We use the SSA-632 to collect pertinent information about the overpaid person and his or her household members, if any, when the overpaid person requests a waiver of overpayment recovery. The overpaid person or a person representing the overpaid person can complete the SSA-632. A technician can assist with completing the SSA-632 if the person requests our assistance. At the top of the SSA-632, we inform the public when to complete the following forms and provide the purpose of the forms:

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  SSA-561, Request for Reconsideration;

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  HA,-501-US, Request for Hearing by Administrative Law Judge; and

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  SSA-634, Request for Change in Overpayment Recovery Rate

If the person requesting a waiver does not live in the United States, obtain an SSA-632-BK and ask the person to show the value of the assets, income, expenses, etc. in local currency. After receiving the completed form, use the Treasury Reporting Rates of Exchange tables to convert the foreign currency to U.S. dollar amounts and specify the type of currency involved.

Inform the person that he or she is responsible for providing proof of all income, certain expenses, and assets, per GN 02250.255. We do not require proof for food and miscellaneous household expenses, unless the expenses seem unusually high. Section 834 of the Bipartisan Budget (BBA) Act of 2015, "Access to Financial Information (AFI) requires the overpaid person to provide authorization for us to access his or her financial account information. If the person fails to provide authorization, we are unable to grant a waiver based on the defeats the purpose provision.

Inform the person that the supporting documents should be no older than 3 months from the date of the waiver request and he or she must submit the documents within 30 days of requesting a waiver. If the person notifies you that he or she is actively trying to obtain the supporting documents and needs additional time, allow him or her the additional time. If the person has not provided the documents within 30 days or he or she has not notified you that he or she needs additional time, you are unable to grant the waiver under the defeats the purpose waiver provision. If the person does not qualify for a waiver under other waiver provisions, you cannot approve the waiver. Notify the person with the appropriate notice found in, GN 02250.370. Process the waiver determination following the instructions in GN 02270.000 and GN 02250.315.

When interviewing the person requesting a waiver, be alert for non-waiver related evidence that may require additional development, such as the person has wages on the SSA-632 when we did not know the person was working. Take the appropriate action, if necessary. Include all development on the non-waiver issue in the waiver documentation.

Fax the SSA-632 and the supporting documents into the Certified Electronic Folder (CEF) for disability claims. For non-disability claims fax the SSA-632 into the Non-Disability Repository for Evidentiary Documents (NDRed) using the Evidence Portal. You can access the Evidence Portal at View Evidence - Evidence Portal (ssa.gov).

Question 1

Anyone who wants to request a waiver must complete Section 1. It includes the person’s name, SSN, and claim number, if any of the overpaid person. If someone else is completing the SSA-632 on behalf of the overpaid person, we ask for the identity of the organization or person who is assisting the person.

Question 2

If the person was the representative payee (payee) for the overpaid person when the overpayment occurred, he or she must complete Section 2. Complete the questions in Section 2 as the questions apply to the representative payee. If we notified the payee that he or she is liable for the overpayment, he or she must request a waiver and complete the questions on the SSA-632 as the questions relate to him or her.

Question 3

If the person is a contingently liable person who received an overpayment notice for a family member’s overpayment, he or she must complete Section 3. The contingently liable person’s answers will inform us if the person was living with the family member and received any of the overpaid money, see GN 02250.150.

Questions 4 through 12

The answers to these questions may help technicians make the fault determination. The responses must thoroughly explain the overpayment situation. Findings of fault must be made separately for each person who requests waiver. The fault of one individual is independent of the fault of any other individual who may be liable for the overpayment.

Questions 4 through 11- The responses to questions 4 through 11 provides information about the person’s overpayment.

Questions 12.A through 12.E - The responses to questions 12.A through 12.E may show whether the person acted in good faith or complied with reporting responsibilities. The responses to the questions will help determine if the overpaid person understands reporting responsibilities and recognizes the events that may affect his or her benefits. If the person reported the change that caused the overpayment, the person will describe the actions he or she took to report and what the person did after the report. The purpose is to assist the technician with making the fault determination.

Question 12.F - Document when a person receives Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), or a pension based on need from the Department of Veterans Affairs (VA). If the person is receiving any of the these benefits at the time you are making the waiver determination and if you have determined that the overpaid person is not at fault, the person does not have to complete any more questions on the form because recovery would Defeat the Purpose of Title XVI of the Act, see SI 02260.020.A.2.

Questions 13 through 16

The responses to questions 13 through 16 will assist with determining if the person had any of the overpaid funds in his or her possession when he or she received the overpayment notice. The answers to these questions will assist technicians with determining if the person meets the defeats the purpose waiver provision, see GN 02250.105.

Question 17

Question 17.A - List dependent family members who live in the same household with the overpaid person. A dependent is a person who depends on the overpaid person for support and whom the overpaid person can claim on his or her income tax return.

If the overpaid person is a minor child, include only the child’s name, if the child does not help with food and household expenses. If the child helps with food and household expenses, list the child’s parents and the parents’ dependents. A child’s ability to repay an overpayment depends on the child’s own income, resources, and expenses. A child’s income and assets must be in the child’s name and available for the child’s use. If the child does not help with household expenses, complete Sections 7, 8, and 9 with the child’s information only.

Question 17.B - If someone lives in the household who is not a dependent, include any money or payments that the person provides for household bills or expenses.

Questions 18 through 19

Question 18.A - Enter the cash in the overpaid person’s and family member’s possession.

Question 18.B - Enter a detailed description of the financial accounts owned by the overpaid person and his or her family members.

Question 19.A - If the overpaid person owns more than one vehicle, enter a description, present value, loan balance, and the main purpose of the additional vehicles for the overpaid person and his or her family members. Do not include a vehicle needed for the support of a handicapped family member. To meet this exclusion, a vehicle must provide necessary support to the handicapped person that the family vehicle cannot provide. The purchase must be for the transportation of the handicapped person.

Question 19.B - Enter a detailed description of any real estate that the overpaid person and the family members own, if it is not where the overpaid person lives.

Question 19.C - Enter a detailed description of any interest in any business, property, or valuables that the overpaid person and family members own.

Questions 20 through 22

Question 20.A - Enter monthly employment information for the overpaid person.

Question 20.B - Enter monthly employment information for the overpaid person’s spouse.

Question 20.C - Enter the total monthly employment information for the overpaid person’s dependents.

Question 21 - Enter the support or contributions from any person, agency, or organization that the overpaid person and family members receive.

Question 22 – Enter unearned monthly income for the overpaid person and family members.

Question 23

Enter the monthly household expenses. Write the amounts in whole dollars and round any cents to the nearest dollar. Do not list an expense withheld from the person’s paycheck, such as medical, child support, alimony, wage garnishments, etc.

When reviewing the household bills do not double count the expenses if the overpaid person uses a credit card for paying bills and making purchases. If the overpaid person pays expenses by credit card, only list it as a credit card expense instead of a another expense for clothing, phone, gas for a vehicle, or etc.

Questions 24 through 25

Section 10 totals the monthly expenses from the total monthly income to determine if the person has money to pay the overpayment. Monthly household expenses usually have some unbudgeted or unaccountable expenses; therefore, we allow a margin of $25.00 to cover those expenses. We use the $25.00 to establish “adjusted household expenses” and compare it to household income when deciding if overpayment recovery defeats the purpose.

Question 26

Question 26.A - Requires the overpaid person to let us know if he or she expects to receive an inheritance within 6 months of requesting the waiver to determine if the person’s assets may increase.

Question 26.B - This question totals the overpaid person and the family members’ assets to determine if recovery reduces the assets below the amount listed in GN 02250.115.

Question 26.C - This question determines if the overpaid person has any assets that he or she cannot convert to cash to repay the overpayment.