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.