TN 18 (11-09)

A. Introduction

Section II of the SSA-632-BK, Request for Waiver of Overpayment Recovery or Change in Repayment Rate, asks for a detailed description of the person's income and assets from all sources and for the expenses of the household.

B. Procedure for completing section II of the SSA-632-BK

The field office (FO) interviewer can help the person complete Section II – Your Financial Statement, if the person wants SSA assistance. However, if the person requests, Section II may be mailed to him or her for completion and signature. The FO may complete Section II in a phone interview and mail the SSA-632-BK to the person for review and signature. Be sure to show the person's name and the Social Security number under which he or she was overpaid.

Where a representative payee and a beneficiary are both liable for an overpayment, obtain separate financial information for each party.

1. When the overpaid person is a child

When the overpaid person is a child, obtain financial information for the entire household if necessary. Per GN 02250.130, Household Membership and Defeat the Purpose, recovery from a minor child will usually defeat the purpose. Since the child is an individual in his or her own right, a child’s ability to repay an overpayment depends on the child’s own income, resources, and expenses. A child’s income and assets must be in the child’s name and be available for the child’s use. The family income and assets are separate from those of the child unless the child’s income and assets support the family. In that situation, the expenses of the entire household are used to determine defeat the purpose.

2. When proof of income, expenses, and assets are needed

Ask the person to bring in (or send in) proof of all income, certain expenses, and assets per GN 02250.250 and GN 02250.255.

NOTE: If the overpayment amount is $75,000 or more also retain copies of whatever proofs the debtor submitted along with their completed SSA-632 in the paper folder, EF, or NDRed. Waiver determinations of $75,000 or more are subject to management review.

3. Person questions need for or refuses to furnish financial information

Explain to the person that:

• The law requires consideration of financial ability to repay a debt as a condition for granting a waiver based on defeat the purpose.

• If the person fails to provide financial information, the request for a lesser rate of withholding may not be approved, and the entire benefit may be withheld to recover the overpayment. Follow instructions in GN 02250.250B.4.

NOTE: If the person wants only an against equity and good conscience finding, financial information is not needed.

4. Person chooses to repay the overpayment

Take the following actions:

• Obtain a signed statement from the person stating that he or she knows that he or she is entitled to a waiver determination, but he or she prefers not to pursue it and can afford to repay the overpayment.

• Input the full rate of withholding to Recovery of Overpayments, Accounting and Reporting (ROAR) using the Establish Offset (Debtor) (DROA) screen in Debt Management System (DMS) (see MSOM DMS 006.015), if repayment is by benefit adjustment.

• Input the remittance using the Field Office Remittance Input (RFOR) screen in DMS (see MSOM DMS 003.006), if repayment is made immediately.

• Input an installment agreement for the full amount to ROAR using the Protest/Stop Recovery Request (FO) (DRPF) screen in DMS (see MSOM DMS 006.019), if the overpaid person agrees to make a full refund by a specified date.

• Input the installment amount to ROAR using the Record Installment Agreement (DRIN) screen in DMS (see MSOM DMS 006.014), if payment will be made in installments. When negotiating the installment amount, see GN 02210.180.

• Annotate DMS remarks (i.e. “NH agreed to repay entire overpayment amount by MM/DD/YY via check.”)

5. Representative payee questions need for or refuses to furnish financial information

If the payee is at fault for the overpayment, there is no need to develop the financial information. Deny the waiver based on fault. If the payee is without fault and used the money on the beneficiary, the payee is not liable (see GN 02205.007, Joint and Several Liability – Overpayment Recovery Title II) and a waiver decision is not appropriate for the payee. If the payee is without fault but did not spend the money on the beneficiary, financial information is needed for a waiver determination unless recovery is against equity and good conscience. For requirements of against equity and good conscience, see GN 02250.150.

NOTE: If the payee is without fault but did not spend the money on the beneficiary, develop for possible misuse, per GN 00604.001.

6. Example of representative payee liability issue

Rita White is payee for her daughter, June, who is a student. June reduced her attendance below full-time but never told her mother. When Mrs. White was notified of the overpayment, she requested waiver. It was determined that she was without fault in causing the overpayment. However, because she used the money to buy herself a new winter coat, she is liable for repayment. (Misuse is not an issue since this was money not due.) Mrs. White will have to show that recovery of the overpayment would be against equity and good conscience or would defeat the purpose for waiver to be approved.

7. Question 8

For a discussion of defeat the purpose when a person has the overpaid funds in his possession, see GN 02250.105. Advise him or her that this money must be refunded (unless recovery would be against equity and good conscience). Control for return of the money.

8. Question 12

If a person is receiving cash public assistance (GN 02250.110) which can be verified, he or she does not have to complete any more information and can skip to page 8 of the SSA-632-BK.   

9. Question 13

This item allows the person to describe his or her household composition and the relationship of the dependent people in the household.

10. Question 14

Part A - Do not include the proceeds of any monthly income listed in Question 18, such as cashing a pay check to pay regular expenses (food, rent, etc.). That is, do not count the same money twice.

Part B - If the answers indicate that the person is receiving income from assets, include that income on line K of Question 18.

11. Question 15

Part A - Do not count as an asset the principle vehicle used for family or work transportation.

Part B - Do not include the primary residence.

12. Question 18

Include the person's income from all sources and the income of a spouse and any dependents living in the same household. Indicate to whom the income belongs.

Total each column to show household income. Correct all income to monthly totals: multiply weekly income by 4 1/3; divide quarterly income by 3; divide yearly income by 12.

The shaded areas after each column are for SSA use. Make a check mark to indicate that, if applicable, a particular item has been verified. When there is a check mark on a line, indicate the type of proof seen and your initials in the far right column.

13. Question 19

With the increased use of credit cards for paying bills and making purchases, be alert to double counting of expenses using the submitted bill and by listing the monthly credit card payments. Show “cc” in the expense line if the expense (e.g., clothing, phone bill) is listed in line F (credit card payments).

Annotate the average monthly expense in the amount column. Multiply weekly expenses by 4 1/3; divide quarterly expenses by 3; divide yearly expenses by 12. Include in “Expense Remarks” any expenses unique to only one household member as well as any unusual or very large expenses.

Annotate what proof was seen and your initials to verify the proof in the shaded column on the right.

14. Question 20

Part C - To take into account any unbudgeted or unaccountable expenses, the $25 adjusted household expense (GN 02250.115A.3., Application of Defeat the Purpose Provisions) is preprinted on the SSA-632-BK so that it will not be overlooked.

15. Question 21

The required explanation helps determine if the person has any income or resources not shown on previous questions or if he or she is going into debt each month.

16. “For SSA Use Only”

• When item 21(A) exceeds item 21(D), enter the difference in the top block

• When item 21(D) exceeds item 21(A), enter the difference in the lower block.

17. Question 22

• Part A - The answer helps determine if we should look beyond the immediate comparison of income and expenses from Question 21.

• Part B - The answer determines if the “ready cash” amount (if any) shown in question 15(A) should or should not be used in the determination of ability to repay.

• Part C and D - The answers determines if the listed assets (if any) can be converted to cash (to repay the overpayments) and if not, why not. Recall that the “family” car and the property where a person lives are not counted as an asset.