TN 15 (02-90)

# NL 00804.210 Overpayments/Underpayments

**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) __ .

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

$$$.¢¢

Choice 1 - instead of $$$.¢¢

Choice 2 - about the first day of the month starting in (Month/Year)

Choice 1 - you

Choice 2 - her

Choice 3 - him

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

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

(Month/Year)

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 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 $$$.¢¢

**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) $$$.¢¢

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - your

Choice 2 - her

Choice 3 - his

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

**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 **and**ends 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.

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - you want

Choice 2 - she wants

Choice 3 - he wants

Choice 1 - your

Choice 2 - her

Choice 3 - his

**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) __

Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - you were

Choice 2 - she was

Choice 3 - he was

(Month/Year)

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 ($$$.¢¢)

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

$$$.¢¢

Choice 1 - instead of ($$$.¢¢)

Choice 2 - about the first day of the month starting in (Month/Year)

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.

**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—

__(6)__not at fault in connection with the overpayment, and__(7)__cashed the__(8)__because__(9)__thought__(10)__due, and__(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) __

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - You have

Choice 2 - She has

Choice 3 - He has

Choice 1 - you agree

Choice 2 - she agrees

Choice 3 - he agrees

Choice 1 - you have

Choice 2 - she has

Choice 3 - he has

Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 1 - You were

Choice 2 - She was

Choice 3 - He was

Choice 1 - you

Choice 2 - she

Choice 3 - he

Choice 1 - check

Choice 2 - checks

Choice 1 - you

Choice 2 - she

Choice 3 - he

Choice 1- it was

Choice 2 - they were

Choice 1- You

Choice 2 - She

Choice 3 - He

Choice 1- your

Choice 2 - her

Choice 3 - his

Choice 1 - you

Choice 2 - she

Choice 3 - he

Choice 1- your

Choice 2 - her

Choice 3 - his

Choice 1- your

Choice 2 - her

Choice 3 - his

Choice 1- you think you meet

Choice 2 - she thinks she meets

Choice 3 - he thinks he meets

Choice 1- you

Choice 2 - she

Choice 3 - he

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

**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—

__(6)__not at fault in connection with the overpayment, and__(7)__cashed the__(8)__because__(9)__thought__(10)__due, and__(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:

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - You have

Choice 2 - She has

Choice 3 - He has

Choice 1 - you agree

Choice 2 - she agrees

Choice 3 - he agrees

Choice 1 - you have

Choice 2 - she has

Choice 3 - he has

Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 1 - You were

Choice 2 - She was

Choice 3 - He was

Choice 1 - you

Choice 2 - she

Choice 3 - he

Choice 1 - check

Choice 2 - checks

Choice 1 - you

Choice 2 - she

Choice 3 - he

Choice 1- it was

Choice 2 - they were

Choice 1- You

Choice 2 - She

Choice 3 - He

Choice 1- your

Choice 2 - her

Choice 3 - his

Choice 1- you

Choice 2 - she

Choice 3 - he

Choice 1- your

Choice 2 - her

Choice 3 - his

Choice 1- your

Choice 2 - her

Choice 3 - his

Choice 1- you think you meet

Choice 2 - she thinks she meets

Choice 3 - he thinks he meets

Choice 1- you

Choice 2 - she

Choice 3 - he

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.

**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.

(Month/Year)

$$$.¢¢

Choice 1 - your

Choice 2 - her

Choice 3 - his

$$$.¢¢

$$$.¢¢

Choice 1 - you receive

Choice 2 - she receives

Choice 3 - he receives

(Month/Year)

$$$.¢¢

Choice 1 - you disagree

Choice 2 - she disagrees

Choice 3 - he disagrees

Choice 1 - you prefer

Choice 2 - she prefers

Choice 3 - he prefers

**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.

Choice 1 - Otherwise,

Choice 2 - Null

Choice 1 - you

Choice 2 - she

Choice 3 - he

$$$.¢¢

Choice 1 - your

Choice 2 - her

Choice 3 - his

(Recipient's Social Security Number)

Choice 1 - you

Choice 2 - she

Choice 3 - he

Choice 1 - your

Choice 2 - her

Choice 3 - his

**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.

**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.

Choice 1 - you are

Choice 2 - she is

Choice 3 - he is

Choice 1 - payment

Choice 2 - payments

$$$.¢¢

Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - is

Choice 2 - are

**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) __ .

Choice 1 - you, you were

Choice 2 - her, she was

Choice 3 - him, he was

Choice 1 - you

Choice 2 - she

Choice 3 - he

Choice 1 - You

Choice 2 - She

Choice 3 - He

$$$.¢¢

Choice 1 - for (Month/Year)

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

Choice 1 - to reduce the overpayment to $$$.¢¢

Choice 2 - to repay the overpayment

**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.

Choice 1 - you, you were

Choice 2 - her, she was

Choice 3 - him, he was

Choice 1 - you

Choice 2 - she

Choice 3 - he

Choice 1 - You

Choice 2 - She

Choice 3 - He

$$$.¢¢

**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) __

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

$$$.¢¢

Choice 1 - you

Choice 2 - her

Choice 3 - him

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.

**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) __

$$$.¢¢

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - you

Choice 2 - she

Choice 3 - he

(Month/Year)

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.

**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) __ .

Choice 1 - your

Choice 2 - her

Choice 3 - his

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

(Month/Year)

**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.

Choice 1 - your

Choice 2 - her

Choice 3 - his

$$$.¢¢

$$$.¢¢

Choice 1 - you

Choice 2 - her

Choice 3 - his

Choice 1 - for (Month/Year)

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

$$$.¢¢

Choice 1 - you

Choice 2 - her

Choice 3 - him

(Month/Year)

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

$$$.¢¢

(Month/Year)

**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.

Choice 1 - you

Choice 2 - her

Choice 3 - him

$$$.¢¢

Choice 1 - of this amount

Choice 2 - of ($$$.¢¢)

Choice 1 - you

Choice 2 - she

Choice 3 - he

**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.

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - your

Choice 2 - her

Choice 3 - his

$$$.¢¢

(Recipient's Social Security Number)

Choice 1 - your

Choice 2 - her

Choice 3 - his

**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.

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - you still owe

Choice 2 - she still owes

Choice 3 - he still owes

$$$.¢¢

(Recipient's Social Security Number)

Choice 1 - your

Choice 2 - her

Choice 3 - his

**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) __ .

$$$.¢¢

(Month/Year)

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

$$$.¢¢

Choice 1 - your

Choice 2 - her

Choice 3 - his

$$$.¢¢

(Month/Year)

**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) __ .

Choice 1 - you

Choice 2 - her

Choice 3 - him

$$$.¢¢

$$$.¢¢

Choice 1 - your

Choice 2 - her

Choice 3 - his

$$$.¢¢

(Month/Year)

**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) __ .

(Month/Year)

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

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

**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.

Choice 1 - you

Choice 2 - her

Choice 3 - him

$$$.¢¢

Choice 1 - you

Choice 2 - her

Choice 3 - him

Choice 1 - Your

Choice 2 - Her

Choice 3 - His

$$$.¢¢

(Month/Year)

(Month/Year)

Choice 1 - your

Choice 2 - her

Choice 3 - his

**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.

Choice 1 - you owe

Choice 2 - she owes

Choice 3 - he owes

Choice 1 - your

Choice 2 - her

Choice 3 - his

**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.

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

Choice 1 - you are

Choice 2 - she is

Choice 3 - he is

Choice 1 - your

Choice 2 - her

Choice 3 - his

Choice 1 - you were

Choice 2 - she was

Choice 3 - he was

**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.

Choice 1 - you owe

Choice 2 - she owes

Choice 3 - he owes

Choice 1 - your

Choice 2 - her

Choice 3 - his

**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) __ .

Choice 1 - you were

Choice 2 - she was

Choice 3 - he was

Choice 1 - owe

Choice 2 - owes

(3) $$$.¢¢

(4) $$$.¢¢

Choice 1 - from the amount now due

Choice 2 - from the amount due

Choice 3 - , the amount now due

Choice 4 - , the amount due

Choice 1 - for (Month/Year)

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

Choice 1 - ,

Choice 2 - and

Choice 3 - Null

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

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

**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) __ .

Choice 1 - You

Choice 2 - Your representative payee

Month/Day/Year

$$$.¢¢

(Month/Day/Year)

$$$.¢¢

$$$.¢¢

Choice 1 - you

Choice 2 - her

Choice 3 - him

(Month/Year)

**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.

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

Choice 1 - (Month/Year)

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

Choice 1 - you

Choice 2 - (Name of overpaid individual)

(Name of the deceased member of the couple)

Month/Year, (Month of death)

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 **sponsor**of his/her **liability**for an **alien's overpayment** , SI 02205.005D.3.

Sample notices for **sponsor/alien overpayment**situations, 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 - 06/05/2012Batch run: 06/05/2012Rev:06/05/2012 |

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