NL 00703: Exhibit and Dictated Letters
TN 31 (02-97)
Document Identifier for Word Processor: E3104
A. Exhibit Letter
Our records show that (1) received $ (2) more in Social Security1 benefits than (3) due. (4) .
When an overpayment is not recovered from the person overpaid, the overpayment may be withheld from any other benefits payable on the same Social Security record.
| 3104A | To recover the overpayment, we plan to withhold your full benefit beginning with the payment you would normally receive about (1) . We will continue to withhold your benefit until the overpayment has been fully recovered. |
| or 3104B |
We plan to recover the overpayment by withholding the payment you would normally receive about (1) . You will receive your monthly payment again about (2) . |
| or 3100B |
If You Think You Should Not Have To Pay Us Back
3100C
If You Disagree With The Decision
3100D
or
3100F
If You Want Help With Your Appeal2
3100E
If You Have Any Questions
3901C
Enclosure:
SSA-3105
B. Requesting Instructions
The person who determines the overpayment (generally the benefit authorizer) is responsible for requesting this notice and providing the appropriate fill-ins.
If the overpayment computation is too complex for a simple narrative explanation, use a chart such as the following:
| Month/Year | Amount Paid | Amount Payable | Difference |
|---|---|---|---|
| 01/85 | |||
| 02/85 | |||
| etc. | |||
| Total |
Use 3104A if the overpayment exceeds the monthly payment.
Use 3104B if the overpayment equals the monthly payment.
Use 3100B if the overpayment is less than the monthly payment.
Use 3100C in all cases.
Use 3100D and 3901C if the person lives in the U.S.
Use 3100F if the person lives outside the U.S.
Listed below are the fill-ins which are generally required:
overpaid person's name
the amount of the overpayment
he was, she was, they were
a narrative overpayment explanation - A chart may be included following the explanation.
| 3104A | (1) month/day/year payment would have been received |
| 3104B | (1) month/day/year payment would have been received |
| (2) month/day/year payment will be received | |
| 3100B | (1) month/day/year payment will be received |
| (2) amount of payment | |
| (3) month/day/year payment will be received |
Refer to NL 00703.100 for 3100C, 3100D, 3100E and 3100F text and fill-ins.
Because the fill-ins may vary according to the different situations, follow the requester's typing instructions carefully.
1 If Black Lung benefits are overpaid, substitute “Black Lung.”
2 If the person lives outside the U.S. or has an attorney omit this paragraph.