Social Security Administration
Supplemental Security Income
Attached is a letter in English about our decision that we paid you too much SSI money
for past months. The letter tells you the months you were overpaid and why you were
overpaid. It also tells you how you can pay us back.
If you cannot read the attached English letter, please ask someone to help you translate
it. If you cannot find help, you can ask any Social Security office to help you translate
If You Disagree With The Decision
If you do not agree with our decision, you have the right to ask us to review (appeal)
this decision. You may also ask us for waiver of your overpayment. Waiver means you
do not have to pay us back the amount you were overpaid.
• You must ask for a review within 60 days of the date you receive this notice. On
the following pages is information that tells you more about your right to appeal
this decision or ask for waiver.
• You can ask for waiver of your overpayment at any time.
If you ask for waiver of your overpayment or appeal this decision in the next 30 days,
we won't withhold money form your check to pay back the overpayment until we make
a new decision.
If You Have Any Questions
If you have any questions you may call, write, or visit any Social Security office.
If you call or visit our office, please have this letter with you and ask for __________________.
Our telephone number is __________________.
Your Right To Ask For Waiver And Appeal
You must pay us back unless we decide you shouldn't have to pay us back or we're wrong
about the overpayment. If you think you shouldn't have to pay us back or you disagree
with the decision about the overpayment, you can:
• Ask for a waiver,
• Ask for an appeal, or
• Do both.
If you ask for waiver or appeal in the next 30 days, we won't change your check until
we decide your case.
If You Think You Should Not Have To Pay Us Back
You may not have to pay us back. Sometimes we can waive the collection of an overpayment,
which means you won't have to pay us back. For us to waive the collection of your
overpayment, two things have to be true.
• It wasn't your fault that you got too much Social Security money.
• Paying us back would mean that you can't pay your bills for food, clothing, housing,
medical care, or other necessary expenses, or it would be unfair for some other reason.
If you think these are true about you, contact my Social Security office. You can
ask for waiver at any time by completing the waiver form and returning it to us. The
form is called Request for Waiver of Recovery or Changes in Repayment Rate, Form SSA-632.
We will be happy to help you fill out the form. If you ask for waiver in the next
30 days, we will not withhold your benefits until we decide if we can waive collection.
If you ask for waiver after that time, we will stop collecting the overpayment while
we decide if we can waive collection.
Do You Disagree With The Decision?
If you disagree with the decision, you have the right to appeal. We will review your
case and consider any new facts you have.
• You have 60 days to ask for an appeal. If you ask in the next 30 days, we won't
change your check until we decide your case.
• Both the 30 day and the 60 day periods start the day after you get this letter.
We assume you got this letter 5 days after the date on it unless you show us that
you did not get it within the 5-day period.
• You must have a good reason if you wait more than 60 days to ask for an appeal.
• To appeal, you must fill out a form called “Request for Reconsideration.” The form
number is SSA-561. This form number is SSA-561. To get this form, contact one of our
offices. We can help you fill out the form.
How To Appeal
There are three ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide
• Case review. You have a right to review the facts in your file. You can give us more facts to add
to your file. Then we'll decide your case again. You won't meet with the person who
decides your case.
• Informal Conference. You'll meet with the person who decides your case. You can tell that person why you
think you're right. You can give us more facts to help prove you're right. You can
bring other people to help explain your case.
• Formal Conference. This is a meeting like an informal conference. The difference is we can make people
come to help prove you're right. We can make them bring important papers about your
case, even if they don't want to help you. You can question these people at your meeting.
If You Want Help With Your Appeal
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it.
English Version of SSA-L8170-U2