BASIC (04-14)

NL 03001.005 Follow-up Request for Repayment of Incorrect Payment After Death Notice for Title II and Title XVI

A. When to use notice

Use this notice to follow up on the initial request for repayment of incorrect payment after death. The notice is available in the Document Processing System.

B. Follow-up request for repayment of incorrect payment after death notice for Title II and Title XVI

We are writing to you about [1] [2] check(s) that [3] cashed after [4] death. We wrote to you about this before, but you have not responded.

Our records show that [5] died on [6]. Since we were unable to stop [7] [8] until [9], payment(s) for [10] [11] made incorrectly. This money was not due [12], because no check is due [13] the month of death or later months. Treasury regulations require repayment of this amount. The Department of Treasury can only recover the money for the check(s) dated [14] from the financial institution that cashed [15]. The financial institution may contact you about the check(s).

Enclosed [16] of the check(s) dated [17]. The person who endorsed the enclosed check(s) or cashed the check(s) owes the Social Security Administration [18].

If you endorsed the check(s) or cashed the check(s), you should repay the money. You can contact any Social Security office about how you will pay us back. If you did not endorse or cash the check(s) but have information about the person who did, please get in touch with us right away.

If you cash Social Security checks after the death of the beneficiary, the law allows us to refer cases to the Office of the Inspector General or the United States Secret Service for possible prosecution.

If You Have Any Questions

If you have any questions, you may call us at 1-800-772-1213, or call your local Social Security office at [19]. We can answer most questions over the phone. You may also write or visit any Social Security office. The office that serves your area is located at: [20]

If you do call or visit an office, please have this letter with you. It will help us answer your questions. If you plan to visit an office, you may want to call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

Fill-ins:

  

[1]

Choice 1 -

name of beneficiary (possessive)

[2]

Choice 1-
Choice 2 -

Social Security
Supplemental Security Income (SSI)

[3]

Choice 1-
Choice 2 -

was
were

[4]

Choice 1-
Choice 2 -

his
her

[5]

Choice 1 -

name of beneficiary

[6]

Choice 1 -

month/day/year in the format (example) March 12, 1999

[7]

Choice 1 -

name of beneficiary (possessive)

[8]

Choice 1 -
Choice 2 -

Social Security benefit payment(s)
Supplemental Security Income payment(s)

[9]

Choice 1 -

month/year in the format (example) June 2000

[10]

Choice 1 -

total dollar amount of incorrect payments

[11]

Choice 1 -
Choice 2 -

was
were

[12]

Choice 1 -

name of beneficiary

[13]

Choice 1 -
Choice 2 -

for
after

[14]

Choice 1 -
Choice 2 -

month/year
month/year through month/year in the format (example) July l999 through June 2000

[15]

Choice 1 -
Choice 2 -

it
them

[16]

Choice 1 -
Choice 2 -

is a photocopy
are photocopies

[17]

Choice 1 -
Choice 2 -

month/year in the format (example) April l999
month/year through month/year in the format (example] April 1999 through June 1999

[18)

Choice 1 -

total dollar amount of incorrect payment(s)

[19]

Choice 1 -

field office telephone number

[20]

Choice 1 -

field office street address, city, state, zip code

C. Completed follow-up request for repayment of incorrect payment after death notice for Title II and Title XVI

Social Security Administration
Supplemental Security Income
Important Information

100 East Capitol St. SE
Washington, DC 20019

Phone: (202) 555-5555

Office Hours: 8:30 a.m. until 5:00 p.m.

Date:

Claim Number: 123-00-6789A

To the Estate of John Doe
103 Main Street
Washington, DC 20019

We are writing to you about John Doe's Supplemental Security Income (SSI) check(s) cashed after his death. We wrote to you previously about this, but have not heard from you.

What Our Records Show

Our records show that John Doe died on March 12, 1999. Since we were unable to stop the Supplemental Security Income payment(s) until June 2000, we incorrectly paid $7,500 in payments. This money was not due Mr. Doe, because no check is due after the month of death or later months. Treasury regulations require repayment of those funds.

The Department of Treasury can only recover the money for the check(s) dated July 1999 through June 2000 from the financial institution that cashed them. The financial institution may contact you about the check(s).

Enclosed you will find photocopies of the check(s) dated April 1999 through June 1999. The person who endorsed the enclosed check(s) or cashed the check(s) owes us $1,500.

What You Need To Do

If you endorsed the check(s) or cashed the check(s), you should repay the money. You can contact any Social Security office about how you will pay us back. If you did not endorse or cash the check, but have information about the person who did, please contact the 800 telephone number listed at the top of this page.

If someone cashes a Social Security checks the death of the beneficiary, the law allows us to refer cases to the Office of the Inspector General or the United States Secret Service for possible prosecution.

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for Sallie Claims rep. The telephone number is at the top of page 1. We can answer most questions over the phone.

If you plan to visit an office, you may want to call ahead to make an appointment. This will help us serve you more quickly.

Field Office Manager

Enclosure(s):

Copy of Endorsed Check(s)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0903001005
NL 03001.005 - Follow-up Request for Repayment of Incorrect Payment After Death Notice for Title II and Title XVI - 06/16/2014
Batch run: 06/16/2014
Rev:06/16/2014