In a letter dated (1), we told you we found that (2) misused (3) (4).

We have new information about these misused benefits. (RPY044)

We confirmed (5) paid you (6) directly. We will reissue you the remaining balance. (RPY127 or RPY134)

We found you are due (7). This is the amount misused minus any money (8) already paid. You should receive this payment within 30 days. (RPY128 or RPY133)

SOCIAL SECURITY LAW (MISC07)

The law has rules for collecting and repaying misused benefits.

When a representative payee misused benefits, we collect the misused amount from the representative payee. We use the amount we collect to replace the beneficiary’s misused payments.

Even when we do not collect from the representative payee, we replace the beneficiary’s misused payments when

• •

  The representative payee was an organization,

• •

  The representative payee was a person serving 15 or more beneficiaries, or

• •

  The representative payee was a person serving 14 or fewer beneficiaries and SSA was negligent. (RPY045)

IF YOU RECEIVE SSI PAYMENTS (SSIC09)

We will exclude these reissued benefits from resources under SSI for 9 months after the month in which you receive them. (SSI041)

Suspect Social Security Fraud?

If you suspect Social Security Fraud, please visit https://oig.ssa.gov/report or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101). (MIS117)

Need more help?

1. 1. 

   Visit www.ssa.gov for fast, simple, and secure online service.

2. 2. 

   Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm. If you are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention this letter when you call.

3. 3. 

   You may also call your local office at 866-555-1212.

   SOCIAL SECURITY

   111 ANY DRIVE

   CITY, ST 11111-1111 (REF196)

Social Security Administration (SSAS11)

 

Send this notice when SSA reimburses misused benefits to the beneficiary or learns the payee paid the beneficiary directly.

Fill-ins:

1. (1) 

   Date of advance notice of misuse of benefits

2. (2) 

   Misuser payee name

3. (3) 

   Your, name of beneficiary (possessive)

4. (4) 

   Social Security, Supplemental Security Income, Social Security and Supplemental Security Income

5. (5) 

   Misuser payee name

6. (6) 

   Money amount the payee paid the beneficiary

7. (7) 

   Money amount to be reissued, in dollars

8. (8) 

   Misuser payee name