TN 2 (09-11)

NL 00720.245 OPT Overpayment

OPT028 NEW OVERPAYMENT AMOUNT INCLUDES PRIOR OVERPAYMENT (M05)

(Requested)

Caption: Your Benefits

However, the total overpayment is  (1)  , which includes a prior overpayment of  (2)  .

Fill-in values:

Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢

Total overpayment

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Current balance of prior overpayment

OPT107 OVERPAYMENT RECOVERED FROM ONE MONTH'S BENEFIT (A57)

(Requested)

Caption: Your Benefits

We will withhold  (1)   (2)   (3)   (4)  payment to recover the money we  (5)   (6)  . This is the payment you would normally receive about  (7)  .

Fill-in values:

Fill-in (1) – Systems Generated

Choice 1: null

Fill-in (2) – Systems Generated

Choice 1: null

Fill-in (3) – Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Choice 4: Beneficiary's name

Fill-in (4) – Systems Generated

month and year (MM/CCYY)

Fill-in (5) – Systems Generated

Choice 1: overpaid

Choice 2: incorrectly paid

Fill-in (6) – Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Choice 4: Beneficiary's name

Fill-in (7) – Systems Generated

month and year (MM/CCYY)

OPT122 BENEFICIARY OVERPAID DUE TO SUSPENSION/TERMINATION (M13)

(Requested)

Caption: Your Benefits

Since we did not stop  (1)  payments until  (2)  ,  (3)  paid  (4)  too much in benefits.

Fill-in values:

Fill-in (1) – Systems Generated

Choice 1: Beneficiary's Name (possessive)

Choice 2: your

Fill-in (2) – Systems Generated

MM/CCYY

Fill-in (3) – Systems Generated

Choice 1: he was

Choice 2: she was

Choice 3: you were

Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢

Choice 1: Amount of overpayment

OPT127 UNDERPAYMENT USED TO REDUCE/RECOVER AN OVERPAYMENT (M03)

(Requested)

Caption: Your Benefits

We used  (1)   of  (2)   benefits to recover  (3)  of an overpayment on this record.

Fill-in values:

Fill-in (1) - Requested As A Money Amount in Format $$$$$.¢¢

Amount used for recovery

Fill-in (2) - Requested As A One Position Alpha Character or Language

Choice 1: (A) your

Choice 2: Name of Beneficiary

Fill-in (3) - Requested As A One Position Alpha Character

Choice 1: (A) all

Choice 2: (B) part

OPT132 DIRECT DEPOSIT — JOINT ACCOUNT — RECOVERY OF PAYMENTS MADE AFTER DEATH (A16)

(Requested)

Caption: Your Benefits

We paid  (1)  more in benefits than we should have. We deposited  (2)  benefits for  (3)  into a bank account which  (4)  also owned. We can't pay benefits for the month of death,  (5)  , or later. Because  (6)  a joint owner of the bank account,  (7)  overpaid  (8)  .

Fill-in values:

Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢

Amount of overpayment

Fill-in (2) Requested

Full name of the deceased beneficiary, possessive

Fill-in (3) Requested As A Date In Format Shown Below

Month(s) and year(s) of incorrect payment

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (4) Systems Generated

Choice 1: you

Choice 2: Beneficiary's first name

Fill-in (5) Requested

Month(s) and year(s) of incorrect payment

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (6) Systems Generated

Choice 1: Beneficiary's name is

Choice 2: you are

Fill-in (7) Systems Generated

Choice 1: Beneficiary's name is

Choice 2: you are

Fill-in (8) Requested

Amount of overpayment

OPT148 CROSS PROGRAM RECOVERY - T16 UNDERPAYMENT USED TO RECOVER T2 OVERPAYMENT (B88)

(System Generated)

Caption: Your Benefits

We used  (1)  of  (2)  SSI benefits to recover some or all of an overpayment on this record.

Fill-in values:

Fill-in (1)

Amount of SSI under payment

Fill-in (2)

Choice 1: Beneficiary's Name possessive

Choice 2: your

OPT149 CROSS PROGRAM RECOVERY - T16 UNDERPAYMENT NOT USED TO REDUCED/RECOVER A T2 OVERPAYMENT (B89)

(System Generated)

Caption: What We Will Pay

We did not use any of 1 SSI benefits to recover an overpayment on this record.

Fill-in values:

Fill-in (1)

Choice 1: Beneficiary's Name

Choice 2: your

OPT151 OVERPAYMENT LIABILITY INFORMATION TO A REPRESENTATIVE PAYEE FOR OVERPAID BENEFICIARY (A27)

(Requested)

Caption: Your Benefits

As representative payee, you are personally liable for repayment unless you used the overpaid funds for the benefit of  (1)  , and the overpayment was made through no fault of your own.

Fill-in values:

Fill-in (1) – Systems Generated

Name(s) of beneficiary (ies)

OPT152 REPAY BENEFITS WITHHELD - PROTEST OF OVERPAYMENT RECEIVED TIMELY (LAF D to C ) (A44)

(Requested)

Caption: Your Benefits

We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. If we later find that our decision was correct, or that we cannot waive the overpayment,  (4)  will have to pay back the  (5)  which  (6)  . Someone from the local Social Security office will contact  (7)  to discuss the overpayment.

Fill-in values:

Fill-in (1) – Systems Generated

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2) - Requested As A Date In Format Shown Below

Date payments resumed MM/CCYY

Fill-in (3) – Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) – Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (5) – Requested As A Money Amount In Format $$$$$.¢¢

Amount of overpayment

Fill-in (6) – Systems Generated

Choice 1: you owe

Choice 2: he owes

Choice 3: she owes

Fill-in (7) – Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

OPT153 OVERPAYMENT WITHHELD FROM BENEFITS IS REPAID — PROTEST RECEIVED TIMELY (A46)

(Requested)

Caption: Your Benefits

 (1)  asked us to review our overpayment decision. While we review  (2)  case, we are sending  (3)  the money we withheld from  (4)  checks.

If we later find that our decision was correct, or that we cannot waive the overpayment,  (5)  will have to pay back the  (6)  which  (7)  . Someone from the local Social Security office will contact  (8)  to discuss the overpayment.

Fill-in values:

Fill-in (1) – Systems Generated

Choice 1: You

Choice 2: Beneficiary's Name

Fill-in (2) – Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3) – Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (4) – Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) – Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢

Amount of overpayment-

Fill-in (7) – Systems Generated

Choice 1: you owe

Choice 2: he owes

Choice 3: she owes

Fill-in (8) – Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

OPT154 OVERPAYMENT PROTESTED - BENEFITS RESUMED AND WITHHELD BENEFITS REPAID - FOREIGN CLAIMS (A47)

(Requested)

Caption: Your Benefits

We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. If we later find that our decision was correct, or that we cannot waive the overpayment,  (4)  will have to pay back the  (5)  which  (6)  .

Fill-in values:

Fill-in (1) – Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (2) – Requested As A Date In Format Shown Below

Date payments resumed MM/CCYY

Fill-in (3) – Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) – Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (5) – Requested As A Money Amount In Format $$$$$.¢¢

Amount of overpayment

Fill-in (6) – Systems Generated

Choice 1: you owe

Choice 2: he owes

Choice 3: she owes

OPT155 OVERPAYMENT PROTESTED - BENEFITS RESUMED - MONEY WITHHELD NOT REPAID - FOREIGN CLAIMS (A48)

(Requested)

Caption: Your Benefits

We are paying  (1)  again beginning  (2)  because  (3)  asked us to review our overpayment decision. For now, we are still withholding the money which we already subtracted from  (4)  checks.

If we later find that our decision was correct, or that we cannot waive the overpayment,  (5)  will have to pay back the  (6)  which  (7)  .

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2) – Requested As A Date In Format Shown Below

Date payments resumed MM/CCYY

Fill-in (3) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢

Amount of the remaining overpayment

Fill-in (7) Systems Generated

Choice 1: you owe

Choice 2: he owes

Choice 3: she owes

OPT156 OVERPAYMENT PROTESTED AFTER RECOVERY COMPLETED/STOPPED - REPAY BENEFITS WITHHELD - FOREIGN CLAIMS (A49)

(Requested)

Caption: Your Benefits

 (1)  asked us to review our overpayment decision. While we review  (2)  case, we are sending  (3)  the money we withheld from  (4)  checks. If we later find that our decision was correct, or that we cannot waive the overpayment,  (5)  will have to pay back the  (6)  which  (7)  .

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: You

Choice 2: Beneficiary's Name

Fill-in (2) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (4) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢

Amount of the overpayment

Fill-in (7) Systems Generated

Choice 1: you owe

Choice 2: he owes

Choice 3: she owes

OPT158 INTRODUCTORY STATEMENT FOR CAT A-A22 NOTICE WHEN OVERPAYMENT ESTABLISHED AND ALIEN TAXATION INVOLVED (ADMINISTRATIVE ADJUSTMENT) (F70)

(Requested)

Caption: None

We are writing to give  (1)  new information about the  (2)  benefits which  (3)  on this Social Security record. In the rest of this letter, we will tell  (4)  :

  • How we paid  (5)   (6)  too much in benefits; and

  • What to do if  (7)  we are wrong about the overpayment.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2) Requested As A One Position Alpha Character

Choice 1: (A) disability

Choice 2: (B) retirement

Choice 3: (C) survivor

Choice 4: (D) auxiliary

Fill-in (3) Systems Generated

Choice 1: you receive

Choice 2: he receives

Choice 3: she receives

Fill-in (4) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (5) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢

Amount of the overpayment

Fill-in (7) Systems Generated

Choice 1: you think

Choice 2: he thinks

Choice 3: she thinks

OPT159 A21 NOTICE OVERPAYMENT RECOVERY (G51)

(System Generated)

Caption: Your Benefits

As we told  (1)  in our previous letter, we are withholding  (2)  benefits to recover the overpayment of  (3)  .

Fill-in values:

Fill-in (1)

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2)

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3)

Amount of the overpayment

OPT161 INTRODUCTORY PARAGRAPH E31 AND E32 NOTICES (G70)

(System Generated)

Caption: None

We are writing to give  (1)  new information about the  (2)  benefits which  (3)  on this Social Security record. In the rest of this letter, we will tell  (4)  :

  • How we paid  (5)   (6)  too much in benefits; and

  • What to do if  (7)  we are wrong about the overpayment.

Fill-in values:

Fill-in (1)

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2)

Choice 1: disability

Choice 2: retirement

Choice 3: survivor

Fill-in (3)

Choice 1: you receive

Choice 2: he receives

Choice 3: she receives

Fill-in (4)

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (5)

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (6)

Amount of the overpayment

Fill-in (7)

Choice 1: you think

Choice 2: he thinks

Choice 3: she thinks

OPT162 E31 AND E34 NOTICES MBP GREATER THAN OVERPAYMENT (G71)

(System Generated)

Caption: Your Benefits

We plan to collect the overpayment from the check which  (1)  will receive around  (2)  . We will reduce  (3)  check to  (4)  . We will send  (5)   (6)  regular monthly benefit amount again beginning  (7)  .

Fill-in values:

Fill-in (1)

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (2)

MM/DD/CCYY

Fill-in (3)

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (4)

Amount of the check

Fill-in (5)

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (6)

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (7)

MM/CCYY

OPT163 E34 NOTICE INTRODUCTORY PARAGRAPH (G72)

(System Generated)

Caption: None

We are writing to give  (1)  new information about Social Security benefits on this record. We paid  (2)   (3)  too much in Social Security benefits. In the rest of this letter, we will tell you:

  • How we paid too much in benefits, and

  • What to do if you think we are wrong about the overpayment.

Fill-in values:

Fill-in (1)

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (2)

Beneficiary's name

Fill-in (3)

Amount of the Overpayment

OPT164 OVERPAYMENT RECOVERY PROPOSED AGAINST OTHER BENEFICIARY E34 NOTICE (G73)

(System Generated)

Caption: None

We cannot recover the overpayment from the person who was overpaid. For this reason, we will withhold the money from the checks of other persons who are paid on the same Social Security record.

Fill-in values:

None

OPT165 CHECK PARAGRAPH FUTURE WITHHOLDING OF OVERPAYMENT (G91)

(System Generated)

Caption: Your Benefits

We will pay  (1)  a monthly check of  (2)  until we start to collect the overpayment.

Fill-in values:

Fill-in (1)

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (2)

PMA or CMA in $$$$$.¢¢ format

OPT166 PREVIOUS CHECK WAS INCORRECT AMOUNT (M02)

(Requested)

Caption: Your Benefits

The check  (1)  received for  (2)  in  (3)  should have been for  (4)  . Therefore we paid  (5)   (6)  more in benefits than  (7)  due.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2) – Requested As A Money Amount In Format $$$$$.¢¢

Amount of check

Fill-in (3) Requested As A Date In Format Shown Below

MM/CCYY

Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢

Amount that should have been paid

Fill-in (5) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢

Amount of overpayment

Fill-in (7) Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

OPT167 OVERPAYMENT RECOVERED (M06)

(Requested)

Caption: Your Benefits

We have recovered all of the money  (1)  owed because of an overpayment.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

OPT168 OVERPAYMENT BALANCE (M08)

(Requested)

Caption: Your Benefits

The total amount of the overpayment is  (1)  .

Fill-in values:

Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢

Amount of the overpayment

OPT169 INCORRECT BENEFIT CAUSED INCORRECT PAYMENT, OVERPAYMENT OR UNDERPAYMENT (M10)

(Requested)

Caption: Your Benefits

Since we paid  (1)   (2)  for  (3)  , we paid  (4)   (5)   (6)  than  (7)  due.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢

Amount paid

Fill-in (3) Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (4) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢

Amount of the overpayment

Fill-in (6) - Requested As A One Position Alpha Character

Choice 1: (A) more

Choice 2: (B) less

Fill-in (7) Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

OPT170 BENEFITS DEFERRED TO RECOVER AN INCORRECT PAYMENT/OVERPAYMENT (M11)

(Requested)

Caption: Your Benefits

We are withholding all of  (1)  benefits for  (2)  and  (3)  of  (4)  benefits for  (5)  to recover the  (6)  that was not due

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (2) Requested As A Date In Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (3) Requested As A Money Amount In Format $$$$$.¢¢

Amount of final adjustment

Fill-in (4) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (5) Requested As A Date In Format Shown Below

MM/CCYY of final adjustment

Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢

Amount of overpayment or incorrect payment

OPT171 OTHER BENEFICIARY OVERPAID DUE TO WORK (M12)

(Requested)

Caption: Your Benefits

We paid  (1)   (2)  too much in benefits because of work and earnings in  (3)  .

Fill-in values:

Fill-in (1) - Requested As A Language

Name of overpaid beneficiary

Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢

Amount of overpayment

Fill-in (3) - Requested As A Date In Format Shown Below

CCYY

OPT179 PAID VS. PAYABLE (M01)

(Requested)

Caption: Your Benefits

We paid  (1)   (2)  for  (3)  . Since we should have paid  (4)   (5)  for  (6)  , we paid  (7)   (8)   (9)  than  (10)  due.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: Beneficiary's Name

Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢

Amount

Fill-in (3) Requested As A Date in Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (4) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (5) Requested As A Money Amount In Format $$$$$.¢¢

Correct Amount

Fill-in (6) Requested As A Date in Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (7) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (8) Requested As A Money Amount In Format $$$$$.¢¢

Amount

Fill-in (9) Systems Generated

Choice 1: more

Choice 2: less

Fill-in (10) Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

OPT180 FOREIGN REFUND REQUEST ADJUSTMENT PROPOSED OVERPAYMENT EXCEEDS MBP (F24)

(System Generated)

Caption: How You Can 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  (1)  claim number (as shown above) on the check or money order.

Please send your check or money order in United States currency or in local currency equal to the United States dollars. When you pay us in local currency, we use the exchange rate in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment directly to us, please go to the  (2)  for help in making the refund.

If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding  (3)  full benefit each month beginning with the benefit  (4)  would normally receive about  (5)  . We will continue to withhold  (6)  benefit until the overpayment has been fully recovered.

Fill-in values:

Fill-in (1)

Choice 1: your

Choice 2: Beneficiary Name possessive

Fill-in (2)

Choice 1: U.S. Veterans Affairs Regional Office, SSA Division, 1131 Roxas Boulevard, Manila

Choice 2: nearest United States Embassy or consulate

Fill-in (3)

Choice 1: your

Choice 2: Beneficiary Name possessive

Fill-in (4)

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (5)

MM/DD/YY

Fill-in (6)

Choice 1: your

Choice 2: his

Choice 3: her

OPT181 (M07) DUPLICATE CHECK OVERPAYMENT

(Requested)

Caption: Your Benefits

We sent  (1)  two checks for  (2)  , both in the amount of  (3)  and both checks were cashed. Since  (4)  due only one check, we paid  (5)   (6)  too much in benefits.

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: you

Choice 2: Beneficiary's name

Fill-in (2) Requested As A Date in Format Shown Below

MM/CCYY

Fill-in (3) Requested As A Money Amount In Format $$$$$.¢¢

Amount

Fill-in (4) Systems Generated

Choice 1: you were

Choice 2: he was

Choice 3: she was

Fill-in (5) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢

Amount of the overpayment

OPT182 PRIOR OVERPAYMENT — WORK MONTHS PREVENTED RECOVERY (A29)

(Requested)

Caption: Your Benefits

Our records show that we paid  (1)   (2)  too much in  (3)  . In our previous letter, we told  (4)  that we would withhold benefits in  (5)  to recover  (6)  amount. But  (7)  recent report shows that  (8)  worked during  (9)  . Because of that work, no benefits were payable for that period. Since we could not use benefits for those months to recover the amount  (10)  owed,  (11)  us  (12)  .

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: Beneficiary's name

Choice 2: you

Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢

Amount of the overpayment

Fill-in (3) Requested As A Date in Format Shown Below

Year of prior overpayment in CCYY

Fill-in (4) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (5) Requested As A Date in Format Shown Below

Choice 1: MM/CCYY

Choice 2: MM/CCYY through MM/CCYY

Fill-in (6) Requested As A One Position Alpha Character

Choice 1: (A) this

Choice 2: (B) part of this

Fill-in (7) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (8) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (9) Requested As A Date in Format Shown Below

Choice 1: month and year of work MM/CCYY

Choice 2: months and years of work MM/CCYY through MM/CCYY

Fill-in (10) Systems Generated

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (11) Systems Generated

Choice 1: you still owe

Choice 2: he still owes

Choice 3: she still owes

Fill-in (12) Requested As A Money Amount In Format $$$$$.¢¢

Overpayment Amount


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720245
NL 00720.245 - OPT Overpayment - 08/29/2013
Batch run: 08/29/2013
Rev:08/29/2013