TN 15 (0290)
NL 00804.210 Overpayments/Underpayments

IC: Use when total withholding is initiated under the 10 percent policy (i.e., when
SSI check amount is less than 10 percent of total income, all of the check will be
withheld).
PE: Use when partial withholding is initiated under the 10 percent policy (i.e., amount
of check is more than 10 percent of income).
NOTE: Paragraph 1436 and paragraph 1017 following will continue to be used in negotiated
rate cases.
(1) will get a check for (2) (3) . As we told (4) before, this is because we are withholding money to get back the (5) . (6) Starting (7) , we will (8) .

(1)
Choice 1  You
Choice 2  She
Choice 3  He
Choice 4  Your bank or other financial institution
Choice 5  Her bank or other financial institution
Choice 6  His bank or other financial institution
Choice 7  Your representative payee


(3)
Choice 1  instead of $$$.¢¢
Choice 2  about the first day of the month starting in (Month/Year)

(4)
Choice 1  you
Choice 2  her
Choice 3  him

(5)
Choice 1  $$$.¢¢you were overpaid
Choice 2  $$$.¢¢she was overpaid
Choice 3  $$$.¢¢he was overpaid
Choice 4  money you were overpaid
Choice 5  money she was overpaid
Choice 6  money he was overpaid

(6)
Choice 1  There is $$$.¢¢left on your overpayment.
Choice 2  There is $$$.¢¢left on her overpayment.
Choice 3  There is $$$.¢¢left on his overpayment.
Choice 4  Null


(8)
Choice 1  raise the amount withheld from your check from $$$.¢ ¢to $$$.¢¢
Choice 2  raise the amount withheld from her check from $$$.¢¢ to $$$.¢¢
Choice 3  raise the amount withheld from his check from $$$.¢¢ to $$$.¢¢

(9)
Choice 1  After (Month/Year) there will be ($$$.¢¢) left on your overpayment.
Choice 2  After (Month/Year) there will be ($$$.¢¢) left on her overpayment.
Choice 3  After (Month/Year) there will be ($$$.¢¢) left on his overpayment.
Choice 4  lower the amount withheld from your check from from $$$.¢ ¢to $$$.¢¢.
Choice 5  lower the amount withheld from her check from $$$.¢¢ to $$$.¢¢
Choice 6  lower the amount withheld from his check from $$$.¢¢ to $$$.¢¢
Choice 7  start withholding $$$.¢¢

IC and PE: When withholding is first initiated under the 10 percent policy and there
is an ongoing check due. Use when going from a negotiated rate to the 10 percent rate
as well as when withholding under the 10 percent rule is first initiated.
NOTE: This paragraph immediately follows paragraph 1015.
The (1) we will withhold is 10 percent of (2) SSI money plus any other money we use in figuring (3) SSI. (4) If (5) us to withhold more or less, please call or visit (6) Social Security office.
(1) $$$.¢¢

(2)
Choice 1  your
Choice 2  her
Choice 3  his

(3)
Choice 1  your
Choice 2  her
Choice 3  his

(4)
Choice 1  We will withhold more than we have before because your SSI money plus any
other money we now use in figuring your SSI is more.
Choice 2  We will withhold more than we have before because her SSI money plus any
other money we now use in figuring her SSI is more.
Choice 3  We will withhold more than we have before because his SSI money plus any
other money we now use in figuring his SSI is more.
Choice 4  We will withhold less than we have before because your SSI money plus any
other money we now use in figuring your SSI is less.
Choice 5  We will withhold less than we have before because her SSI money plus any
other money we now use in figuring her SSI is less.
Choice 6  We will withhold less than we have before because his SSI money plus any
other money we now use in figuring his SSI is less.
Choice 7  Null

IC and PE: Whenever withholding is first initiated and no ongoing check is due (i.e.,
the entire check will be withheld to recover the overpayment). Use with both the first
month of withholding and when changing withholding from a negotiated rate to the 10
percent rate. Also use when total withholding under the 10 percent policy begins andends in the same month.
IC: This will follow either paragraph 1436 or 1015 as appropriate.
The most we withhold from (1) SSI check is 10 percent of (2) SSI money plus any other money we use in figuring (3) SSI. If (4) SSI check is the same as or less than the 10 percent amount, we will withhold (5) entire check. If (6) us to withhold less, please call or visit (7) Social Security office.

(1)
Choice 1  your
Choice 2  her
Choice 3  his

(2)
Choice 1  your
Choice 2  her
Choice 3  his

(3)
Choice 1  your
Choice 2  her
Choice 3  his

(4)
Choice 1  your
Choice 2  her
Choice 3  his

(5)
Choice 1  your
Choice 2  her
Choice 3  his

(6)
Choice 1  you want
Choice 2  she wants
Choice 3  he wants

(7)
Choice 1  your
Choice 2  her
Choice 3  his

There is an ongoing check reduction to recover an overpayment and 10% withholding
amount changes because payment level increases or decreases.
As we told (1) before, we are withholding part of (2) check to get back money (3) overpaid. Starting (4) , we will (5) . Therefore, (6) will receive a check for (7) (8) . (9)

(1)
Choice 1  you
Choice 2  her
Choice 3  him

(2)
Choice 1  your
Choice 2  her
Choice 3  his

(3)
Choice 1  you were
Choice 2  she was
Choice 3  he was


(5)
Choice 1  raise the amount withheld from your check from ($$$.¢ ¢) to ($$$.¢¢)
Choice 2  raise the amount withheld from her check from ($$$.¢¢) to ($$$.¢¢)
Choice 3  raise the amount withheld from his check from ($$$.¢¢) to ($$$.¢¢)
Choice 4  lower the amount withheld from your check from ($$$.¢¢) to ($$$.¢¢)
Choice 5  lower the amount withheld from her check from ($$$.¢¢) to ($$$.¢¢)
Choice 6  lower the amount withheld from his check from ($$$.¢¢) to ($$$.¢¢)
Choice 7  start withholding ($$$.¢¢)

(6)
Choice 1  you
Choice 2  she
Choice 3  he
Choice 4  your bank or other financial institution
Choice 5  her bank or other financial institution
Choice 6  his bank or other financial institution
Choice 7  your representative payee


(8)
Choice 1  instead of ($$$.¢¢)
Choice 2  about the first day of the month starting in (Month/Year)

(9)
Choice 1  After (Month/Year) there will be ($$$.¢¢) left on your overpayment.
Choice 2  After (Month/Year) there will be ($$$.¢¢) left on her overpayment.
Choice 3  After (Month/Year) there will be ($$$.¢¢) left on his overpayment.

Explanation of waiver rights used on award notices with an overpayment carried forward
from a prior record.
Please read the rest of this notice for important information concerning (1) right to appeal this determination of overpayment. (2) certain additional rights with respect to overpayments whether or not (3) that (4) been overpaid. Under the law, an overpayment must be withheld from payments due (5) or paid back unless both of the following are true—

1.
(6) not at fault in connection with the overpayment, and (7) cashed the (8) because (9) thought (10) due, and

2.
(11) could not meet (12) current necessary living expenses if (13) had to pay the money back, or repayment would be unfair for some other reason.
To make this decision, we may need additional information about (14) resources and (15) monthly income and expenses. If (16) both of above conditions, write or visit a Social Security office within 30 days
after getting this notice to explain why (17) should not have to repay the overpayment. (18)

(1)
Choice 1  your
Choice 2  her
Choice 3  his

(2)
Choice 1  You have
Choice 2  She has
Choice 3  He has

(3)
Choice 1  you agree
Choice 2  she agrees
Choice 3  he agrees

(4)
Choice 1  you have
Choice 2  she has
Choice 3  he has

(5)
Choice 1  you
Choice 2  her
Choice 3  him

(6)
Choice 1  You were
Choice 2  She was
Choice 3  He was

(7)
Choice 1  you
Choice 2  she
Choice 3  he

(8)
Choice 1  check
Choice 2  checks

(9)
Choice 1  you
Choice 2  she
Choice 3  he

(10)
Choice 1 it was
Choice 2  they were

(11)
Choice 1 You
Choice 2  She
Choice 3  He

(12)
Choice 1 your
Choice 2  her
Choice 3  his

(13)
Choice 1  you
Choice 2  she
Choice 3  he

(14)
Choice 1 your
Choice 2  her
Choice 3  his

(15)
Choice 1 your
Choice 2  her
Choice 3  his

(16)
Choice 1 you think you meet
Choice 2  she thinks she meets
Choice 3  he thinks he meets

(17)
Choice 1 you
Choice 2  she
Choice 3  he

(18)
Choice 1 If you do not get in touch with us, we will recover the overpayment as described
above.
Choice 2  If she does not get in touch with us, we will recover the overpayment as
described above.
Choice 3  If he does not get in touch with us, we will recover the overpayment as
described above.
Choice 4  Null

Explanation of waiver rights.
NOTE: OBSOLETE—(Replaced by 1434, January 31, 1987.)
Please read the other side of this notice for important information concerning (1) right to appeal this determination of overpayment. (2) certain additional rights with respect to overpayments whether or not (3) that (4) been overpaid. An overpayment must be withheld from payments due (5) or paid back unless both of the following are true—

1.
(6) not at fault in connection with the overpayment, and (7) cashed the (8) because (9) thought (10) due, and

2.
(11) could not meet (12) current necessary living expenses if (13) had to pay the money back, or repayment would be unfair for some other reason.
To make this decision, we may need additional information about (14) resources and (15) monthly income and expenses. If (16) both of the above conditions, write or visit a Social Security office within 30 days
after getting this notice to explain why (17) should not have to repay the overpayment. (18)
Fillins:

(1)
Choice 1  your
Choice 2  her
Choice 3  his

(2)
Choice 1  You have
Choice 2  She has
Choice 3  He has

(3)
Choice 1  you agree
Choice 2  she agrees
Choice 3  he agrees

(4)
Choice 1  you have
Choice 2  she has
Choice 3  he has

(5)
Choice 1  you
Choice 2  her
Choice 3  him

(6)
Choice 1  You were
Choice 2  She was
Choice 3  He was

(7)
Choice 1  you
Choice 2  she
Choice 3  he

(8)
Choice 1  check
Choice 2  checks

(9)
Choice 1  you
Choice 2  she
Choice 3  he

(10)
Choice 1 it was
Choice 2  they were

(11)
Choice 1 You
Choice 2  She
Choice 3  He

(12)
Choice 1 your
Choice 2  her
Choice 3  his

(13)
Choice 1 you
Choice 2  she
Choice 3  he

(14)
Choice 1 your
Choice 2  her
Choice 3  his

(15)
Choice 1 your
Choice 2  her
Choice 3  his

(16)
Choice 1 you think you meet
Choice 2  she thinks she meets
Choice 3  he thinks he meets

(17)
Choice 1 you
Choice 2  she
Choice 3  he

(18)
Choice 1 If you do not get in touch with us, we will recover the overpayment as described
below.
Choice 2  If she does not get in touch with us, we will recover the overpayment as
described below.
Choice 3  If he does not get in touch with us, we will recover the overpayment as
described below.

Overpayment and advance payment collected from retroactive check—additional amount
due.
Beginning (1) we will withhold (2) from (3) monthly payments of (4) until the overpayment of (5) has been repaid. Therefore, the check (6) for (7) will be for (8) . Please get in touch with a Social Security office if (9) with the proposed rate of repayment or if (10) to make refund.



(3)
Choice 1  your
Choice 2  her
Choice 3  his



(6)
Choice 1  you receive
Choice 2  she receives
Choice 3  he receives



(9)
Choice 1  you disagree
Choice 2  she disagrees
Choice 3  he disagrees

(10)
Choice 1  you prefer
Choice 2  she prefers
Choice 3  he prefers

IC: Used in denial notices.
PE: Request for refund—no ongoing payments due.
(1) (2) should refund the overpayment of (3) . Make (4) check or money order payable to the Social Security Administration, (5) , and mail it in the enclosed envelope. If (6) cannot refund the full amount at this time, please get in touch with (7) Social Security office about making monthly installments.

(1)
Choice 1  Otherwise,
Choice 2  Null

(2)
Choice 1  you
Choice 2  she
Choice 3  he


(4)
Choice 1  your
Choice 2  her
Choice 3  his

(5)
(Recipient's Social Security Number)

(6)
Choice 1  you
Choice 2  she
Choice 3  he

(7)
Choice 1  your
Choice 2  her
Choice 3  his

IC: Overpayment made on previous record.
PE: Apparent overpayment on record which may be addressed by subsequent overpayment
notice.
We may be in touch with you later about any payments we previously made.

IC: Used on denial notice when a claimant received a onetime payment, advance payment,
or a presumptive disability payment and is denied for nondisability reasons.
Since (1) not eligible to receive Supplemental Security Income payments, the (2) of (3) which we sent (4) while we were working on (5) claim (6) an overpayment.

(1)
Choice 1  you are
Choice 2  she is
Choice 3  he is

(2)
Choice 1  payment
Choice 2  payments


(4)
Choice 1  you
Choice 2  her
Choice 3  him

(5)
Choice 1  your
Choice 2  her
Choice 3  his

(6)
Choice 1  is
Choice 2  are

IC: Used on award notices when overpayment and advance payment are recovered from
retroactive payment.
As we previously notified (1) overpaid when (2) formerly received Supplemental Security Income payments. (3) must still repay (4) from the amount due (5) , (6) .

(1)
Choice 1  you, you were
Choice 2  her, she was
Choice 3  him, he was

(2)
Choice 1  you
Choice 2  she
Choice 3  he

(3)
Choice 1  You
Choice 2  She
Choice 3  He


(5)
Choice 1  for (Month/Year)
Choice 2  for (Month/Year through (Month/Year)

(6)
Choice 1  to reduce the overpayment to $$$.¢¢
Choice 2  to repay the overpayment

IC: Used on award notices when overpayment and advance payment are recovered from
retroactive payment—no additional retroactive payment due to recover remaining overpayment.
As we previously notified (1) overpaid when (2) formerly received Supplemental Security Income payments. (3) must still repay (4) of the overpayment.

(1)
Choice 1  you, you were
Choice 2  her, she was
Choice 3  him, he was

(2)
Choice 1  you
Choice 2  she
Choice 3  he

(3)
Choice 1  You
Choice 2  She
Choice 3  He


While an overpayment is being recovered by deduction, an intervening event causes
a decrease or an increase and the amount due is equal to or less than the amount being
recovered. Recipient will not be sent a monthly check but is not in suspense.
However, because (1) (2) , no check is due (3) at this time. (4)

(1)
Choice 1  you previously received excess payments and still owe
Choice 2  she previously received excess payments and still owes
Choice 3  he previously received excess payments and still owes


(3)
Choice 1  you
Choice 2  her
Choice 3  him

(4)
Choice 1  Based on the information we have now, you will receive ($$$.¢¢) per month
beginning (Month/Year).
Choice 2  Based on the information we have now, she will receive ($$$.¢¢) per month
beginning (Month/Year)
Choice 3  Based on the information we have now, he will receive ($$$. ¢¢) per month
beginning (Month/Year)
Choice 4  Based on the information we have now, you will receive a payment of ($$$.¢¢)
for (Month/Year) and your full monthly payment amount of ($$$.¢¢) thereafter.
Choice 5  Based on the information we have now, she will receive a payment of ($$$.¢¢)
for (Month/Year) and your full monthly payment amount of ($$$.¢¢) thereafter.
Choice 6  Based on the information we have now, he will receive a payment of ($$$.¢¢)
for (Month/Year) and your full monthly payment amount of ($$$.¢¢) thereafter.
Choice 7  We will let you know as soon as payment can be made.

Payment reduced while excess payments are being recovered. Prior recovery rate equals
or is larger than new monthly amount due.
Because we are withholding (1) from (2) check each month to recover the overpayment, (3) will not receive a check beginning (4) . (5)


(2)
Choice 1  your
Choice 2  her
Choice 3  his

(3)
Choice 1  you
Choice 2  she
Choice 3  he


(5)
Choice 1  Based on the information we have now, you will receive $$$. ¢¢per month
beginning (Month/Year).
Choice 2  Based on the information we have now, she will receive $$$. ¢¢per month
beginning (Month/Year).
Choice 3  Based on the information we have now, he will receive $$$.¢ ¢per month
beginning (Month/Year).
Choice 4  Based on the information we have now, you will receive a payment of $$$.¢¢for
(Month/Year) and your full monthly payment amount of $$$.¢¢thereafter.
Choice 5  Based on the information we have now, she will receive a payment of $$$.¢¢for
(Month/Year) and her full monthly payment amount of $$$.¢¢thereafter.
Choice 6  Based on the information we have now, he will receive a payment of $$$.¢¢for
(Month/Year) and his full monthly payment amount of $$$.¢¢thereafter.
Choice 7  We will let you know as soon as payment can be made.

Only ongoing check due. Full rate payable due to completing recovery of overpayment.
NOTE: This paragraph replaces 2438.
Because we have completed recovery of (1) overpayment, we will send (2) the full amount in (3) .

(1)
Choice 1  your
Choice 2  her
Choice 3  his

(2)
Choice 1  you
Choice 2  your bank or other financial institution
Choice 3  her bank or other financial institution
Choice 4  his bank or other financial institution
Choice 5  your representative payee


Only ongoing check due. Amount due for some retroactive months offset against overpayment
for different period. Ongoing check reduced.
We are reducing (1) overpayment of (2) by withholding (3) , the payment now due (4) (5) . We will withhold (6) from the payments due (7) beginning (8) . Therefore, we are sending (9) a check in the amount of (10) for (11) . The check should be received about the first of the month.

(1)
Choice 1  your
Choice 2  her
Choice 3  his



(4)
Choice 1  you
Choice 2  her
Choice 3  his

(5)
Choice 1  for (Month/Year)
Choice 2  for (Month/Year) through (Month/Year)


(7)
Choice 1  you
Choice 2  her
Choice 3  him


(9)
Choice 1  you
Choice 2  your bank or other financial institution
Choice 3  her bank or other financial institutuion
Choice 4  his bank or other financial institution
Choice 5  your representative payee



Waiver approved for total overpayment.
We previously notified (1) about a (2) overpayment and you requested that we not require repayment (3) . We considered the information you gave us and have determined that (4) will not have to pay this money back.

(1)
Choice 1  you
Choice 2  her
Choice 3  him


(3)
Choice 1  of this amount
Choice 2  of ($$$.¢¢)

(4)
Choice 1  you
Choice 2  she
Choice 3  he

Overpayment recovery not completed. Recovery stopped because of ineligibility for
payments.
Because we can no longer withhold (1) payments to recover the overpayment, you should refund the remainder of (2) overpayment. You should make a check or money order for (3) payable to the Social Security Administration, (4) and mail it in the enclosed envelope. If you cannot refund the full amount, please
get in touch with (5) Social Security office about making monthly installments.

(1)
Choice 1  your
Choice 2  her
Choice 3  his

(2)
Choice 1  your
Choice 2  her
Choice 3  his


(4)
(Recipient's Social Security Number)

(5)
Choice 1  your
Choice 2  her
Choice 3  his

Advance payment recovery not completed. Recovery halted because of ineligibility for
payment.
Because we can no longer withhold (1) payments to recover the advance payment, you should refund the amount (2) us. You should make a check or money order for (3) payable to the Social Security Administration, (4) , and mail it in the enclosed envelope. If you cannot refund the full amount, please
get in touch with (5) Social Security office about making monthly installments.

(1)
Choice 1  your
Choice 2  her
Choice 3  his

(2)
Choice 1  you still owe
Choice 2  she still owes
Choice 3  he still owes


(4)
(Recipient's Social Security Number)

(5)
Choice 1  your
Choice 2  her
Choice 3  his

Only ongoing check due. Recovery rate adjusted for final month of recovery of overpayment.
By withholding (1) from the (2) check, we will complete recovery of the overpayment. Therefore, we will send (3) a check in the amount of (4) about the first of the month, and we will send (5) regular monthly payment of (6) beginning (7) .



(3)
Choice 1  you
Choice 2  your bank or other financial institution
Choice 3  her bank or other financial institution
Choice 4  his bank or other financial institution
Choice 5  your representative payee


(5)
Choice 1  your
Choice 2  her
Choice 3  his



Overpayment being recovered by monthly withholding. Intervening event causes an increase
or decrease in monthly payment amount. (Used with paragraph 2451.)
The new payment due (1) as shown above is the amount we would send each month if we were not recovering an
overpayment. Because we will continue to withhold (2) each month until the remaining overpayment of (3) is recovered, (4) new payment amount will be (5) beginning (6) .

(1)
Choice 1  you
Choice 2  her
Choice 3  him



(4)
Choice 1  your
Choice 2  her
Choice 3  his



Overpayment being recovered by monthly withholding. Intervening event causes an increase
or decrease in monthly payment amount. (Used with paragraph 2450.)
NOTE: This paragraph is OBSOLETE.
Based on this withholding, we will complete recovery of the overpayment in (1) and will send (2) .


(2)
Choice 1  the full amount of ($$$.¢¢) beginning (Month/ Year)
Choice 2  a payment of ($$$.¢¢) for (Month/Year) and the full amount of ($$$.¢¢)
thereafter.

Overpayment being recovered by monthly withholding—intervening event causes a change
in payment amount. Recovery complete.
NOTE: This paragraph is OBSOLETE.
The new amount due (1) is the amount we would send each month if we were not recovering an overpayment.
By withholding (2) from the amount due (3) , we have completed recovery of the overpayment. (4) new payment amount will be (5) for (6) . Beginning (7) we will pay you (8) full monthly payment.

(1)
Choice 1  you
Choice 2  her
Choice 3  him


(3)
Choice 1  you
Choice 2  her
Choice 3  him

(4)
Choice 1  Your
Choice 2  Her
Choice 3  His




(8)
Choice 1  your
Choice 2  her
Choice 3  his

Individual receives no payment because of 100% withholding to recover an overpayment.
The payment due and rate of withholding both exceed 10% of the total monthly countable
income. The recipient may request a lower adjustment rate. (Follows 2450 or 2451 when
2450 and 2451 are produced together.)
NOTE: OBSOLETE—(Replaced by 2456, January 31, 1987.)
Because of a new law, the amount we hold back from Supplemental Security Income (SSI)
checks has changed. In most cases now we hold back 10 percent of total income. Total
income is the SSI money plus any other money a person gets which we use in figuring
the SSI payment. We are holding back more than 10 percent to get back the money (1) us. If you want us to hold back less money from (2) SSI checks, call or visit your Social Security office. If you go to a Social Security
office, be sure to bring this letter with you.

(1)
Choice 1  you owe
Choice 2  she owes
Choice 3  he owes

(2)
Choice 1  your
Choice 2  her
Choice 3  his

When an overpaid individual enters LAD. Used with both a negotiated and 10% recovery
rate. Used on notices produced after January 20, 1985.
(1) (2) in an institution where Medicaid pays for more than half the cost of (3) care, we will not withhold money to get back money (4) overpaid.

(1)
Choice 1  You will get an SSI check for ($$$.¢¢) about the first day of the month
beginning (Month/Year). We were withholding money from your check to get back money
you were overpaid. Now, while
Choice 2  She will get an SSI check for ($$$.¢¢) about the first day of the month
beginning (Month/Year). We were withholding money from her check to get back money
you were overpaid. Now, while
Choice 3  He will get an SSI check for ($$$.¢¢) about the first day of the month
beginning (Month/Year). We were withholding money from his check to get back money
he was overpaid. Now, while
Choice 4  While

(2)
Choice 1  you are
Choice 2  she is
Choice 3  he is

(3)
Choice 1  your
Choice 2  her
Choice 3  his

(4)
Choice 1  you were
Choice 2  she was
Choice 3  he was

Individual receives no payment because of 100% withholding to recover an overpayment.
The payment due and rate of withholding both exceed 10% of the total monthly countable
income. The recipient may request a lower adjustment rate. (Follows 2450 or 2451 when
2450 and 2451 are produced together.)
Because of a new law, the amount we hold back from Supplemental Security Income (SSI)
checks has changed. In most cases now we hold back only 10 percent of total income.
Total income is the SSI money plus any other money a person gets which we use in figuring
the SSI payment. We are holding back more than 10 percent to get back the money (1) us. If you want us to hold back less money from (2) SSI checks, call or visit your Social Security office.

(1)
Choice 1  you owe
Choice 2  she owes
Choice 3  he owes

(2)
Choice 1  your
Choice 2  her
Choice 3  his

Retroactive check due. Overpayment not completely recovered.
Because (1) overpaid previously and still (2) us (3) , we are withholding (4) (5) (6) (7) to recover the overpayment. (8) (9) .

(1)
Choice 1  you were
Choice 2  she was
Choice 3  he was

(2)
Choice 1  owe
Choice 2  owes
(3) $$$.¢¢
(4) $$$.¢¢

(5)
Choice 1  from the amount now due
Choice 2  from the amount due
Choice 3  , the amount now due
Choice 4  , the amount due

(6)
Choice 1  for (Month/Year)
Choice 2  for (Month/Year) through (Month/Year)

(7)
Choice 1  ,
Choice 2  and
Choice 3  Null

(8)
Choice 1  Therefore, we are sending you a check for ($$$.¢¢). The check should be
received no later than (Month/Day/Year).
Choice 2  Therefore, we are sending your bank or other financial institution a check
for ($$$.¢¢). The check should be received no later than (Month/Day/Year).
Choice 3  Therefore, we are sending her bank or other financial institution a check
for ($$$.¢¢). The check should be received no later than (Month/Day/Year).
Choice 4  Therefore, we are sending his bank or other financial institution a check
for ($$$.¢¢). The check should be received no later than (Month/Day/Year).
Choice 5  Therefore, we are sending your representative payee a check for ($$$.¢¢).
The check should be received no later than (Month/Day/ Year).
Choice 6  Null

(9)
Choice 1  Your regular monthly check will then be sent about the first day of the
month.
Choice 2  Her regular monthly check will then be sent about the first day of the
month.
Choice 3  His regular monthly check will then be sent about the first day of the
month.
Choice 4  Null

Additional supplemental security payment or a supplemental payment and underpayment
being made in the supplementation period.
(1) should receive a check on (2) for (3) and an additional check on (4) for (5) . The total of the two checks (6) , is the new payment due (7) for (8) .

(1)
Choice 1  You
Choice 2  Your representative payee






(7)
Choice 1  you
Choice 2  her
Choice 3  him


IC and PE: U1 or U2 diary established, underpayment is due but awaiting review before
release.
We may be in touch with you about money that may be due for earlier months.
Manual Paragraphs
OPTM50. Situation Where Used:
Overpayment because of direct deposit to a surviving spouse.
We paid you too much SSI because we deposited (1) SSI payments for (2) into a bank account which (3) also owned. These SSI payments were incorrect because we can't pay SSI to (4) for months after (5) , when (6) died.

(1)
(Name of deceased member of the couple (possessive), for example James Brown's.)

(2)
Choice 1  (Month/Year)
Choice 2  (Month/Year) through (Month/Year) (Months the incorrect payments began
and ended.)

(3)
Choice 1  you
Choice 2  (Name of overpaid individual)

(4)
(Name of the deceased member of the couple)

(5)
Month/Year, (Month of death)

(6)
Choice 1  she
Choice 2  he
OPTM51. Situation Where Used:
Notification of representative payee of overpayment.
Special Message For You As The Representative Payee
You're responsible for paying us back because you were (overpaid individual's name)
representative payee when (she/he) was overpaid.
OPTM52. Situation Where Used:
Part of overpayment is waived, part is still to be collected.
We are writing to tell you that we decided to waive the collection of part of your
Supplemental Security Income (SSI) overpayment of $$$.¢¢(amount of overpayment). We
decided that you won't have to pay back $$$.¢¢of this overpayment.
However, this means that you still have to pay us back $$$.¢¢(amount of collect decision)
of this overpayment. In the rest of this letter we'll give you our reasons for this
decision and tell you what you can do if you think we're wrong.
References:
Notices to survivors, SI 02101.008
Notice to deny payment of underpayment; no underpayment on the record, SI 02101.008A and SI 02101.008B
Notice that underpayment will be paid to a survivor SI 02101.008C
Notice to deny request for payment of underpayment; underpayment due State for IAR, SI 02101.008D
Notice of partial payment to survivor—IAR involvement, SI 02101.008E
Notice to deny request for payment of underpayment to deceased's estate, SI 02101.008F
Notice to deny request for payment of underpayment; spouse not living with deceased, SI 02101.008G
Notice to deny request for payment of underpayment; claimant not deceased child's natural or adoptive parent, SI 02101.008H
Notice to deny request for payment of underpayment; parent not living with deceased child SI 02101.008I
Notice to deny request for payment of underpayment; claimant not deceased's spouse, SI 02101.008J
Notice to deny request for payment of underpayment used to offset overpayment, SI 02101.008K
Alien is overpaid and not in current pay status; paragraph says we will withhold overpayment from future
payments, SI 02205.001C.1.b.
Good cause found for sponsor; sponsor not required to repay alien's overpayment, SI 02205.001D.5.
Good cause not found for sponsor; sponsor is required to repay alien's overpayment, SI 02205.005D.2.
Informs sponsorof his/her liabilityfor an alien's overpayment , SI 02205.005D.3.
Sample notices for sponsor/alien overpaymentsituations, SI 02205.005 E.