TN 4 (08-12)

NL 00720.275 RCY Recovery

RCY002 CROSS PROGRAM RECOVERY – REDUCTION TO COLLECT YOUR SSI OVERPAYMENT (B81)

(System Generated)

Caption: Your Benefits

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) .

Fill-in values:

Fill-in (1)

Choice 1: Beneficiary's Name

Choice 2: you

Fill-in (2)

Choice 1: he was

Choice 2: she was

Choice 3: you were

Fill-in (3)

Choice 1: he still owes

Choice 2: she still owes

Choice 3: you still owe

Fill-in (4)

Amount of SSI overpayment

Fill-in (5)

Choice 1: he receives

Choice 2: she receives

Choice 3: you receive

Fill-in (6)

Withholding amount

Fill-in (7)

Choice 1: his

Choice 2: her

Choice 3: your

Fill-in (8)

Choice 1: some of

Choice 2: null

Fill-in (9)

Choice 1: he owes

Choice 2: she owes

Choice 3: you owe

RCY006 PARTIAL ADJUSTMENT OF OVERPAYMENT COMPLETE - -OVERPAYMENT RECOVERED (A33)

(Requested/Generated)

Caption: Your Benefits

We have raised  (1)  benefits back to  (2)  regular monthly payment amount. This is because  (3)  repaid the overpayment money  (4)  owed us.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Beneficiary's Name

Choice 2: your

Fill-in (2) - Systems Generated

Choice 1: his

Choice 2: her

Choice 3: your

Fill-in (3) - Systems Generated

Choice 1: he

Choice 2: she

Choice 3: you

Fill-in (4) - Systems Generated

Choice 1: he

Choice 2: she

Choice 3: you

RCY021 CROSS PROGRAM RECOVERY – REVIEW REQUEST FOR SSI OVERPAYMENT (B82)

(Requested/Generated)

Caption: Your Benefits

 (1)  may ask us to review our finding that  (2)  the money.  (3)  may have evidence to show that  (4)  already paid some or all of the money or that we previously waived collection of it. If so, give us this evidence when  (5)  for review. We will review the evidence  (6)  us and the information we have. We will send  (7)  a letter with our decision. If we find that  (8)  not owe us this amount, then we will correct our records. For more information on requesting a review, see "Do You Think We Are Wrong?" below.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: You

Choice 2: Beneficiary's name

Fill-in (2) - Systems Generated

Choice 1: you still owe

Choice 2: he still owes

Choice 3: she still owes

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) - Systems Generated

Choice 1: you ask