TN 9 (06-18)

NL 00720.295 RFU Refund

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


Fill-in values:
Fill-in (1) – Systems Generated (when it is not requested on the ENB) or Requested As A Money Amount in Format $$$$$.¢¢
Overpayment Amount
Fill-in (2) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) Systems Generated (when it is not requested on the ENB) Requested As A Money Amount in Format $$$$$.¢¢
Overpayment Amount

RFU003 REQUEST FOR REFUND AND ADJUSTMENT PROPOSED - OVERPAID PERSON IN NONPAY STATUS AND IS REPRESENTATIVE PAYEE FOR OTHER - OVERPAYMENT EXCEEDS MONTHLY PAYMENT (A26)

(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 “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 hold back  (3)  full benefit starting with the payment you would normally receive  (4)  about

 (5) . We will continue holding back  (6)  benefits until we recover the overpayment.

If you cannot refund the full overpayment now or cannot afford to have us hold back  (7)  full 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.


Fill-in values:
Fill-in (1) Systems Generated
Amount of Overpayment
Fill-in (2) 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
Fill-in (4) Systems Generated
Choice 1: NULL
Choice 2: for him
Choice 3: for her
Fill-in (5) Systems Generated
MM/DD/CCYY
Fill-in (6) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

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.


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
Choice 1: MM/CCYY
Choice 2: MM/CCYY through MM/CCYY

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)  .


Fill-in values:
Fill-in (1) Requested As A One Position Alpha Character
Choice 1: (A) some of
Choice 2: (B) null
Fill-in (2) Requested As A One Position Alpha Character
Choice 1: (A) incorrectly paid
Choice 2: (B) overpaid
Fill-in (3) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
Choice 4: Beneficiary's Name

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 “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 hold back  (3)  full benefit starting with the payment you would normally receive  (4)  about

 (5) . We will continue holding back  (6)  benefits until we recover the overpayment.

If you cannot refund the full overpayment now or cannot afford to have us hold back  (7)  full 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.


Fill-in values:
Fill-in (1) - Systems Generated (when it is not requested on the ENB) Requested As A Money Amount in Format $$$$$.¢¢
Overpayment Amount
Fill-in (2) - 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
Fill-in (4) - Systems Generated
Choice 1: null
Choice 2: for him
Choice 3: for her
Fill-in (5) - Systems Generated (when it is not requested on the ENB) Requested As A Date In Format Shown Below
MM/DD/CCYY
Fill-in (6) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (7) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (8) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her

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)  Social Security 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 you 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 you pay us in local currency, we use the exchange rates 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 to us, please contact your Federal Benefits Unit. Visit  (3)  for a list of Federal Benefits Units. They will help you make the refund.


Fill-in values:
Fill-in (1) Systems Generated
Choice 1: Beneficiary's name possessive
Choice 2: your
Fill-in (2) Systems Generated
Overpayment amount in $$$$$¢¢
Fill-in (3) Systems Generated
www.socialsecurity.gov/foreign/foreign.htm

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720295
NL 00720.295 - RFU Refund - 06/28/2018
Batch run: 06/28/2018
Rev:06/28/2018