RFU001 REQUEST FOR REFUND - OVERPAID PERSON IN NONPAY STATUS NO CROSS PROGRAM ADJUSTMENT POSSIBLE (A19) (G13)

(Requested/Generated)

Caption: How To Pay Us Back

You should refund this overpayment of  (1)  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  (2)  Social Security claim number on your check or money order.

If you cannot refund the full  (3)  now, please send:

• •

  A partial payment

• •

  An explanation of why you cannot pay the full amount now, and

• •

  A plan to repay the money

RFU007 SSI OFFSET NOT APPLICABLE (A59)

(Requested)

Caption: Your Benefits

Our records show that  (1)  did not get SSI money for  (2)  . So we can refund all of the Social Security money we held.

RFU008 REFUND/RETURNED CHECK(S) USED TO REDUCE OVERPAYMENT (A34)

(Requested)

Caption: Your Benefits

We used the amount refunded to replace  (1)  the money we  (2)   (3)  .

RFU012 REQUEST FOR REFUND AND ADJUSTMENT PROPOSED — OVERPAID PERSON IN CURRENT PAY — OVERPAYMENT EXCEEDS MONTHLY PAYMENT (A24)

(Requested/Generated)

Caption: How To Pay Us Back

You should refund this overpayment of $ (1)  within 30 days. Please make your check or money order payable to the "Social Security Administration," and send it to us in the enclosed envelope.

Always include  (2)  Social Security claim number on your check or money order.

If we do not receive your refund within 30 days, we will withhold 10 percent of  (3)  total monthly benefit or $10 (whichever is more) starting with the payment you will receive  (4)  on or about  (5)  . We will continue withholding from  (6)  benefits until we recover the overpayment.

If you cannot refund the full overpayment now or cannot afford to have us withhold 10 percent of  (7)  benefit, you may ask us to hold back a smaller amount each month. Contact us to discuss your plan for repaying the balance. You may need to show us proof of  (8)  assets, monthly income, and expenses. The minimum withholding amount we will accept is $10.

RFU020 FOREIGN REFUND REQUEST NONPAY STATUS (F19)

Caption: How To Pay Us Back

(System Generated)

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)  claim number on the check or money order. If you cannot refund the full  (2)  now, you should submit:

1. a. 

   partial payment,

2. b. 

   an explanation of your financial circumstances, and

3. c. 

   a definite plan for repaying the balance.

If  (3)  pay us by check or money order, make sure that the check or money order is in United States (U.S.) dollars or in local currency equal to U.S. dollars. When  (4)  pay us in local currency, we use the exchange rates in effect at the time we get  (5)  payment. If this causes a difference between the amount  (6)  pay us and the amount  (7)  us, we will let you know. If you cannot mail  (8)  payment to us, please contact your Federal Benefits Unit. Visit  (9)  for a list of FBUs. If you are in Canada, visit  (10)  to find the office that services your area. They will help you make the refund.

If you have questions about Medicare, please visit  (11)  for information.

RFU036 REQUEST FOR REFUND AND ADJUSTMENT PROPOSED — OVERPAID PERSON IN CURRENT PAY — OVERPAYMENT EXCEEDS MONTHLY PAYMENT (A24)

(Requested)

Caption: How To Pay Us Back

You should refund this overpayment of $ (1)  within 30 days. Please make your check or money order payable to the "Social Security Administration," and send it to us in the enclosed envelope.

Always include  (2)  Social Security claim number on your check or money order.

If we do not receive your refund within 30 days, we will withhold  (3)  full benefit starting with the payment you will receive  (4)  on or about  (5)  . We will continue withholding from  (6)  benefits until we recover the overpayment.