TN 15 (02-90)

NL 00804.210 Overpayments/Underpayments

 

  1. Situation Where Used:

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

     

  2. $$$.¢¢

     

  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

     

  7. (Month/Year)

     

  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 $$$.¢¢

     

  1. Situation Where Used

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) $$$.¢¢

 

  1. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  2. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  3. 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

     

  1. Situation Where Used:

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

     

  1. Situation Where Used:

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

     

  4. (Month/Year)

     

  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

     

  7. $$$.¢¢

     

  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.

     

  1. Situation Where Used:

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

     

  1. Situation Where Used:

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)   

Fill-ins:

  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.

     

  1. Situation Where Used

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.

 

  1. (Month/Year)

     

  2. $$$.¢¢

     

  3. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  4. $$$.¢¢

     

  5. $$$.¢¢

     

  6. Choice 1 - you receive

    Choice 2 - she receives

    Choice 3 - he receives

     

  7. (Month/Year)

     

  8. $$$.¢¢

     

  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

     

  1. Situation Where Used:

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

     

  3. $$$.¢¢

     

  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

     

  1. Situation Where Used:

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.

 

  1. Situation Where Used:

IC: Used on denial notice when a claimant received a one-time 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

     

  3. $$$.¢¢

     

  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

     

  1. Situation Where Used:

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

     

  4. $$$.¢¢

     

  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

     

  1. Situation Where Used:

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

     

  4. $$$.¢¢

     

  1. Situation Where Used:

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

     

  2. $$$.¢¢

     

  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.

     

  1. Situation Where Used:

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)   

 

  1. $$$.¢¢

     

  2. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  3. Choice 1 - you

    Choice 2 - she

    Choice 3 - he

     

  4. (Month/Year)

     

  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.

     

  1. Situation Where Used:

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

     

  3. (Month/Year)

     

  1. Situation Where Used:

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

     

  2. $$$.¢¢

     

  3. $$$.¢¢

     

  4. Choice 1 - you

    Choice 2 - her

    Choice 3 - his

     

  5. Choice 1 - for (Month/Year)

    Choice 2 - for (Month/Year) through (Month/Year)

     

  6. $$$.¢¢

     

  7. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

     

  8. (Month/Year)

     

  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

     

  10. $$$.¢¢

     

  11. (Month/Year)

     

  1. Situation Where Used:

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

     

  2. $$$.¢¢

     

  3. Choice 1 - of this amount

    Choice 2 - of ($$$.¢¢)

     

  4. Choice 1 - you

    Choice 2 - she

    Choice 3 - he

     

  1. Situation Where Used:

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

     

  3. $$$.¢¢

     

  4. (Recipient's Social Security Number)

     

  5. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  1. Situation Where Used:

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

     

  3. $$$.¢¢

     

  4. (Recipient's Social Security Number)

     

  5. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  1. Situation Where Used:

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)    .

 

  1. $$$.¢¢

     

  2. (Month/Year)

     

  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

     

  4. $$$.¢¢

     

  5. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  6. $$$.¢¢

     

  7. (Month/Year)

     

  1. Situation Where Used:

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

     

  2. $$$.¢¢

     

  3. $$$.¢¢

     

  4. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  5. $$$.¢¢

     

  6. (Month/Year)

     

  1. Situation Where Used:

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)    .

 

  1. (Month/Year)

     

  2. Choice 1 - the full amount of ($$$.¢¢) beginning (Month/ Year)

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

     

  1. Situation Where Used:

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

     

  2. $$$.¢¢

     

  3. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

     

  4. Choice 1 - Your

    Choice 2 - Her

    Choice 3 - His

     

  5. $$$.¢¢

     

  6. (Month/Year)

     

  7. (Month/Year)

     

  8. Choice 1 - your

    Choice 2 - her

    Choice 3 - his

     

  1. Situation Where Used:

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

     

  1. Situation Where Used:

When an overpaid individual enters LA-D. 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

     

  1. Situation Where Used:

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

     

  1. Situation Where Used:

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) $$$.¢¢

 

  1. Choice 1 - from the amount now due

    Choice 2 - from the amount due

    Choice 3 - , the amount now due

    Choice 4 - , the amount due

     

  2. Choice 1 - for (Month/Year)

    Choice 2 - for (Month/Year) through (Month/Year)

     

  3. Choice 1 - ,

    Choice 2 - and

    Choice 3 - Null

     

  4. 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

     

  5. 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

     

  1. Situation Where Used:

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

     

  2. Month/Day/Year

     

  3. $$$.¢¢

     

  4. (Month/Day/Year)

     

  5. $$$.¢¢

     

  6. $$$.¢¢

     

  7. Choice 1 - you

    Choice 2 - her

    Choice 3 - him

     

  8. (Month/Year)

     

  1. Situation Where Used:

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 survivorIAR 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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900804210
NL 00804.210 - Overpayments/Underpayments - 06/05/2012
Batch run: 06/05/2012
Rev:06/05/2012