TN 44 (04-19)

GN 02210.030 Request for Change in Overpayment Recovery Rate, Form SSA-634-BK

CITATIONS:

Social Security Act 204(b)

20 CFR 404.502

A. A change in overpayment recovery rate

When we establish a Title II overpayment on an individual’s record the automated system will begin full benefit withholding after the 60-day due process period expires. We recover the overpayment by withholding the individual’s benefit until we fully recover the overpayment, see GN 02210.001. If an individual is unable to meet his or her ordinary and necessary living expenses because we are withholding the entire monthly payment, the individual may request to change the rate of recovery.

B. Requesting a different overpayment recovery rate within 12 or 36 months

When an individual requests a change in repayment rate, we must always attempt to negotiate a rate of withholding with the individual, which results in full recovery of the total outstanding debt within 12 months. We allow the individual to pay a minimum of $10.00 per month, if we can collect the debt within 12 months. We do not need the person to provide information about his or her income, assets, or living expenses if we collect the debt within 12 months.

If we cannot collect the debt within 12 months, negotiate a rate that permits full recovery within 36 months. The individual must pay a minimum of $10.00 per month. If the individual requests to extend the debt to 36 months, verbally collect the individual's allegations of his or her assets, income, and living expenses and document the information on the Remarks screen in the Debt Management System (DMS). Input the new rate of recovery in the Reconciling Recovery of Overpayments Accounting and Reporting System (ROAR).

Note: Do not request an SSA-634-BK, Request for Change in Overpayment Recovery Rate, if we recover the total debt within 36 months.

Example: Documenting a request for a change in overpayment recovery rate on the Remarks screen in DMS:

Sally Snow‘s overpayment amount is $2,400.00. She requested that we withhold $120.00 per month beginning February 2018. Ms. Snow alleges assets of $0.00, Social Security benefits of $1,200.00, and living expenses of $1,000.00 per month. Ms. Snow will pay her debt within 20 months; therefore, I approved her request for partial withholding. I made the input in ROAR and sent a notice to Ms. Snow on January 6, 2018. – John Jones FO A12

Note: If the individual receives Title II benefits and Title XVI payments, see GN 02210.045.

C. Requesting a different overpayment recovery rate extending beyond 36 months

If the negotiated rate would not permit recovery within 36 months, the individual must complete the SSA-634-BK form. For instruction on completing the SSA-634, see section G below. Evaluate the individual’s income, expenses and assets as follows:

  1. 1. 

    Compare the monthly household expenses and the total monthly income to determine if the person’s income exceeds his or her expenses.

  2. 2. 

    Review the person’s financial information to determine if assets are below $3,000.00.

If the individual’s assets are below $3,000.00 and his or her income does not exceed adjusted expenses, consider approving a lower rate of recovery. However, do not allow the person to pay less than 10.00 per month. If the individual's assets are below $3,000.00 and his or her income exceeds the adjusted expenses, consider approving a lower rate of recovery with the difference in the individual's income and expenses.

Example: Tom Greene requested a change in repayment rate that would extend his debt beyond 36 months. We sent an SSA-634 to him for completion. His debt is $7,500.00. Mr. Greene has $2,500.00 in assets, his expenses are $2,000.00 and his income is $2,400.00. We determined that Mr. Greene can afford to repay $375.00 per month without financial hardship.

Exception: If the person has a 100% Medicare Part D subsidy, take the following actions:

  1. 1. 

    Grant any request that is at a minimum $10.00.

  2. 2. 

    Do not request a completed Form SSA-634-BK.

  3. 3. 

    Document the decision on the Remarks screen in DMS.

D. Denying a request for different rate of recovery

If you deny or partially deny the request for a different rate of recovery, send a notice providing the basis for the denial and the manner in which we will recover the overpayment. Do not include a reconsideration paragraph. The decision as to the amount of withholding is an administrative action and not an initial determination. Document the Remarks screen in DMS.

E. Fraud conviction

If an individual has a fraud conviction or if we establish that similar fault exists for the debt, do not approve a request to lower the rate of withholding. The individual must pay the overpayment through full withholding. Notify the individual that we will not change the repayment rate because fraud or similar fault exists. Annotate the Remarks screen in DMS.

Example: Documenting a request for a lower rate of withholding when a person has a fraud conviction on the Remarks screen in DMS:

Luke Brown requested partial withholding on April 4, 2018. On January 5, 2018, we determined that Mr. Brown’s overpayment resulted from fraud; therefore,I cannot approve Mr. Brown’s request. I sent a Mr. Brown a notice on April 27, 2018. – John Jones FO A12.

F. Effective date of lower recovery rate

1. Request made prior to any adjustment

Initiate withholding is effective with the Current Operating Month (COM), or the specific date requested by the debtor as long as it does not go beyond six months of COM.

2. Request made after full adjustment initiated

Process the request in the month the individual requests the rate change. If you process the action later than the month the individual requested the rate change, pay the difference between what we withheld and what we should have withheld based on the request.

3. Lesser request made after partial adjustment initiated

Process the lesser amount effective with the COM.

G. Completing the SSA-634

1. Purpose of the SSA-634

The purpose of the SSA-634 is to gather information to assist technicians with determining if they can approve a change in an individual’s repayment rate if the individual cannot pay his or her entire debt within 36 months. The overpaid individual or an individual representing the overpaid individual can complete the form. A technician can assist with completing the SSA-634 if the individual requests our assistance. Sections H through N below provides guidance on completing each section of the form.

2. Request for a change in overpayment recovery rate from an overpaid individual who lives outside the United States

If the individual requesting a change in overpayment recovery rate does not live in the United States, obtain an SSA-634-BK, if the individual says he or she cannot repay the debt within 36 months. Ask the person to show the value of the assets, income, expenses, 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.

3. Proof of assets, expenses, and expenses

Inform the individual that he or she is responsible for providing proof of all assets, income and certain expenses. We do not require proof for food and miscellaneous household expenses, unless the expenses seem unusually high.

4. Storing the SSA-634

Fax the SSA-634 and the supporting documents into the Certified Electronic Folder (CEF) for disability claims or the Non-Disability Repository for Evidentiary Documents (NDRed) for non-disability claims. For the link to the NDRed application, see GN 00301.310.

H. Questions on the SSA-634

1. Section 1 - Identifying information

Questions 1 through 4

Question 1 - The individual must provide his or her name, SSN, and claim number, if any. If someone else is completing the SSA-634 on behalf of the overpaid individual, we ask for the identity of the organization or individual who is assisting the individual.

Question 2 - Enter the type of income the individual is currently receiving.

Question 3 - Enter the total amount that the individual owes to SSA.

Question 4 - Enter the monthly amount that the overpaid individual can afford to pay.

2. Section 2 - Assets - things you have and own

Questions 5 through 6

Question 5.A - Enter the cash in the overpaid individual’s possession.

Question 5.B - Enter a detailed description of the financial accounts owned by the overpaid individual.

Question 6.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.

Question 6.B - Enter a detailed description of any real estate owned by the overpaid individual, if it is not where the overpaid person lives.

Question 6.C - Enter a detailed description of any interest in any business, property, or valuables that the overpaid individual owns.

3. Section 3 - Monthly household income

Questions 7 through 9

Question 7 - Enter monthly employment information for the overpaid individual.

Question 8.A - Enter any support or contributions from any person, agency, or organization that the overpaid individual receives.

Question 8.B – Enter whether the overpaid individual receives the support or contributions under a loan agreement.

Question 8.C – Enter the amount of the support or contributions that the overpaid individual receives.

Question 9 - Enter unearned monthly income for the overpaid individual.

4. Section 4 - Monthly household expenses

Question 10

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.

5. Section 5 - Income and expenses comparison

Questions 11 through 12

Section 5 compares the monthly income with the monthly household expenses. We subtract the total monthly household expenses from the total monthly household income to determine if the person has money to repay the overpayment. If the monthly expenses exceed monthly income, the overpaid person must explain how he or she is pays the monthly bills.

6. Section 6 - Financial expectations and funds availability

Question 13

Question 13.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 13.B - This question totals the overpaid person’s assets to determine if the person has money to repay his or her overpayment.

Question 13.C - This question determines if the overpaid person has any assets that he or she cannot convert to cash.

I. References

  • GN 02210.001 - Overpayment Recovery by Benefit Adjustment

  • GN 02210.045 - Rate of Overpayment Adjustment - Title II/Title XVI Beneficiary

  • GN 00301.310 - The Non Disability Repository for Evidentiary Documents (NDRed) Application - Overview


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202210030
GN 02210.030 - Request for Change in Overpayment Recovery Rate, Form SSA-634-BK - 04/19/2019
Batch run: 04/19/2019
Rev:04/19/2019