Social Security

Identification Number:	EM-23076
Intended Audience:	All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs/OHO/OARO
Originating Office:	ORDP OISP
Title:	Revised Form SSA-632-BK, Request for Waiver of Overpayment Recovery
Type:	EM - Emergency Messages
Program:	Title II (RSI); Title XVI (SSI)
Link To Reference:

B. Background
The SSA-632-BK is completed when an individual requests waiver of recovery of their SSA overpayment. In September 2023, we revised the form SSA-632-BK to address concerns regarding the length of time and effort needed to complete the form.

C. Revisions to form SSA-632, Request for Waiver of Overpayment Recovery
We renamed sections and reorganized questions to align with standard best practices for form design. We shortened the form by reducing the number of pages, sections, and questions. Below are some of the more notable changes to the SSA-632-BK:

· Added information under the title “When Not to Complete This Form,” to inform the public that they may not need to complete the SSA-632-BK, if they think they are not at fault and their overpayment amount is $1,000 or less.
· Reduced the number of questions in Section 1, “Identifying Questions.”
· Changed the title of Section 2, from “Questions for Representative Payee” to “Waiver Request”. Also, we eliminated the questions regarding representative payees, reduced the number of Waiver Request questions, and added instructions for individuals to call us if their overpayment amount is $1,000 or less.
· Changed the title of Section 3, from “If you are Responsible for a Family Member’s or another Individual’s Overpayment” to “Needs Based Income”. We also added questions about SSI payments and other needs-based assistance for “Deemed to Defeat the Purpose” determinations.
· Changed the title of Section 4, from “Information about Receiving the Overpayment” to “Members of the Household.”
· Changed the title of Section 5, from “Your Financial Statement” to “Assets-Things You Have and Own.”
· Changed the title of Section 6, from “Members of the Household” to “Monthly Household Income.”
· Changed the title of Section 7, from “Assets – Things You Have and Own” to “Monthly Household Expenses.”
· Removed the sections titled “Income and Expenses Comparison” and “Financial Expectations and Funds Availability.”

· ssa.gov/forms
· GN 02250.400 SSA-632-BK, Request for Waiver of Overpayment Recovery – Exhibit,
· SI 02260.045 Form SSA-632-BK, Request for Waiver of Overpayment Recovery – Exhibit, and
· inForm Library