because  (3)  deported from the United States.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: You
Choice 2: Beneficiary's full name
Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
Amount of the Overpayment
Fill-in (3) Systems Generated
Choice 1: you were
Choice 2: he was
Choice 3: she was

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720245
NL 00720.245 - OPT Overpayment - 09/24/2019
Batch run: 09/24/2019
Rev:09/24/2019