NOTE: See NL 00755.500C. for a sample of a fugitive felon closed period of suspension notice with an overpayment
for a past period of fugitive felon suspension.
Social Security Administration
Retirement,
Survivors, and Disability
Insurance
Important Information
Mid-America Program
Service Center
225
E. Oak Street
Central
City, ST 00000
Claim
Number: XXX-XX-XXXXA
Date:
July 1, 2005
Debra Echkart
4023 Perry Court
Danielsville PA 18038
We cannot pay benefits to you beginning 01/2005 because you have an outstanding arrest warrant for a felony crime.
Information About Your Benefits
Beginning January 2005, the law prohibits us from paying Social Security benefits
to individuals who have an outstanding arrest warrant for a crime which is a felony
(or, in jurisdictions that do not define crimes as felonies, a crime that is punishable
by death or imprisonment for a term exceeding 1 year), or who have violated a condition
of probation or parole under Federal or State law. We have information that you fall
into one of these categories.
The Information We Have
Our records show that the XYZ Sheriffs Dept., 123 Cypress Lane, New York, NY 12345,
PHONE: 800-923-4567, issued a warrant for your arrest for a violent or drug-related
crime on 1/5/2005.
The warrant information we have is:
Warrant number: NY123456
Originating case number: 2345678
National Crime Information Center number: 3456789
Social Security cannot provide further information about the warrant. Please contact
the XYZ Sheriffs Dept. directly.
How Your Benefits Can Be Paid
We will pay you if you contact us at any time and can show us that any of the following
apply:
-
•
The warrant was issued incorrectly in your name because someone stole your identity.
To prove this, submit a copy of the police report that you filed as a victim of identity
theft or another official document from the court or the warrant issuing agency stating
that the warrant was erroneously issued in your name.
-
•
You were found not guilty of the criminal offense. To prove this, submit a copy of
the court docket indicating you were found not guilty of the criminal charges or a
copy of the court decision showing that you were found not guilty of the criminal
charges.
-
•
The underlying charges relating to the criminal offense were dismissed. To prove this,
submit a copy of the court docket indicating charges were dismissed or another official
court or law enforcement agency document stating that it dismissed the criminal charges.
-
•
The warrant for your arrest for the criminal offense was withdrawn. To prove this,
submit a copy of the court docket or another official document from the issuing agency,
indicating the warrant in question was withdrawn.
-
•
You were otherwise cleared of the criminal offense. To prove this, submit a copy of
the court docket or other court document indicating you were cleared of the criminal
charges.
If none of the above applies, we also may pay you benefits if you contact us within
12 months from 02/15/2005 and can show us that:
-
•
The crime for which the warrant was issued or the probation or parole violation was
both nonviolent and not drug related and, if a probation or parole violation is involved,
the original crime(s) for which you were paroled or put on probation was both nonviolent
and not drug related.
And
-
•
You have neither been convicted of nor pled guilty to another felony crime since the
date of the warrant.
And
-
•
The law enforcement agency that issued the warrant reports that it will not extradite
you for the charges on the warrant or that it will not take action on the warrant
for your arrest.
Or
-
•
The crime for which the warrant was issued is based on or the probation or parole
violation was both nonviolent and not drug related and, if a probation or parole violation
is involved, the original crime(s) for which you were paroled or put on probation
was both nonviolent and not drug related.
And
-
•
You have neither been convicted of nor pled guilty to another felony crime since the
date of the warrant.
And
-
•
The only existing warrant was issued 10 or more years ago.
And
-
•
Your medical condition impairs your mental capability to resolve the warrant; or you
are incapable of managing your benefits; or you are legally incompetent; or Social
Security has appointed a representative payee to handle your benefits or you are residing
in a long-term care facility, such as a nursing home or mental treatment/care facility.
Overpayment Information
Since we did not stop your payments until 03/2005, you were paid $1,500 too much in
benefits.
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. The people in any Social Security office will be glad to help you complete
the forms for requesting reconsideration (SSA-561-U2, Request for Reconsideration)
and/or waiver (SSA-632-13K, Overpayment Recovery Questionnaire).
Even if you do not want to request reconsideration or waiver, please call, write or
visit any Social Security office if you have questions or need more information. Please
take this letter with you if you do visit an office.
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 indicated above) on the check or money
order. If you cannot refund the full overpayment now, you should submit:
-
-
b.
an explanation of your financial circumstances, and
-
c.
a definite plan for repaying the balance.
If You Disagree With The Decision
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide your case. We will correct any mistakes. We will review those parts of
the decision which you believe are wrong and will look at any new facts you have.
We may also review those parts which you believe are correct and may make them unfavorable
or less favorable to you.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason for waiting more than 60 days to ask for an appeal.
-
•
You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2,
called "Request for Reconsideration." Contact one of our offices if you want help.
Please read the enclosed pamphlet, "Your Right to Question the Decision Made on Your
Social Security Claim." It contains more information about the appeal.
If You Want Help With Your Appeal
You can have a friend, representative, or someone else help you. There are groups
that can help you find a representative or give you free legal services if you qualify.
There are also representatives who do not charge unless you win your appeal. Your
Social Security office has a list of groups that can help you with your appeal. If
you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before they can collect it.
If You Have Any Questions
We invite you to visit our website at www.SSA.gov on the Internet to find general information about Social Security. If you have any
specific questions, you may call us toll-free at 1-800-772-1213, or call your local
Social Security office at 1-610-433-3237. We can answer most questions over the phone.
If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You
can also write or visit any Social Security office. The office that serves your area
is located at:
SOCIAL SECURITY
41 N 4TH ST
ALLENTOWN, PA 18102
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. 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
SSA-3105, Important Information About Your Appeal and Waiver Rights
Refund Envelope
NOTE: The referral paragraph and the appropriate signature are also required for this notice.
See NL 00601.040 for additional paragraphs required on post-entitlement notices; e.g., Medicare paragraphs,
etc. See NL 00601.003 for name and signature requirements on notices.