TN 36 (03-99)

If the termination action was processed later than the actual event date, causing an overpayment to the terminated beneficiary or the representative payee, the termination notice will require overpayment, refund/recovery, and waiver language. We indicate on the exhibit where this language should be. Below we show what the language should be for various situations.

All Termination Notices with an Overpayment will include paragraph 3922A, below.

Fill-ins:

1. your; when representative payee involved, “Mr.” or “Ms.” last name possessive, if adult; if child, first name, possessive

2. month we actually stopped payments

3. for “Mr.” or “Ms.” last name if adult; for first name, if child; or omit if no payee

4. month(s) of overpayment

5. total amount of overpayment (including taxes withheld from alien)

The refund/recovery and waiver/appeal language will depend on the situation. Every overpayment letter must include one of the refund/recovery paragraphs and one of the waiver paragraphs. All overpayment letters must include a refund envelope and Form SSA-3105.

REFUND/RECOVERY PARAGRAPHS

1. TERMINATED BENEFICIARY RECEIVING BENEFITS FOR OTHER BENEFICIARY IN SAME HOUSEHOLD — REFUND REQUESTED OR ADJUSTMENT PROPOSED —OVERPAYMENT MORE THAN MONTHLY PAYMENT—

   3102A     (See NL 00703.102)

2. TERMINATED BENEFICIARY RECEIVING BENEFITS FOR OTHER BENEFICIARY IN SAME HOUSEHOLD — REFUND REQUESTED OR ADJUSTMENT PROPOSED —OVERPAYMENT MORE THAN MONTHLY PAYMENT — ALIEN TAX WITHHOLDING INVOLVED

   3103A     (See NL 00703.103)

3. TERMINATED BENEFICIARY RECEIVING BENEFITS FOR OTHER BENEFICIARY IN SAME HOUSEHOLD — OVERPAYMENT LESS THAN MONTHLY PAYMENT

   3102B     (See NL 00703.102)

4. TERMINATED BENEFICIARY RECEIVING BENEFITS FOR OTHER BENEFICIARY IN SAME HOUSEHOLD — OVERPAYMENT EQUAL TO MONTHLY PAYMENT

   3102C     (See NL 00703.102)

5. TERMINATED BENEFICIARY RECEIVING BENEFITS FOR OTHER BENEFICIARY IN SAME HOUSEHOLD — OVERPAYMENT LESS THAN MONTHLY PAYMENT — ALIEN TAX WITHHOLDING INVOLVED

   3103B     (See NL 00703.103)

6. TERMINATED BENEFICIARY RECEIVING BENEFITS FOR OTHER BENEFICIARY IN SAME HOUSEHOLD — OVERPAYMENT EQUAL TO MONTHLY PAYMENT — ALIEN TAX WITHHOLDING INVOLVED

   3103C     (See NL 00703.103)

7. REFUND REQUESTED FROM TERMINATED BENEFICIARY

   3106E     (See NL 00703.106)

   3106A     (See NL 00703.106)

Use fill in 3106A if the liable individual is receiving other program benefits (e.g., a person liable for repayment of a title II overpayment receives or title XVI payments). Use 3100FC if the person is outside the U.S.

8. REFUND REQUESTED FROM TERMINATED BENEFICIARY — ALIEN TAX WITHHOLDING INVOLVED

   3107B     (See NL 00703.107)

   3106A     (See NL 00703.106)

Use fill-in 3106A if the liable individual is receiving other program benefits.

9. WAIVER AND APPEAL RIGHTS WHEN ADJUSTMENT PROPOSED

   3100C     (See NL 00703.100)

   AND

   3100D     (See NL 00703.100)

   OR

   3100F     (See NL 00703.100)

10. WAIVER AND APPEAL RIGHTS WHEN REFUND IS REQUESTED

    3106B     (See NL 00703.106)

    AND

    3106C     (See NL 00703.106)

    OR

    3106D     (See NL 00703.106)