TN 14 (02-98)

A. Policy

The SSA-632-BK is the vehicle used to gather sufficient information about fault, financial circumstances and against equity to enable SSA to make a waiver determination.

The form is also used:

• To request a change in the rate of partial withholding if recovery will take more than 36 months or the amount is less than $10 a month (GN 02210.045);

• To report the overpayment to the Department of Justice for enforced collection (GN 02215.150);

• When a compromise offer of less than 80 percent of the overpayment is offered (GN 02215.115.)

While we encourage completion of the SSA-632-BK with the assistance of the FO interviewer to ensure that the explanation of without fault agrees with the facts of the overpayment and that the financial statements accurately reflect the person's current situation, it can be completed without FO assistance.

When the form is needed, page one is always completed. It provides identifying information and has check blocks to indicate why the form is being completed.

Section I is completed only if waiver is requested. It allows the person to explain why he is without fault in causing the overpayment.

Section II captures financial information and is completed when any of the situations mentioned above applies.

B. Procedure - Foreign Cases

Indicate on the SSA-632-BK whether the amounts shown are in U.S. dollars or foreign currency.

1. OIO Action

• When development is needed to obtain an SSA-632-BK from the overpaid individual, ask that all amounts be shown in local currency.

• When the completed form is received, use the Treasury Reporting Rates of Exchange tables to convert the foreign currency to U.S. dollar amounts (GN 02215.005A.).

2. FSP/VARO Action

Specify the type of currency involved (e.g., all amounts shown are in Mexican pesos).

C. Procedure - Beginning Interview

Before completing the SSA-632-BK, interview the person carefully to be sure that an SSA-632-BK is really necessary. See GN 02250.230A. If so, determine what sections of the form must be completed.

Review any available documents which may contain information relevant to the overpayment (e.g., overpayment notice, MBR and PHUS printouts, material from the claims folder). Be aware of the circumstances of the overpayment and be prepared to ask meaningful questions to elicit more direct or complete responses. Thoroughly explore and document allegations. If the overpayment was caused by multiple events, obtain fault information for all events. If necessary, contact the PC via OPTEL for information (GN 01070.235A.).

Record any observations and comments on the person's without fault allegations on the SSA-632SUP or on an RC.

D. PRocedure - Completion of Page 1

1. For SSA Use Only

The FO will:

• Show the date the FO inputs the waiver request to ROAR.

• Indicate if there is SSI involvement.

• Show the period and amount of the overpayment. In cases involving multiple or subsequent overpayments, the amount entered will clarify which overpayment is in question.

2. Question 1

List all people included in the waiver request including their SSN's.

3. Question 2

Check the appropriate block(s) to indicate what type of relief the person is seeking.

• Check block A if waiver is requested.

• Check block B if the person is requesting a lesser rate of withholding that is less than $10 a month or will not complete recovery within 36 months (or before entitlement terminates).

• Check block C only in SSI cases when the installment amount requested is less than $10 a month or will not complete recovery within 36 months.

• Check block D if an SSI recipient wants to repay the overpayment at an amount other than 10 percent of his total income (SI 02220.015B.5).