TN 3 (05-92)
NL 00803.115 Completion of the Notice of Overpayment
The Notice of Overpayment has six fill-ins. Fill-ins (1) through (3) apply to all three Notices of Overpayment. Fill-ins (4) through (6) appear only on the SSA-L8170-U3 and are used to propose check adjustment.
2. Fill-ins (1) Through (3)
Fill-ins (1) through (3) appear in the opening paragraph of each Notice of Overpayment form as follows:
“We are writing to let you know that we've paid you (1) too much Supplemental Security Income (SSI) money. The overpayment happened (2) . (3) .”
1. Fill-in (1)
Enter the amount of the overpayment. This is the amount the individual owes for the period after reduction by any underpayment we may net against the incorrect or excess payment(s).
2. Fill-in (2)
Enter the period of incorrect payment. Enter “in Month Year” or “Month Year through Month Year.”
If the period of incorrect payment has intermittent underpayment and/ or nonoverpayment months, show the entire period over which the overpayment happened. Begin with the first month of an incorrect payment and end with the last month of incorrect payment.
NOTE: The period of incorrect payment is different from the overpayment period defined in SI 02201.005B.3. The period of incorrect payment only applies to completion of the Notice of Overpayment.
3. Fill-in (3) - General
Use fill-in (3) to give a brief reason for the overpayment. (Due to provisions of a court settlement, fill-in (3) only has enough blank space for no more than two reasons for an overpayment.) When an overpayment has more than two reasons, refer the reader to the Detailed Explanation attachment page for information about the additional reasons.
4. Fill-in (3) - AONS Language
See the second sentence in paragraph 2900 in NL 00804.260 for approved AONS notice language for fill-in (3). See 5. below, when AONS language is inappropriate for the situation.
NOTE: You may replace the words “spouse” and “parent” appearing in the AONS language with the proper name.
5. Fill-in (3) - AONS Exclusions
Because AONS processing exclusions require you to develop notice language on a case by case basis, model the language after paragraph 2900 and follow instructions in NL 00801.010B.4. for writing clear notice language. In addition, provide a specific reason for the overpayment and a more detailed explanation on the Detailed Explanation attachment page.
If a prior overpayment is currently being collected, see paragraph 2901 for appropriate notice language.
The following chart lists AONS exclusions and the message you should convey in fill-in (3).
|IF...||THEN USE A BRIEF STATEMENT ADVISING THAT THE OVERPAYMENT WAS CAUSED BY...|
|the type and/or amount of income exclusions||a change in the amount of income we use to figure out the payment amount|
|the type and/or amount of certain income and/or living allowance allocations in the deeming computation (SI 01320.001 ff.) changed||a change in the amount of the deemor's income we used to figure out the payment amount|
|the optional or mandatory minimum State supplement changed||a change in the amount payable from the individual's State of residence|
|the status of an individual changes requiring a change in the Type of Master Record or category(ies) of eligibility||a change in the maximum payment that we could pay|
|the individual has failed to establish eligibility (payment status N05) or confirm eligibility (payment status N20)||the individual's failure to cooperate|
|a surviving eligible spouse received the direct deposit checks of a deceased spouse after the month of death||an incorrect deposit of the deceased's SSI payment to the joint account after death. In addition, for the Detailed Explanation page use paragraph OPTM50 (NL 00804.210).|