We are writing about your request that we waive the collection of your Social Security overpayment. You have not given us the information we need to process your request.

If We Do Not Hear From You

If we do hear from you by (1) , we will assume that you are no longer interested in filing for the waiver. We will then expect payment in full.

How To Pay Us Back

You should refund this overpayment within 30 days. Please make your check or money order payable to “Social Security Administration” and send it to us in the enclosed envelope. Always include your claim number (as shown above) on the check or money order.

(2)

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (3) . The telephone number is shown above. We can answer most questions over the phone.

Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

Enclosure:

Refund Envelope

Fill-ins:

1. (1) 

   MM/DD/YY (30 days)

2. (2) 

   Optional paragraph — Use when beneficiary is in current pay.

   If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding your full benefit beginning with the payment you would normally receive about (a) . We will continue withholding your benefit until the overpayment has been fully recovered.

   (a)

   MM/DD/YY

3. (3) 

   CR name

Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. Because the requested fill-ins and paragraphs may vary according to the different situations, follow the requester's instructions carefully. There is a refund envelope enclosure. Include a “refund envelope” with the letter and type the claim number on the inside of the envelope below the flap. Place the envelope lengthwise on the left-hand side of the notice and staple in the upper left-hand corner.