Our records show that you earned (1) .
If you disagree with (2) and can show (3) wrong, please get in touch with any Social Security office and we will correct our
records.
(Optional) |
A50. |
We have changed the month in which you are first entitled to benefits to (1) . This is the month which is most favorable to you.
|
(Optional) |
A52. |
When you applied for benefits, you asked that they start in the month which would
be most favorable to you. We have reviewed your record, and found that (1) is still the month in which you should first be entitled to benefits.
|
Based on the earnings on our records, $(4) should have been withheld from our benefits for (5) .
Based on this, you received $(6) more in Social Security benefits than you were due.
How To Pay Us Back
3106E
3106A (Optional)
If You Think You Should Not Have To Pay Us Back
3106B
If You Disagree With the Decision
3106C
If You Want Help With Your Appeal1
3100E
Your Responsibilities
3413D |
If you earn more than $ (1) this year, please let us know right away, because it can affect the amount of benefits
you are due. You will also have to report how much you earned at the end of the year.
|
If Your Have Any Questions
3901C
Enclosures:
SSA-3105
Refund Envelope
1 If the person has an attorney, omit this paragraph.