If none of the above applies, we also may not consider (1) overpaid (2) for the month(s)
                  of (3) (4) (5) if you contact us within 12 months from the date of this notice and
                  can show us that:
               
               
                  - 
                     
                        • 
                           The crime for which the warrant was issued or the probation or parole violation was
                              both nonviolent and not drug related and, if a probation or parole violation is involved,
                              the original crime(s) for which (6) paroled or put on probation was both nonviolent
                              and not drug related.
                            
 
 
And
               
                  - 
                     
                        • 
                           (7) neither been convicted of nor pled guilty to another felony crime since the date
                              of the warrant.
                            
 
 
And
               
                  - 
                     
                        • 
                           The law enforcement agency that issued the warrant reports that it will not extradite
                              (8) for the charges on the warrant or that it will not take action on the warrant
                              for (9) arrest.
                            
 
 
Or
               
                  - 
                     
                        • 
                           The crime for which the warrant was issued is based on or the probation or parole
                              violation was both nonviolent and not drug related and, if a probation or parole violation
                              is involved, the original crime(s) for which (10) paroled or put on probation was
                              both nonviolent and not drug related.
                            
 
 
And
               
                  - 
                     
                        • 
                           (11) neither been convicted of nor pled guilty to another felony crime since the date
                              of the warrant.
                            
 
 
And
               
                  - 
                     
                        • 
                           The only existing warrant was issued 10 or more years ago. 
 
 
And
               (12) medical condition impairs (13) mental capability to resolve the warrant; or (14)
                  incapable of managing (15) benefits; or (16) legally incompetent; or Social Security
                  has appointed a representative payee to handle (17) benefits or (18 ) residing in
                  a long-term care facility, such as a nursing home or mental treatment/care facility.
               
               
                  
                     
                        
                        
                     
                     
                        
                        
                           
                           | FILLINS: |   | 
                     
                     
                        
                        
                           
                           |   FILLIN 1
                               |   | 
                        
                           
                           |   Choice 1
                               | BGN plus BLN | 
                        
                           
                           |   Choice 2
                               | you | 
                        
                           
                           |   FILLIN 2
                               | Show the amount of the new overpayment due to the fugitive felon suspension | 
                        
                           
                           |   FILLIN 3
                               |   | 
                        
                           
                           |   Choice 1
                               | Show the first effective date in HIST data that corresponds to the ongoing FUGFEL
                                 suspension (e.g. January 2006)
                               | 
                        
                           
                           |   Choice 2
                               | Show the first effective date in HIST data that corresponds to the embedded period
                                 of suspension (e.g. January 2006)
                               | 
                        
                           
                           |   FILLIN 4
                               |   | 
                        
                           
                           |   Choice 1
                               | and | 
                        
                           
                           |   Choice 2
                               | through | 
                        
                           
                           |   Choice 3
                               | null (this value is used for an ongoing suspension) | 
                        
                           
                           |   FILLIN 5
                               |   | 
                        
                           
                           |   Choice 1
                               | Show COM – 1 month as the effective date for the last month of FUGFEL suspension for
                                 an ongoing suspension (e.g. May 2006)
                               | 
                        
                           
                           |   Choice 2
                               | For an embedded FUGFEL suspension show the last month of the suspension (e.g. May
                                 2006)
                               | 
                        
                           
                           |   FILLIN 6
                               |   | 
                        
                           
                           |   Choice 1
                               | he was | 
                        
                           
                           |   Choice 2
                               | she was | 
                        
                           
                           |   Choice 3
                               | you were | 
                        
                           
                           |   FILLIN 7
                               |   | 
                        
                           
                           |   Choice 1
                               | He has | 
                        
                           
                           |   Choice 2
                               | She has | 
                        
                           
                           |   Choice 3
                               | You have | 
                        
                           
                           |   FILLIN 8
                               |   | 
                        
                           
                           |   Choice 1
                               | him | 
                        
                           
                           |   Choice 2
                               | her | 
                        
                           
                           |   Choice 3
                               | you | 
                        
                           
                           |   FILLIN 9
                               |   | 
                        
                           
                           |   Choice 1
                               | his | 
                        
                           
                           |   Choice 2
                               | her | 
                        
                           
                           |   Choice 3
                               | your | 
                        
                           
                           |   FILLIN 10
                               |   | 
                        
                           
                           |   Choice 1
                               | he was | 
                        
                           
                           |   Choice 2
                               | she was | 
                        
                           
                           |   Choice 3
                               | you were | 
                        
                           
                           |   FILLIN 11
                               |   | 
                        
                           
                           |   Choice 1
                               | He has | 
                        
                           
                           |   Choice 2
                               | She has | 
                        
                           
                           |   Choice 3
                               | You have | 
                        
                           
                           |   FILLIN 12
                               |   | 
                        
                           
                           |   Choice 1
                               | His | 
                        
                           
                           |   Choice 2
                               | Her | 
                        
                           
                           |   Choice 3
                               | Your | 
                        
                           
                           |   FILLIN 13
                               |   | 
                        
                           
                           |   Choice 1
                               | his | 
                        
                           
                           |   Choice 2
                               | her | 
                        
                           
                           |   Choice 3
                               | your | 
                        
                           
                           |   FILLIN 14
                               |   | 
                        
                           
                           |   Choice 1
                               | he is | 
                        
                           
                           |   Choice 2
                               | she is | 
                        
                           
                           |   Choice 3
                               | you are | 
                        
                           
                           |   FILLIN 15
                               |   | 
                        
                           
                           |   Choice 1
                               | his | 
                        
                           
                           |   Choice 2
                               | her | 
                        
                           
                           |   Choice 3
                               | your | 
                        
                           
                           |   FILLIN 16
                               |   | 
                        
                           
                           |   Choice 1
                               | he is | 
                        
                           
                           |   Choice 2
                               | she is | 
                        
                           
                           |   Choice 3
                               | you are | 
                        
                           
                           |   FILLIN 17
                               |   | 
                        
                           
                           |   Choice 1
                               | his | 
                        
                           
                           |   Choice 2
                               | her | 
                        
                           
                           |   Choice 3
                               | your | 
                        
                           
                           |   FILLIN 18
                               |   | 
                        
                           
                           |   Choice 1
                               | he is | 
                        
                           
                           |   Choice 2
                               | she is | 
                        
                           
                           |   Choice 3
                               | you are |