NL 00720.245:
OPT Overpayment
Effective Dates: 08/29/2013 - Present- Effective Dates: 06/28/2018 - Present
TN 2 (09-11)- TN 9 (06-18)
- NL 00720.245 OPT Overpayment
- OPT028 NEW OVERPAYMENT AMOUNT INCLUDES PRIOR OVERPAYMENT (M05)
- (Requested)
- Caption: Your Benefits
- However, the total overpayment is (1) , which includes a prior overpayment of (2) .
- Fill-in values:
- Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
- Total overpayment
- Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
- Current balance of prior overpayment
- OPT107 OVERPAYMENT RECOVERED FROM ONE MONTH'S BENEFIT (A57)
- (Requested)
- Caption: Your Benefits
- We will withhold (1) (2) (3) (4) payment to recover the money we (5) (6) . This is the payment you would normally receive about (7) .
- Fill-in values:
- Fill-in (1) – Systems Generated
- Choice 1: null
- Fill-in (2) – Systems Generated
- Choice 1: null
- Fill-in (3) – Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Choice 4: Beneficiary's name
- Fill-in (4) – Systems Generated
- month and year (MM/CCYY)
- Fill-in (5) – Systems Generated
- Choice 1: overpaid
- Choice 2: incorrectly paid
- Fill-in (6) – Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Choice 4: Beneficiary's name
- Fill-in (7) – Systems Generated
- month and year (MM/CCYY)
- OPT122 BENEFICIARY OVERPAID DUE TO SUSPENSION/TERMINATION (M13)
- (Requested)
- Caption: Your Benefits
- Since we did not stop (1) payments until (2) , (3) paid (4) too much in benefits.
- Fill-in values:
- Fill-in (1) – Systems Generated
- Choice 1: Beneficiary's Name (possessive)
- Choice 2: your
- Fill-in (2) – Systems Generated
- MM/CCYY
- Fill-in (3) – Systems Generated
- Choice 1: he was
- Choice 2: she was
- Choice 3: you were
- Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount of overpayment
- OPT127 UNDERPAYMENT USED TO REDUCE/RECOVER AN OVERPAYMENT (M03)
- (Requested)
- Caption: Your Benefits
We used (1) of (2) benefits to recover (3) of an overpayment on this record.- We used (1) of (2) benefits to recover (3) of an overpayment on this record.
- Fill-in values:
- Fill-in (1) - Requested As A Money Amount in Format $$$$$.¢¢
- Amount used for recovery
- Fill-in (2) - Requested As A One Position Alpha Character or Language
- Choice 1: (A) your
- Choice 2: Name of Beneficiary
- Fill-in (3) - Requested As A One Position Alpha Character
- Choice 1: (A) all
- Choice 2: (B) part
- OPT132 DIRECT DEPOSIT — JOINT ACCOUNT — RECOVERY OF PAYMENTS MADE AFTER DEATH (A16)
- (Requested)
- Caption: Your Benefits
- We paid (1) more in benefits than we should have. We deposited (2) benefits for (3) into a bank account which (4) also owned. We can't pay benefits for the month of death, (5) , or later. Because (6) a joint owner of the bank account, (7) overpaid (8) .
- Fill-in values:
- Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of overpayment
- Fill-in (2) Requested
- Full name of the deceased beneficiary, possessive
- Fill-in (3) Requested As A Date In Format Shown Below
- Month(s) and year(s) of incorrect payment
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (4) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's first name
- Fill-in (5) Requested
- Month(s) and year(s) of incorrect payment
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (6) Systems Generated
- Choice 1: Beneficiary's name is
- Choice 2: you are
- Fill-in (7) Systems Generated
- Choice 1: Beneficiary's name is
- Choice 2: you are
- Fill-in (8) Requested
- Amount of overpayment
- OPT148 CROSS PROGRAM RECOVERY - T16 UNDERPAYMENT USED TO RECOVER T2 OVERPAYMENT (B88)
- (System Generated)
- Caption: Your Benefits
- We used (1) of (2) SSI benefits to recover some or all of an overpayment on this record.
- Fill-in values:
- Fill-in (1)
- Amount of SSI under payment
- Fill-in (2)
- Choice 1: Beneficiary's Name possessive
- Choice 2: your
- OPT149 CROSS PROGRAM RECOVERY - T16 UNDERPAYMENT NOT USED TO REDUCED/RECOVER A T2 OVERPAYMENT (B89)
- (System Generated)
- Caption: What We Will Pay
- We did not use any of 1 SSI benefits to recover an overpayment on this record.
- Fill-in values:
- Fill-in (1)
- Choice 1: Beneficiary's Name
- Choice 2: your
- OPT151 OVERPAYMENT LIABILITY INFORMATION TO A REPRESENTATIVE PAYEE FOR OVERPAID BENEFICIARY (A27)
- (Requested)
- Caption: Your Benefits
- As representative payee, you are personally liable for repayment unless you used the overpaid funds for the benefit of (1) , and the overpayment was made through no fault of your own.
- Fill-in values:
- Fill-in (1) – Systems Generated
- Name(s) of beneficiary (ies)
- OPT152 REPAY BENEFITS WITHHELD - PROTEST OF OVERPAYMENT RECEIVED TIMELY (LAF D to C ) (A44)
- (Requested)
- Caption: Your Benefits
- We are paying (1) again beginning (2) because (3) asked us to review our overpayment decision. If we later find that our decision was correct, or that we cannot waive the overpayment, (4) will have to pay back the (5) which (6) . Someone from the local Social Security office will contact (7) to discuss the overpayment.
- Fill-in values:
- Fill-in (1) – Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2) - Requested As A Date In Format Shown Below
- Date payments resumed MM/CCYY
- Fill-in (3) – Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) – Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (5) – Requested As A Money Amount In Format $$$$$.¢¢
- Amount of overpayment
- Fill-in (6) – Systems Generated
- Choice 1: you owe
- Choice 2: he owes
- Choice 3: she owes
- Fill-in (7) – Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- OPT153 OVERPAYMENT WITHHELD FROM BENEFITS IS REPAID — PROTEST RECEIVED TIMELY (A46)
- (Requested)
- Caption: Your Benefits
- (1) asked us to review our overpayment decision. While we review (2) case, we are sending (3) the money we withheld from (4) checks.
- If we later find that our decision was correct, or that we cannot waive the overpayment, (5) will have to pay back the (6) which (7) . Someone from the local Social Security office will contact (8) to discuss the overpayment.
- Fill-in values:
- Fill-in (1) – Systems Generated
- Choice 1: You
- Choice 2: Beneficiary's Name
- Fill-in (2) – Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) – Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (4) – Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) – Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of overpayment-
- Fill-in (7) – Systems Generated
- Choice 1: you owe
- Choice 2: he owes
- Choice 3: she owes
- Fill-in (8) – Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- OPT154 OVERPAYMENT PROTESTED - BENEFITS RESUMED AND WITHHELD BENEFITS REPAID - FOREIGN CLAIMS (A47)
- (Requested)
- Caption: Your Benefits
- We are paying (1) again beginning (2) because (3) asked us to review our overpayment decision. If we later find that our decision was correct, or that we cannot waive the overpayment, (4) will have to pay back the (5) which (6) .
- Fill-in values:
- Fill-in (1) – Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's name
- Fill-in (2) – Requested As A Date In Format Shown Below
- Date payments resumed MM/CCYY
- Fill-in (3) – Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) – Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (5) – Requested As A Money Amount In Format $$$$$.¢¢
- Amount of overpayment
- Fill-in (6) – Systems Generated
- Choice 1: you owe
- Choice 2: he owes
- Choice 3: she owes
- OPT155 OVERPAYMENT PROTESTED - BENEFITS RESUMED - MONEY WITHHELD NOT REPAID - FOREIGN CLAIMS (A48)
- (Requested)
- Caption: Your Benefits
- We are paying (1) again beginning (2) because (3) asked us to review our overpayment decision. For now, we are still withholding the money which we already subtracted from (4) checks.
- If we later find that our decision was correct, or that we cannot waive the overpayment, (5) will have to pay back the (6) which (7) .
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2) – Requested As A Date In Format Shown Below
- Date payments resumed MM/CCYY
- Fill-in (3) Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of the remaining overpayment
- Fill-in (7) Systems Generated
- Choice 1: you owe
- Choice 2: he owes
- Choice 3: she owes
- OPT156 OVERPAYMENT PROTESTED AFTER RECOVERY COMPLETED/STOPPED - REPAY BENEFITS WITHHELD - FOREIGN CLAIMS (A49)
- (Requested)
- Caption: Your Benefits
- (1) asked us to review our overpayment decision. While we review (2) case, we are sending (3) the money we withheld from (4) checks. If we later find that our decision was correct, or that we cannot waive the overpayment, (5) will have to pay back the (6) which (7) .
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: You
- Choice 2: Beneficiary's Name
- Fill-in (2) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (4) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of the overpayment
- Fill-in (7) Systems Generated
- Choice 1: you owe
- Choice 2: he owes
- Choice 3: she owes
- OPT158 INTRODUCTORY STATEMENT FOR CAT A-A22 NOTICE WHEN OVERPAYMENT ESTABLISHED AND ALIEN TAXATION INVOLVED (ADMINISTRATIVE ADJUSTMENT) (F70)
- (Requested)
- Caption: None
- We are writing to give (1) new information about the (2) benefits which (3) on this Social Security record. In the rest of this letter, we will tell (4) :
- * How we paid (5) (6) too much in benefits; and
- * What to do if (7) we are wrong about the overpayment.
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2) Requested As A One Position Alpha Character
- Choice 1: (A) disability
- Choice 2: (B) retirement
- Choice 3: (C) survivor
- Choice 4: (D) auxiliary
- Fill-in (3) Systems Generated
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- Fill-in (4) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (5) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of the overpayment
- Fill-in (7) Systems Generated
- Choice 1: you think
- Choice 2: he thinks
- Choice 3: she thinks
- OPT159 A21 NOTICE OVERPAYMENT RECOVERY (G51)
- (System Generated)
- Caption: Your Benefits
- As we told (1) in our previous letter, we are withholding (2) benefits to recover the overpayment of (3) .
- Fill-in values:
- Fill-in (1)
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2)
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3)
- Amount of the overpayment
- OPT161 INTRODUCTORY PARAGRAPH E31 AND E32 NOTICES (G70)
- (System Generated)
- Caption: None
- We are writing to give (1) new information about the (2) benefits which (3) on this Social Security record. In the rest of this letter, we will tell (4) :
- * How we paid (5) (6) too much in benefits; and
- * What to do if (7) we are wrong about the overpayment.
- Fill-in values:
- Fill-in (1)
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2)
- Choice 1: disability
- Choice 2: retirement
- Choice 3: survivor
- Fill-in (3)
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- Fill-in (4)
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (5)
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (6)
- Amount of the overpayment
- Fill-in (7)
- Choice 1: you think
- Choice 2: he thinks
- Choice 3: she thinks
- OPT162 E31 AND E34 NOTICES MBP GREATER THAN OVERPAYMENT (G71)
- (System Generated)
- Caption: Your Benefits
- We plan to collect the overpayment from the check which (1) will receive around (2) . We will reduce (3) check to (4) . We will send (5) (6) regular monthly benefit amount again beginning (7) .
- Fill-in values:
- Fill-in (1)
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (2)
- MM/DD/CCYY
- Fill-in (3)
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (4)
- Amount of the check
- Fill-in (5)
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (6)
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (7)
- MM/CCYY
- OPT163 E34 NOTICE INTRODUCTORY PARAGRAPH (G72)
- (System Generated)
- Caption: None
- We are writing to give (1) new information about Social Security benefits on this record. We paid (2) (3) too much in Social Security benefits. In the rest of this letter, we will tell you:
- * How we paid too much in benefits, and
- * What to do if you think we are wrong about the overpayment.
- Fill-in values:
- Fill-in (1)
- Choice 1: you
- Choice 2: Beneficiary's name
- Fill-in (2)
- Beneficiary's name
- Fill-in (3)
- Amount of the Overpayment
- OPT164 OVERPAYMENT RECOVERY PROPOSED AGAINST OTHER BENEFICIARY E34 NOTICE (G73)
- (System Generated)
- Caption: None
- We cannot recover the overpayment from the person who was overpaid. For this reason, we will withhold the money from the checks of other persons who are paid on the same Social Security record.
- Fill-in values:
- None
- OPT165 CHECK PARAGRAPH FUTURE WITHHOLDING OF OVERPAYMENT (G91)
- (System Generated)
- Caption: Your Benefits
- We will pay (1) a monthly check of (2) until we start to collect the overpayment.
- Fill-in values:
- Fill-in (1)
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (2)
- PMA or CMA in $$$$$.¢¢ format
- OPT166 PREVIOUS CHECK WAS INCORRECT AMOUNT (M02)
- (Requested)
- Caption: Your Benefits
- The check (1) received for (2) in (3) should have been for (4) . Therefore we paid (5) (6) more in benefits than (7) due.
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2) – Requested As A Money Amount In Format $$$$$.¢¢
- Amount of check
- Fill-in (3) Requested As A Date In Format Shown Below
- MM/CCYY
- Fill-in (4) Requested As A Money Amount In Format $$$$$.¢¢
- Amount that should have been paid
- Fill-in (5) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of overpayment
- Fill-in (7) Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- OPT167 OVERPAYMENT RECOVERED (M06)
- (Requested)
- Caption: Your Benefits
- We have recovered all of the money (1) owed because of an overpayment.
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- OPT168 OVERPAYMENT BALANCE (M08)
- (Requested)
- Caption: Your Benefits
- The total amount of the overpayment is (1) .
- Fill-in values:
- Fill-in (1) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of the overpayment
- OPT169 INCORRECT BENEFIT CAUSED INCORRECT PAYMENT, OVERPAYMENT OR UNDERPAYMENT (M10)
- (Requested)
- Caption: Your Benefits
- Since we paid (1) (2) for (3) , we paid (4) (5) (6) than (7) due.
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
- Amount paid
- Fill-in (3) Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (4) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (5) - Requested As A Money Amount In Format $$$$$.¢¢
- Amount of the overpayment
- Fill-in (6) - Requested As A One Position Alpha Character
- Choice 1: (A) more
- Choice 2: (B) less
- Fill-in (7) Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- OPT170 BENEFITS DEFERRED TO RECOVER AN INCORRECT PAYMENT/OVERPAYMENT (M11)
- (Requested)
- Caption: Your Benefits
- We are withholding all of (1) benefits for (2) and (3) of (4) benefits for (5) to recover the (6) that was not due
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: your
- Choice 2: Beneficiary's Name possessive
- Fill-in (2) Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (3) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of final adjustment
- Fill-in (4) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) Requested As A Date In Format Shown Below
- MM/CCYY of final adjustment
- Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of overpayment or incorrect payment
- OPT171 OTHER BENEFICIARY OVERPAID DUE TO WORK (M12)
- (Requested)
- Caption: Your Benefits
- We paid (1) (2) too much in benefits because of work and earnings in (3) .
- Fill-in values:
- Fill-in (1) - Requested As A Language
- Name of overpaid beneficiary
- Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
- Amount of overpayment
- Fill-in (3) - Requested As A Date In Format Shown Below
- CCYY
- OPT179 PAID VS. PAYABLE (M01)
- (Requested)
- Caption: Your Benefits
- We paid (1) (2) for (3) . Since we should have paid (4) (5) for (6) , we paid (7) (8) (9) than (10) due.
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's Name
- Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
- Amount
- Fill-in (3) Requested As A Date in Format Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (4) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (5) Requested As A Money Amount In Format $$$$$.¢¢
- Correct Amount
- Fill-in (6) Requested As A Date in Format Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (7) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (8) Requested As A Money Amount In Format $$$$$.¢¢
- Amount
- Fill-in (9) Systems Generated
- Choice 1: more
- Choice 2: less
- Fill-in (10) Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- OPT180 FOREIGN REFUND REQUEST ADJUSTMENT PROPOSED OVERPAYMENT EXCEEDS MBP (F24)
- (System Generated)
Caption: How You Can Pay Us Back- Caption: 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 (1) claim number (as shown above) on the check or money order.- 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.
Please send your check or money order in United States currency or in local currency equal to the United States dollars. When you pay us in local currency, we use the exchange rate in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment directly to us, please go to the (2) for help in making the refund.- Always include (1) Social Security claim number on the check or money order.
If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding (3) full benefit each month beginning with the benefit (4) would normally receive about (5) . We will continue to withhold (6) benefit until the overpayment has been fully recovered.- Please send your check or money order in United States currency or in local currency equal to the United States dollars. When you pay us in local currency, we use the exchange rate in effect at the time we get your payment. If this causes a difference between the amount you pay us and the amount you owe us, we will let you know. If you cannot mail your payment directly to us, please contact your Federal Benefits Unit for help in making the refund. Visit (2) for a list of Federal Benefits Units.
- If we do not receive your refund within 30 days, we plan to recover the overpayment by withholding (3) full benefit each month beginning with the benefit (4) would normally receive about (5) . We will continue to withhold (6) benefit until the overpayment is fully recovered.
- Fill-in values:
Fill-in (1)- Fill-in (1) Systems Generated
- Choice 1: your
- Choice 2: Beneficiary Name possessive
Fill-in (2)Choice 1: U.S. Veterans Affairs Regional Office, SSA Division, 1131 Roxas Boulevard, Manila- Fill-in (2) Systems Generated
Choice 2: nearest United States Embassy or consulate- Choice 1: www.socialsecurity.gov/foreign/foreign.htm
Fill-in (3)- Fill-in (3) Systems Generated
- Choice 1: your
- Choice 2: Beneficiary Name possessive
Fill-in (4)- Fill-in (4) Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
Fill-in (5)- Fill-in (5) Systems Generated
MM/DD/YY- MM/DD/CCYY
Fill-in (6)- Fill-in (6) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- OPT181 (M07) DUPLICATE CHECK OVERPAYMENT
- (Requested)
- Caption: Your Benefits
We sent (1) two checks for (2) , both in the amount of (3) and both checks were cashed. Since (4) due only one check, we paid (5) (6) too much in benefits.- We sent (1) two checks for (2) , both in the amount of (3) and both checks were cashed. Since (4) due only one check, we paid (5) (6) too much in benefits.
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's name
- Fill-in (2) Requested As A Date in Format Shown Below
- MM/CCYY
- Fill-in (3) Requested As A Money Amount In Format $$$$$.¢¢
- Amount
- Fill-in (4) Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- Fill-in (5) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (6) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of the overpayment
- OPT182 PRIOR OVERPAYMENT — WORK MONTHS PREVENTED RECOVERY (A29)
- (Requested)
- Caption: Your Benefits
- Our records show that we paid (1) (2) too much in (3) . In our previous letter, we told (4) that we would withhold benefits in (5) to recover (6) amount. But (7) recent report shows that (8) worked during (9) . Because of that work, no benefits were payable for that period. Since we could not use benefits for those months to recover the amount (10) owed, (11) us (12) .
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: Beneficiary's name
- Choice 2: you
- Fill-in (2) Requested As A Money Amount In Format $$$$$.¢¢
- Amount of the overpayment
- Fill-in (3) Requested As A Date in Format Shown Below
- Year of prior overpayment in CCYY
- Fill-in (4) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (5) Requested As A Date in Format Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (6) Requested As A One Position Alpha Character
- Choice 1: (A) this
- Choice 2: (B) part of this
- Fill-in (7) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (8) Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (9) Requested As A Date in Format Shown Below
- Choice 1: month and year of work MM/CCYY
- Choice 2: months and years of work MM/CCYY through MM/CCYY
- Fill-in (10) Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (11) Systems Generated
- Choice 1: you still owe
- Choice 2: he still owes
- Choice 3: she still owes
- Fill-in (12) Requested As A Money Amount In Format $$$$$.¢¢
- Overpayment Amount
x
← This means that the line
was removed and
was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.