Fill-in (4) appears directly under the first sentence following the caption, “If We Don't Hear From You In The Next 30 Days.”

Fill-ins (5) and (6) are under the caption “How To Pay Us Back” as follows:

“As we said earlier, we plan to hold back    (5)   from your SSI check until you've paid us back.    (6)    .”

See paragraph 2903 in NL 00804.260 for language for fill-in (4). When it will take more than two months to recover the overpayment, use the notice language that gives the month overpayment recovery will begin and the continuing recovery rate.

In fill-in (5) enter the amount to be withheld from the recipient's monthly check even if it is equal to the recipient's entire check.

Choose appropriate fill-in language from paragraph 2907 (NL 00804.260) based on the length of time needed to recover the overpayment.