TN 3 (05-92)
The SSA-L8176-U2 is a manual form only. It provides representative payees with information
about representative payee liability and waiver.
NOTE: The representative payee's copy of the AONS notice incorporates this information.
The SSA-L8176-U2 informs the representative payee that we will ask him/her to repay
the balance of the overpayment if the overpaid individual:
Does not repay the overpayment; or
Begins to repay the overpayment but stops before it is repaid.
The SSA-L8176-U2 also informs the representative payee to contact the FO to request
a waiver if:
The SSI payments were used for the overpaid individual's needs; and
It was not the representative payee's fault that the overpayment occurred.
Issue an SSA-L8176-U2 with the representative payee's copy of the Notice of Overpayment
when the overpaid individual has a representative payee.
Fill in the recipient's name on the first line of the notice and in the first line
following the first caption, “Special Message for You as the Representative Payee.” Document the file with the FO copy of the notice.