We use the SSA-632-BK form to collect essential information to assist with making waiver determinations. When a person receives an overpayment notice, he or she may request a waiver. We may waive recovery of an overpayment if:

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  The person is not at fault in causing the overpayment; and

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  Recovery would defeat the purpose of Title XVI of the Act; or

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  Recovery would be against equity and good conscience; or

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  Recovery would impede effective or efficient administration of Title XVI of the Act.

Information from the SSA-632 will assist technicians with making the waiver determination. We included the SSA-4641, Authorization for Social Security to Obtain Accounts Records from a Financial Institution and Request for Records at the bottom of the form so that we can collect a person's authorization to access his or her financial account information. We provide form SSA-632 to the overpaid person, his or her representative payee, legal counsel, or other appointed representative upon request. We inform the person requesting a waiver that he or she may download the waiver request form from ssa.gov/forms/ssa-632.pdf.

NOTE: If a person wants to request a waiver of more than one overpayment, he or she must complete a new SSA-632 for each overpayment.

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  When there is equivalent information in the file over the individual’s signature, or that of his or her representative payee, legal counsel, or other appointed representative.

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  You approve an administrative discontinuation of recovery or adjustment because the overpaid person is not at fault in causing the overpayment and the original overpayment amount is $1,000.00 or less. Instead of an SSA-632, document the request for waiver or reconsideration on the MSSICS DROC screen in a statement containing the following:

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  The overpaid person's name and SSN;

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  If different, the name and SSN of the person who is requesting a waiver;

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  The overpayment amount; and

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  The person's or payee's request for waiver.

For non-MSSICS cases, document the information above on a form SSA-795, Statement of Claimant or Other Person and fax it into the Non-Disability Repository for Evidentiary Documents (NDRED) using the Evidence Portal (EP). For more information on EP, see MS 09701.001. For the link to the NDRED application, see GN 00301.310.

Approve a waiver of recovery on an overpayment caused by resources exceeding the appropriate resource limit by $50.00 or less.

If a person wants to request a change in overpayment repayment rate, the person must complete form SSA-634-BK, Request for Change in Overpayment Recovery Rate.

The overpaid person or a person representing the overpaid person can complete the SSA-632 to request a waiver of overpayment recovery. A technician can assist with completing the SSA-632 if the person needs help completing the form. At the top of the SSA-632, we inform the public when to complete the following forms and the purpose of the forms:

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  SSA-561, Request for Reconsideration

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  SSA-634, Request for Change in Overpayment Recovery Rate

NOTE: If the person has a fraud conviction related to this overpayment he or she is not eligible for a waiver of recovery of this overpayment.

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 completing the form that, if the overpaid person is no longer receiving SSI or other needs based income, he or she is responsible for providing proof of all income, and certain expenses and assets per GN 02250.255. Expenses not requiring proof are food and miscellaneous household expenses, unless the expenses seem unusually high. Section 834 of the Bipartisan Budget Act (BBA) of 2015, 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 approve a waiver based on recovery defeats the purpose of Title XVI of the Act. We do not collect an authorization for family members.

Fax the SSA-632 and the supporting documents into the Certified Electronic Folder (CEF) for disability claims, or NDRED for non-disability claims using the Evidence Portal (EP).

Question 1

Anyone who want 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.

Question 2

If the person was the representative 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 parent or a jointly liable spouse who received an overpayment notice for an overpaid child or spouse’s overpayment, he or she must complete Section3. The parent or jointly liable spouse's answers will inform us if the person was living with the overpaid person and received any of the overpaid money. See SI 02260.025.

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 provide 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). NOTE: If the person is receiving SSI payments at the time you are making the waiver determination, and if you have determined that he or she is not at fault, the person does not have to complete any more questions on the form because recovery is deemed to defeat the purpose of Title XVI of the Act. See SI 02260.020.

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 persons meets the defeats the purpose waiver provision. See SI 02260.020A.

Question 17

Question 17.A - List dependent family members and deemors 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 be 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 person provides for household bills or expenses.

Questions 18 through 19

Question 18.A - Enter the cash in the overpaid person's and family members' possession.

Question 18.B - Enter a detailed description of the financial accounts for the overpaid person and the family members.

Question 19.A - Enter a description of the vehicles that the overpaid person and the family members own. List, but do not count as an asset, the principal vehicle used for family or work transportation.

Question 19.B - Enter a detailed description of any real estate that the overpaid person and the family members own. Don not include the primary residence.

Question 19.C - Enter a detailed description of any interest in any business, property, or values 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 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 the 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 another expense for clothing, phone, gas for a vehicle, etc.

Questions 24 through 25

Section 10 compares the total monthly household expenses to the total monthly household income to determine if the person has enough money to repay the overpayment or if overpayment recovery would defeat the purpose of Title XVI. See SI 02260.020.

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's and family members' total assets to determine if overpayment recovery will reduce the assets below the amount(s) listed in SI 02260.025.

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