This Overpayment Information notice tells a recipient in current pay that we decided not to waive the overpayment. We will withhold the entire check because this is less than 10 percent of the claimant's supplemental security income and countable income. This example includes the special caption and paragraph that goes on the representative payee's copy if a payee questions payee liability.

Example: Completed Field Office Manually Prepared Version of the SSA-L8173-U3 Overpayment Information

Example: Completed Field Office Manually Prepared Version of the SSA-L8173-U3 Overpayment Information

Example: Completed Field Office Manually Prepared Version of the SSA-L8173-U3 Overpayment Information