TN 47 (09-25)
   
   
   
   
      OPT028 NEW OVERPAYMENT AMOUNT INCLUDES PRIOR OVERPAYMENT (M05)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      However, the total overpayment is  (1)  , which includes a prior overpayment of  (2)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Total overpayment
         Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Current balance of prior overpayment
          
    
   
      OPT107 OVERPAYMENT RECOVERED FROM ONE MONTH'S BENEFIT (A57)
      
      
      (Requested/Systems Generated in E31 and E34)
      
      Caption: Your Benefits
      
      We will withhold up to 50 percent from (1)   (2)  payment to recover the money we  (3)   (4)  . This is the payment you will receive on or about  (5)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) – Systems Generated
            
            
Choice 1:
               your
            
            Choice 2: Beneficiary's name (possessive)
         Fill-in (2) – Systems Generated As A Date in Format Shown Below
            
            
First month of reduced payment in Month CCYY format
         Fill-in (3) – Systems Generated
            
            
Choice 1:
               overpaid
            
            Choice 2:
               incorrectly
               paid
            
         Fill-in (4) – Systems Generated or Requested By A Technician
            
            
Choice 1: you (NOT USED BY MADCAP)
            Choice 2: him (NOT USED BY MADCAP)
            Choice 3: her (NOT USED BY MADCAP)
            Choice 4: Beneficiary's name (not possessive) or the word "you" (only
               required when requested)
            
         Fill-in (5) – Systems Generated As A Date In Format Shown Below
            
            
Date of first payment being reduced for recovery in Month
               DD, CCYY format 
            
          
    
   
      OPT122 BENEFICIARY OVERPAID DUE TO SUSPENSION/TERMINATION (M13)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      Since we did not stop  (1)  payments until  (2)  ,  (3)  paid  (4)  too much in benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) – Systems Generated
            
            
Choice 1: Beneficiary's Name (possessive)
            Choice 2: your
         Fill-in (2) – Systems Generated
            
            
MM/CCYY
         Fill-in (3) – Systems Generated
            
            
Choice 1: he was
            Choice 2: she was
            Choice 3: you were
         Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Choice 1: Amount of overpayment
          
    
   
      OPT127 UNDERPAYMENT USED TO REDUCE/RECOVER AN OVERPAYMENT (M03)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We used  (1)  of  (2)  benefits to recover  (3)  of an overpayment on this record.
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A Money Amount in Format $$$$$.¢¢
            
            
Amount used for recovery
         Fill-in (2) - Requested As A One Position Alpha Character or Language
            
            
Choice 1: (A) your
            Choice 2: Name of Beneficiary
         Fill-in (3) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) all
            Choice 2: (B) part
          
    
   
      OPT132 DIRECT DEPOSIT — JOINT ACCOUNT — RECOVERY OF PAYMENTS MADE AFTER DEATH (A16)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We paid  (1)  more in benefits than we should have. We deposited (2)  benefits for  (3)  into a bank account which  (4)  also owned. We can't pay benefits for the month of death,  (5)  , or later. Because  (6)  a joint owner of the bank account,  (7)  overpaid  (8)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of overpayment
         Fill-in (2) Requested
            
            
Full name of the deceased beneficiary,  
               possessive
            
         Fill-in (3) Requested As A Date In Format Shown Below
            
            
Month(s) and year(s) of incorrect payment
            Choice 1: MM/CCYY
            Choice 2: MM/CCYY
               and
               MM/CCYY
            
            Choice 3: MM/CCYY through MM/CCYY
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's first name
         Fill-in (5) Requested As A Date In Format Shown Below
            
            
Date
               of death in MM/CCYY format
            
         Fill-in (6) Systems Generated
            
            
Choice 1: Beneficiary's name is
            Choice 2: you are
         Fill-in (7) Systems Generated
            
            
Choice 1: Beneficiary's name is
            Choice 2: you are
         Fill-in (8) Requested
            
            
Amount of overpayment
          
    
   
      OPT148 CROSS PROGRAM RECOVERY - T16 UNDERPAYMENT USED TO RECOVER T2 OVERPAYMENT (B88)
      
      
      (System Generated)
      
      Caption: Your Benefits
      
      We used (1)  of  (2)  SSI benefits to recover some or all of an overpayment on this record.
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Amount of SSI under payment
         Fill-in (2)
            
            
Choice 1: Beneficiary's Name possessive
            Choice 2: your
          
    
   
      OPT149 CROSS PROGRAM RECOVERY - T16 UNDERPAYMENT NOT USED TO REDUCED/RECOVER A T2 OVERPAYMENT
         (B89)
      
      
      (System Generated)
      
      Caption: What We Will Pay
      
      We did not use any of  (1)  SSI benefits to recover an overpayment on this record.
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: Beneficiary's Name
            Choice 2: your
          
    
   
      OPT151 OVERPAYMENT LIABILITY INFORMATION TO A REPRESENTATIVE PAYEE FOR OVERPAID BENEFICIARY
         (A27)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      As representative payee, you are personally liable for repayment unless you used the
         overpaid funds for the benefit of  (1)  , and the overpayment was made through no fault of your own.
      
      
      
      Fill-in values:
         
         Fill-in (1) – Systems Generated
            
            
Name(s) of beneficiary (ies)
          
    
   
      OPT152 REPAY BENEFITS WITHHELD - PROTEST OF OVERPAYMENT RECEIVED TIMELY (LAF D to C ) (A44)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. If we later find that our decision was
         correct, or that we cannot waive the overpayment,  (4)  will have to pay back the  (5)  which  (6)  . Someone from the local Social Security office will contact  (7)  to discuss the overpayment.
      
      
      
      Fill-in values:
         
         Fill-in (1) – Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's Name
         Fill-in (2) - Requested As A Date In Format Shown Below
            
            
Date payments resumed MM/CCYY
         Fill-in (3) – Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (4) – Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (5) – Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of overpayment
         Fill-in (6) – Systems Generated
            
            
Choice 1: you owe
            Choice 2: he owes
            Choice 3: she owes
         Fill-in (7) – Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
          
    
   
      OPT153 OVERPAYMENT WITHHELD FROM BENEFITS IS REPAID — PROTEST RECEIVED TIMELY (A46)
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  asked us to review our overpayment decision. While we review  (2)  case, we are sending  (3)  the money we withheld from  (4)  checks.
      
      
      If we later find that our decision was correct, or that we cannot waive the overpayment,
          (5)  will have to pay back the  (6)  which  (7)  . Someone from the local Social Security office will contact  (8)  to discuss the overpayment.
      
      
      
      Fill-in values:
         
         Fill-in (1) – Systems Generated
            
            
Choice 1: You
            Choice 2: Beneficiary's Name
         Fill-in (2) – Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (3) – Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (4) – Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (5) – Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of overpayment-
         Fill-in (7) – Systems Generated
            
            
Choice 1: you owe
            Choice 2: he owes
            Choice 3: she owes
         Fill-in (8) – Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
          
    
   
      OPT154 OVERPAYMENT PROTESTED - BENEFITS RESUMED AND WITHHELD BENEFITS REPAID - FOREIGN CLAIMS
         (A47)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. If we later find that our decision was
         correct, or that we cannot waive the overpayment,  (4)  will have to pay back the  (5)  which  (6)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) – Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's name
         Fill-in (2) – Requested As A Date In Format Shown Below
            
            
Date payments resumed MM/CCYY
         Fill-in (3) – Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (4) – Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (5) – Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of overpayment
         Fill-in (6) – Systems Generated
            
            
Choice 1: you owe
            Choice 2: he owes
            Choice 3: she owes
          
    
   
      OPT155 OVERPAYMENT PROTESTED - BENEFITS RESUMED - MONEY WITHHELD NOT REPAID - FOREIGN CLAIMS
         (A48)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. For now, we are still withholding the
         money which we already subtracted from  (4)  checks.
      
      
      If we later find that our decision was correct, or that we cannot waive the overpayment,
          (5)  will have to pay back the  (6)  which  (7)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's Name
         Fill-in (2) – Requested As A Date In Format Shown Below
            
            
Date payments resumed MM/CCYY
         Fill-in (3) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (4) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (5) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the remaining overpayment
         Fill-in (7) Systems Generated
            
            
Choice 1: you owe
            Choice 2: he owes
            Choice 3: she owes
          
    
   
      OPT156 OVERPAYMENT PROTESTED AFTER RECOVERY COMPLETED/STOPPED - REPAY BENEFITS WITHHELD -
         FOREIGN CLAIMS (A49)
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  asked us to review our overpayment decision. While we review  (2)  case, we are sending  (3)  the money we withheld from  (4)  checks. If we later find that our decision was correct, or that we cannot waive the
         overpayment,  (5)  will have to pay back the  (6)  which  (7)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You
            Choice 2: Beneficiary's Name
         Fill-in (2) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (3) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (4) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (5) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the overpayment
         Fill-in (7) Systems Generated
            
            
Choice 1: you owe
            Choice 2: he owes
            Choice 3: she owes
          
    
   
      OPT158 INTRODUCTORY STATEMENT FOR CAT A-A22 NOTICE WHEN OVERPAYMENT ESTABLISHED AND ALIEN
         TAXATION INVOLVED (ADMINISTRATIVE ADJUSTMENT) (F70)
      
      
      (Requested)
      
      Caption: None
      
      We are writing to give  (1)  new information about the  (2)  benefits which  (3)  on this Social Security record. In the rest of this letter, we will tell  (4)  :
      
      
      
         - 
            
               • 
                  How we paid  (5)   (6)  too much in benefits; and
                   
 
 
- 
            
               • 
                  What to do if  (7)  we are wrong about the overpayment.
                   
 
 
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's Name
         Fill-in (2) Requested As A One Position Alpha Character
            
            
Choice 1: (A) disability
            Choice 2: (B) retirement
            Choice 3: (C) survivor
            Choice 4: (D) auxiliary
         Fill-in (3) Systems Generated
            
            
Choice 1: you receive
            Choice 2: he receives
            Choice 3: she receives
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (5) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the overpayment
         Fill-in (7) Systems Generated
            
            
Choice 1: you think
            Choice 2: he thinks
            Choice 3: she thinks
          
    
   
      OPT159 A21 NOTICE OVERPAYMENT RECOVERY (G51)
      
      
      (System Generated)
      
      Caption: Your Benefits
      
      As we told  (1)  in our previous letter, we are withholding up to 50 percent of  (2)  benefits to recover the overpayment of  (3)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's Name
         Fill-in (2) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (3) Systems Generated
            
            
Amount of the overpayment
          
    
   
      OPT161 INTRODUCTORY PARAGRAPH E31 AND E32 NOTICES (G70)
      
      
      (System Generated)
      
      Caption: None
      
      We are writing to give  (1)  new information about the  (2)  benefits which  (3)  on this Social Security record. In the rest of this letter, we will tell  (4)  :
      
      
      
         - 
            
               • 
                  How we paid  (5)   (6)  too much in benefits; and
                   
 
 
- 
            
               • 
                  What to do if  (7)  we are wrong about the overpayment.
                   
 
 
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: you
            Choice 2: Beneficiary's Name
         Fill-in (2)
            
            
Choice 1: disability
            Choice 2: retirement
            Choice 3: survivor
         Fill-in (3)
            
            
Choice 1: you receive
            Choice 2: he receives
            Choice 3: she receives
         Fill-in (4)
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (5)
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (6)
            
            
Amount of the overpayment
         Fill-in (7)
            
            
Choice 1: you think
            Choice 2: he thinks
            Choice 3: she thinks
          
    
   
      OPT162 E31 AND E34 NOTICES MBP GREATER THAN 10% OF THE OVERPAYMENT OR $10 (G71)
      
      
      (System Generated)
      
      Caption: Your Benefits
      
      We plan to collect the overpayment from the payment which  (1)  will receive on or around  (2)  . We will reduce  (3)  check to  (4)  . The amount we will withhold is up to 50 percent of the total monthly benefit amount.
         We will send  (5)   (6)  regular monthly benefit amount again beginning  (7)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (2) Systems Generated
            
            
DPRD check date in
               Month DD, CCYY
               format
            
         Fill-in (3) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (4) Requested By Technician As A Money Amount
            
            
Amount of the
               reduced
               check
            
         Fill-in (5) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (6) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (7) Requested By Technician As A Date in Format Shown Below
            
            
Date of first payment
               after recovery ends in MM/CCYY
            
          
    
   
      OPT163 E34 NOTICE INTRODUCTORY PARAGRAPH (G72)
      
      
      (System Generated)
      
      Caption: None
      
      We are writing to give  (1)  new information about Social Security benefits on this record. We paid  (2)   (3)  too much in Social Security benefits. In the rest of this letter, we will tell you:
      
      
      
         - 
            
               • 
                  How we paid too much in benefits, and 
 
 
- 
            
               • 
                  What to do if you think we are wrong about the overpayment. 
 
 
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's name
         Fill-in (2) Requested By Technician As A Name
            
            
Beneficiary's name
         Fill-in (3) Requested By Technician As A Money Amount
            
            
Amount of the Overpayment
          
    
   
      OPT164 OVERPAYMENT RECOVERY PROPOSED AGAINST OTHER BENEFICIARY E34 NOTICE (G73)
      
      
      (System Generated)
      
      Caption: None
      
      We cannot recover the overpayment from the person who was overpaid. For this reason,
         we will withhold up to 50 percent of the total monthly benefits of each of the other
         persons who are paid on the same Social Security record.
      
      
    
   
      OPT165 CHECK PARAGRAPH FUTURE WITHHOLDING OF OVERPAYMENT (G91)
      
      
      (System Generated)
      
      Caption: Your Benefits
      
      We will pay  (1)  a monthly check of  (2)  until we start to collect the overpayment.
      
      
      
      Fill-in values:
         
         Fill-in (1)
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (2)
            
            
PMA or CMA in $$$$$.¢¢ format
          
    
   
      OPT166 PREVIOUS CHECK WAS INCORRECT AMOUNT (M02)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      The check  (1)  received for  (2)  in  (3)  should have been for  (4)  . Therefore we paid  (5)   (6)  more in benefits than  (7)  due.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's Name
         Fill-in (2) – Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of check
         Fill-in (3) Requested As A Date In Format Shown Below
            
            
MM/CCYY
         Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount that should have been paid
         Fill-in (5) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of overpayment
         Fill-in (7) Systems Generated
            
            
Choice 1: you were
            Choice 2: he was
            Choice 3: she was
          
    
   
      OPT167 OVERPAYMENT RECOVERED (M06)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We have recovered all of the money  (1)  owed because of an overpayment.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
          
    
   
      OPT168 OVERPAYMENT BALANCE (M08)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      The total amount of the overpayment is  (1)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the overpayment
          
    
   
      OPT169 INCORRECT BENEFIT CAUSED INCORRECT PAYMENT, OVERPAYMENT OR UNDERPAYMENT (M10)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      Since we paid  (1)   (2)  for  (3)  , we paid  (4)   (5)   (6)  than  (7)  due.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's Name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount paid
         Fill-in (3) Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
            Choice 2: MM/CCYY through MM/CCYY
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the overpayment
         Fill-in (6) - Requested As A One Position Alpha Character
            
            
Choice 1: (A) more
            Choice 2: (B) less
         Fill-in (7) Systems Generated
            
            
Choice 1: you were
            Choice 2: he was
            Choice 3: she was
          
    
   
      OPT170 BENEFITS DEFERRED TO RECOVER AN INCORRECT PAYMENT/OVERPAYMENT (M11)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We are withholding 50 percent of  (1)  benefits for  (2)  and  (3)  of  (4)  benefits for  (5)  to recover the  (6)  that was not due
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary's Name possessive
         Fill-in (2) Requested As A Date In Format Shown Below
            
            
Choice 1: MM/CCYY
            Choice 2: MM/CCYY through MM/CCYY
         Fill-in (3) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of final adjustment
         Fill-in (4) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (5) Requested As A Date In Format Shown Below
            
            
MM/CCYY of final adjustment
         Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of overpayment or incorrect payment
          
    
   
      OPT171 OTHER BENEFICIARY OVERPAID DUE TO WORK (M12)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We paid  (1)   (2)  too much in benefits because of work and earnings in  (3)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) - Requested As A Language
            
            
Name of overpaid beneficiary
         Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of overpayment
         Fill-in (3) - Requested As A Date In Format Shown Below
            
            
CCYY
          
    
   
      OPT179 PAID VS. PAYABLE (M01)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We paid  (1)   (2)  for  (3)  . Since we should have paid  (4)   (5)  for  (6)  , we paid  (7)   (8)   (9)  than  (10)  due.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's Name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount
         Fill-in (3) Requested As A Date in Format Shown Below
            
            
Choice 1: MM/CCYY
            Choice 2: MM/CCYY through MM/CCYY
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (5) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Correct Amount
         Fill-in (6) Requested As A Date in Format Shown Below
            
            
Choice 1: MM/CCYY
            Choice 2: MM/CCYY through MM/CCYY
         Fill-in (7) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (8) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount
         Fill-in (9) Systems Generated
            
            
Choice 1: more
            Choice 2: less
         Fill-in (10) Systems Generated
            
            
Choice 1: you were
            Choice 2: he was
            Choice 3: she was
          
    
   
      OPT180 FOREIGN REFUND REQUEST ADJUSTMENT PROPOSED OVERPAYMENT EXCEEDS MBP (F24)
      
      
      (System Generated)
      
      Caption: How To Pay Us Back
      
      You should refund this overpayment within 30 days. Please make your check or money
         order payable to the “Social Security Administration” and send it to us in the enclosed envelope.
      
      
      Always include  (1)  Social Security claim number on the check or money order.
      
      
      Please send your check or money order in United States currency or in local currency
         equal to the United States dollars. When you pay us in local currency, we use the
         exchange rate in effect at the time we receive your payment. If this causes a difference
         between the amount you pay us and the amount you owe us, we will let you know. If
         you cannot mail your payment directly to us, please contact your Federal Benefits
         Unit for help in making the refund. Visit  (2)  for a list of Federal Benefits Units.
      
      
      If we do not receive your refund within 30 days, we plan to recover the overpayment
         by withholding 50 percent of  (3)  total benefit each month beginning with the benefit  (4)  will receive on or about  (5)  . We will continue to withhold from  (6)  benefit until the overpayment is fully recovered.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary Name possessive
         Fill-in (2) Systems Generated
            
            
         Fill-in (3) Systems Generated
            
            
Choice 1: your
            Choice 2: Beneficiary Name possessive
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (5) Systems Generated
            
            
MM/DD/CCYY
         Fill-in (6) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
          
    
   
      OPT181 (M07) DUPLICATE CHECK OVERPAYMENT
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We sent  (1)  two checks for  (2)  , both in the amount of  (3)  and both checks were cashed. Since  (4)  due only one check, we paid  (5)   (6)  too much in benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: you
            Choice 2: Beneficiary's name
         Fill-in (2) Requested As A Date in Format Shown Below
            
            
MM/CCYY
         Fill-in (3) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount
         Fill-in (4) Systems Generated
            
            
Choice 1: you were
            Choice 2: he was
            Choice 3: she was
         Fill-in (5) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the overpayment
          
    
   
      OPT182 PRIOR OVERPAYMENT — WORK MONTHS PREVENTED RECOVERY (A29)
      
      
      (Requested)
      
      Caption: Your Benefits
      
      Our records show that we paid  (1)   (2)  too much in  (3)  . In our previous letter, we told  (4)  that we would withhold benefits in  (5)  to recover  (6)  amount. But  (7)  recent report shows that  (8)  worked during  (9)  . Because of that work, no benefits were payable for that period. Since we could
         not use benefits for those months to recover the amount  (10)  owed,  (11)  us  (12)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: Beneficiary's name
            Choice 2: you
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the overpayment
         Fill-in (3) Requested As A Date in Format Shown Below
            
            
Year of prior overpayment in CCYY
         Fill-in (4) Systems Generated
            
            
Choice 1: you
            Choice 2: him
            Choice 3: her
         Fill-in (5) Requested As A Date in Format Shown Below
            
            
Choice 1: MM/CCYY
            Choice 2: MM/CCYY through MM/CCYY
         Fill-in (6) Requested As A One Position Alpha Character
            
            
Choice 1: (A) this
            Choice 2: (B) part of this
         Fill-in (7) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (8) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (9) Requested As A Date in Format Shown Below
            
            
Choice 1: month and year of work MM/CCYY
            Choice 2: months and years of work MM/CCYY
               through                     MM/CCYY
            
         Fill-in (10) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (11) Systems Generated
            
            
Choice 1: you still owe
            Choice 2: he still owes
            Choice 3: she still owes
         Fill-in (12) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Overpayment Amount 
          
    
   
      OPT262 OVERPAYMENT ESTABLISHED DUE TO INCORRECT COMPUTATION, A LEGALLY DEFINED OVERPAYMENT
         OR TO RECOVER A SKELETON DUE PROCESS OVERPAYMENT
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because the payment amount was incorrect. We corrected  (3)  record, which caused (4)  benefit amount to decrease.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
         Fill-in (3) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
          
    
   
      OPT263 OVERPAYMENT ESTABLISHED DUE TO SUBVERSIVE ACTIVITY
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  convicted of a crime against the United States.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you were
            Choice 2: he was
            Choice 3: she was
          
    
   
      OPT264 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY DID NOT HAVE A CHILD IN THEIR CARE
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received (2)  too much in benefits because  (3)  a child in  (4)  care who receives benefits from us.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you no longer have
            Choice 2:he no longer has
            Choice 3: she no longer has
         Fill-in (4) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
          
    
   
      OPT265 OVERPAYMENT ESTABLISHED BECAUSE A WARRANT FOR THE BENEFICIARY'S ARREST EXISTS
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received (2)  too much in benefits. We should not have paid  (3)  because of a warrant for  (4)  arrest.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2:him
            Choice 3: her
         Fill-in (4) Systems Generated
            
            
Choice 1: your
            Choice 2: his
            Choice 3: her
          
    
   
      OPT266 OVERPAYMENT ESTABLISHED BECAUSE OF STATE OR FEDERAL ASSISTANCE
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because (3)  received State or Federal assistance.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
          
    
   
      OPT267 OVERPAYMENT CAUSED BY REPRESENTATIVE PAYEE MISUSE OF BENEFITS
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received (2)  too much in benefits because  (3)  misused funds while acting as a representative payee.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
          
    
   
      OPT268 OVERPAYMENT CAUSED BY DISABILITY CESSATION
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because we cannot pay benefits after  (3)  disability ends.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Requested As A One Position Alpha Character or Wage Earner's Name for
            Choice 4
            
            
Choice 1: (A) your 
            Choice 2: (B) his
            Choice 3: (C) her
            Choice 4: Wage Earner's name (possessive)
          
    
   
      OPT269 OVERPAYMENT ESTABLISHED DUE TO RECEIPT OF PROVISIONAL BENEFITS ON A CLAIM THAT WAS
         LATER DENIED
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  received temporary benefits while we were making a decision on  (4)  claim that we later denied.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
          
    
   
      OPT270 OVERPAYMENT ESTABLISHED DUE TO CROSS-BENEFIT ADJUSTMENT
      
      
      (Requested)
      
      Caption: Your Benefits
      
      We moved  (1)  overpayment of  (2)  to  (3)  for collection.
      
      
      
      Fill-in values:
         
         Fill-in (1) Requested As A Alpha Character or the Beneficiary's Name
            
            
Choice 1: (A) another person's 
            Choice 2: Beneficiary's full name (possessive)
               
            
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: Beneficiary’s full name
          
    
   
      OPT271 OVERPAYMENT ESTABLISHED DUE TO CHANGE IN THE AMOUNT OR COMMENCEMENT OF THE GOVERNMENT
         PENSION OFFSET
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because we must offset  (3)  benefit payments due to  (4)  receipt of a government pension.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
         Fill-in (4) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
          
    
   
      OPT272 OVERPAYMENT ESTABLISHED DUE TO RECEIPT OF A PENSION BASED ON WORK NOT COVERED BY SOCIAL
         SECURITY TAXES
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because (3)  received a pension based on work not covered by Social Security taxes.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Requested As A One Position Alpha Character or Wage Earner's name for
            Choice 4
            
            
Choice 1: (A) you 
            Choice 2: (B) he
            Choice 3: (C) she
            Choice 4: Wage Earner's name (not possessive) 
          
    
   
      OPT273 OVERPAYMENT ESTABLISHED DUE TO RECEIPT OF PAYMENTS AFTER CONFINEMENT TO A MENTAL INSTITUTION
         BECAUSE OF A COURT ORDER
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received (2)  too much in benefits because  (3)  received payments after being confined to an institution because of a court order.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
          
    
   
      OPT274 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WAS AN ALIEN LIVING OUTSIDE THE UNITED
         STATES WHILE RECEIVING BENEFITS
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because (3)  not a United States citizen and  (4)  outside the country for six months in a row.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you are 
            Choice 2: he is
            Choice 3: she is
         Fill-in (3) Systems Generated
            
            
Choice 1: you are 
            Choice 2: he was
            Choice 3: she was
          
    
   
      OPT275 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WORKED OUTSIDE THE US IN A JOB NOT
         COVERED UNDER SOCIAL SECURITY TAXES
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  worked outside the United States in a job not covered by United States Social Security
         taxes.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
          
    
   
      OPT276 OVERPAYMENT ESTABLISHED DUE TO PRISONER SUSPENSION
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of  (3)  criminal conviction and confinement in a correctional institution for more than 30
         days.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
          
    
   
      OPT277 OVERPAYMENT ESTABLISHED DUE TO DEATH RECLAMATION, REPRESENTATIVE PAYEE ELECTRONIC
         FUNDS TRANSFER (EFT) AFTER DEATH OR REPRESENTATIVE PAYEE DEATH
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because we cannot pay benefits for the month of death or later.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
          
    
   
      OPT278 OVERPAYMENT ESTABLISHED DUE TO PERMANENT DEDUCTIONS RESULTING FROM THE ANNUAL EARNINGS
         TEST
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of  (3)  work and earnings.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
            Choice 4: null
          
    
   
      OPT279 OVERPAYMENT ESTABLISHED DUE TO DEATH SUPER-ENDORSEMENT
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  signed and cashed a check for the month of death or later.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
          
    
   
      OPT280 OVERPAYMENT ESTABLISHED DUE TO A CHANGE IN MARITAL STATUS
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of a change in  (3)  marital status.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
          
    
   
      OPT281 OVERPAYMENT ESTABLISHED DUE TO ENTITLEMENT TO WORKERS' COMPENSATION, PUBLIC DISABILITY
         OR BOTH
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of  (3)  receipt of workers’ compensation, public disability payments, or both of these payments.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
          
    
   
      OPT282 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY CONTINUED TO RECEIVE BENEFITS AFTER
         THE AGE OF 18
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because we do not pay benefits once a student reaches age 18,
         unless he or she is a full-time elementary or high school student.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
          
    
   
      OPT283 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY CONTINUED TO RECEIVE BENEFITS AFTER
         AGE 19 OR 22
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because we do not pay benefits once a full-time student reaches
         age 19 , unless  (3)  blind or disabled, or meet(s) an exception which allows benefits to continue:
      
      
      
         - 
            
               • 
                  for 2 months after a student turns 19, or; 
 
 
- 
            
               • 
                  until the end of the school term, whichever comes first. 
 
 
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you are 
            Choice 2: he is
            Choice 3: she is
          
    
   
      OPT284 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY IS NO LONGER IN FULL-TIME SCHOOL ATTENDANCE
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because we do not pay benefits once a student stops going to
         school full-time.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
          
    
   
      OPT285 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY REFUSED TO ACCEPT VOCATIONAL REHABILITATION
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because we should not have paid benefits when (3)  refused vocational rehabilitation services.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you  
            Choice 2: he
            Choice 3: she 
          
    
   
      OPT286 OVERPAYMENT ESTABLISHED DUE TO UNPAID ATTORNEY FEES
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of unpaid attorney's fees.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
          
    
   
      OPT287 OVERPAYMENT ESTABLISHED RAILROAD RETIREMENT BOARD EARNINGS WERE INCORRECTLY USED TO
         ESTABLISH THE BENEFICARY'S ENTITLEMENT
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  received incorrect payments from the Railroad Retirement Board.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he 
            Choice 3: she 
          
    
   
      OPT288 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICARY WAS NOT A UNITED STATES (U.S.) CITIZEN
         OR LAWFULLY PRESENT IN THE U.S.
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  received payments even though  (4)  not a United States citizen or lawfully present in the U.S.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
         Fill-in (4) Systems Generated
            
            
Choice 1: you were
            Choice 2: he was
            Choice 3: she was
          
    
   
      OPT289 OVERPAYMENT ESTABLISHED BECAUSE THE MONTH OF ENTITLEMENT WAS INCORRECT
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of a change in the month  (3)  benefits started.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his 
            Choice 3: her
          
    
   
      OPT290 OVERPAYMENT ESTABLISHED DUE TO MULTIPLE ENTITLEMENTS
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  received payments on two or more records for the same month(s).
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you
            Choice 2: he 
            Choice 3: she
          
    
   
      OPT291 OVERPAYMENT ESTABLISHED BECAUSE INSURED STATUS WAS NOT MET
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  worked long enough under Social Security to receive monthly benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you have not
            Choice 2: he has not 
            Choice 3: she has not
          
    
   
      OPT292 OVERPAYMENT ESTABLISHED BECAUSE THE BENFICIARY MISUSED FUNDS WHILE SERVING AS A REPRESENTATIVE
         PAYEE
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  misused benefits that  (4)  received as the representative payee for another person.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
         Fill-in (4) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
          
    
   
      OPT293 OVERPAYMENT CAUSED BY SUBSTANTIAL GAINFUL WORK ACTIVITY (SGA) DURING THE EXTENDED
         PERIOD OF ELIGIBILITY (EPE) OR DISABILITY CESSATION DUE TO SGA
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of  (3)  work activity.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Requested As A One Position Alpha Character or the Wage Earner's Name
            for Choice 4
            
            
Choice 1: (A) your 
            Choice 2:(B)  his  
            Choice 3:(C)  her
            Choice 4: Wage Earmer's name (possessive)
          
    
   
      OPT294 OVERPAYMENT ESTABLISHED VIA CROSS PROGRAM RECOVERY (CPR) TO RECOVER A TITLE VIII SPECIAL
         VETERANS BENEFITS (SVB) PAID IN EXCESS
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in Special Veterans Benefit (SVB) payments.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
          
    
   
      OPT295 OVERPAYMENT CAUSED DUE TO INCORRECT PAYMENTS FOR MEDICARE SERVICES
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of incorrect payments for Medicare services.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
          
    
   
      OPT296 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFCIARY WAS CONVICTED OF A CRIME OR IMPRISONED
         FOR MORE THAN 30 DAYS DUE TO FELONIOUS HOMICIDE
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because of (3)  criminal conviction and imprisonment for more than 30 days.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: your 
            Choice 2: his
            Choice 3: her
          
    
   
      OPT297 OVERPAYMENT CAUSED BY WINDFALL OFFSET
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received (2)  too much in benefits because  (3)  received Supplemental Security Income (SSI) payments  (4)   (5)  .
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you
            Choice 2: he
            Choice 3: she
         Fill-in (4) Systems Generated
            
            
Choice 1: from
            Choice 2: in
         Fill-in (5) Systems Generated
            
            
Choice 1: MM/CCYY through MM/CCYY 
            Choice 2: MM/CCYY
          
    
   
      OPT298 OVERPAYMENT ESTABLISHED BECAUSE MORE THAN ONE PAYMENT WAS CASHED FOR THE SAME MONTH
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because we should not have paid two payments for the same month(s).
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
          
    
   
      OPT299 OVERPAYMENT ESTABLISHED DUE TO INVALID FAMILY RELATIONSHIPS
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  did not meet the relationship requirements to receive benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you 
            Choice 2: he
            Choice 3: she
          
    
   
      OPT300 OVERPAYMENT ESTABLISHED BECAUSE OF INVALID ENTITLEMENT
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  did not qualify for benefits.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you  
            Choice 2: he 
            Choice 3: she 
          
    
   
      OPT301 OVERPAYMENT ESTABLISHED BECAUSE THE BENEFICIARY WAS DEPORTED
      
      
      (Requested)
      
      Caption: Your Benefits
      
       (1)  received  (2)  too much in benefits because  (3)  deported from the United States.
      
      
      
      Fill-in values:
         
         Fill-in (1) Systems Generated
            
            
Choice 1: You 
            Choice 2: Beneficiary's full name
         Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
            
            
Amount of the Overpayment 
         Fill-in (3) Systems Generated
            
            
Choice 1: you were 
            Choice 2: he was
            Choice 3: she was