TN 25 (09-22)
WAV - Waiver
WAV001 OVERPAYMENT RECONSIDERATION AND WAIVER INFORMATION - INITIAL OVERPAYMENT NOTICE -REFUND
REQUESTED, ADJUSTMENT NOT PROPOSED (A07) (F07)
(System Generated)
Caption: Do You Think We Are Wrong About The Overpayment?
You have certain rights with respect to this overpayment and its recovery.
1. Right to Appeal: If you disagree in any way with this overpayment determination,
you have the right, within 60 days of the date you receive this notice, to request
that the determination be reconsidered. If you request this independent review of
the overpayment determination, please submit any additional information you have which
pertains to the overpayment.
2. Right to Request Waiver: You also have the right to request a determination concerning
the need to recover the overpayment. An overpayment must be refunded or withheld from
benefits unless both of the following are true:
a. The overpayment was not your fault in any way, and
b. You could not meet your necessary living expenses if we
recovered the overpayment, or recovery would be unfair for some
other reason.
If you request waiver, we may need a statement of your assets and monthly income and
expenses.
If you request reconsideration and/or waiver within 30 days, the overpayment will
not have to be recovered until the case is reviewed. This review is described in more
detail on the attached form SSA-3105, Important Information About Your Appeal and
Waiver Rights. Please contact us if you need help completing the forms for requesting
reconsideration(SSA-561-U2, Request for Reconsideration) and/or waiver (SSA-632-BK,
Request for Waiver of Overpayment Recovery or Change in Repayment Options.)
If you have any additional questions, please contact us, and have this letter with
you so that we may help you more quickly.
WAV002 OVERPAYMENT RECONSIDERATION AND WAIVER INFORMATION- INITIAL OVERPAYMENT NOTICE, ADJUSTMENT
PROPOSED (A09)
(Requested/Generated)
Caption: Do You Think We Are Wrong About The Overpayment?
You have certain rights with respect to this overpayment and its recovery.
1. Right to Appeal: If you disagree in any way with this overpayment determination,
you have the right, within 60 days of the date you receive this notice, to request
that the determination be reconsidered. If you request this independent review of
the overpayment determination, please submit any additional information you have which
pertains to the overpayment.
2. Right to Request Waiver: You also have the right to request a determination concerning
the need to recover the overpayment. An overpayment must be refunded or withheld from
benefits unless both of the following are true:
a. The overpayment was not your fault in any way, and
b. You could not meet your necessary living expenses if we
recovered the overpayment, or recovery would be unfair for some
other reason.
If you request waiver, we may need a statement of your assets and monthly income and
expenses.
If you request reconsideration and/or waiver within 30 days, the planned withholding
of your benefit to recover the overpayment will not take place until your case is
reviewed. This review is described in more detail on the attached form SSA-3105, Important
Information About Your Appeal and Waiver Rights. Please contact us if you need help
completing the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration)
or waiver (SSA-632-BK, Overpayment Recovery Questionnaire).
If you have any additional questions, please contact us, and have this letter available
so that we can help you more quickly.
WAV002 FOREIGN RECONSIDERATION & WAIVER RIGHTS INITIAL OVERPAYMENT NOTICE ADJUSTMENT PROPOSED
(F09)
(System Generated)
Caption: Do You Think We Are Wrong About The Overpayment?
You have certain rights with respect to this overpayment and its recovery.
1. Right to Appeal: If you disagree in any way with this overpayment determination,
you have the right, within 60 days of the date you receive this notice, to request
that the determination be reconsidered. If you request this independent review of
the overpayment determination, please submit any additional information you have which
pertains to the overpayment.
2. Right to Request Waiver: You also have the right to request a determination concerning
the need to recover the overpayment. An overpayment must be refunded or withheld from
benefits unless both of the following are true:
a. The overpayment was not your fault in any way, and
b. You could not meet your necessary living expenses if we
recovered the overpayment, or recovery would be unfair for some
other reason.
If you request waiver, we may need a statement of your assets and monthly income and
expenses.
If you request reconsideration and/or waiver within 30 days, the planned withholding
of your benefit to recover the overpayment will not take place until your case is
reviewed. This review is described in more detail on the attached form SSA-3105, Important
Information About Your Appeal, Waiver Rights and Repayment Options. Please contact
us if you need help completing the forms for requesting reconsideration (SSA-561-U2,
Request for Reconsideration) and/or waiver (SSA-632-BK, Overpayment Recovery Questionnaire).
If you have any additional questions, please contact us, and have this letter available
so that we can help you more quickly.
Unless we hear from you within 30 days, we will withhold your payment as shown above.
WAV005 CROSS PROGRAM RECOVERY – WAIVER REQUEST FOR SSI OVERPAYMENT (B83)
(Requested/Generated)
Caption: Your Benefits
You may not have to pay us back. Sometimes we can waive the collection of an overpayment,
which means you won't have to pay us back. For us to waive the collection of the overpayment,
two things have to be true.
-
•
It wasn't your fault that you got too much SSI money.
AND
-
•
Paying us back would mean you can't pay (1) bills for food, clothing, housing, medical care or other necessary expenses, or it
would be unfair for some other reason
If you think these are true about you, contact any Social Security office. You can
ask for waiver at any time by completing the waiver form and returning it to us. The
form is called Request for Waiver of Recovery or Change in Repayment Rate, Form SSA-632-BK.
We will be happy to help you fill out the form. If you ask for waiver after that time,
we will stop collecting the overpayment while we decide if we can waive collection.
Fill-in values:
Fill-in (1) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her