FECA Form Letter 1

File Number: 250281977
opprelimfault-NO-0

U.S. DEPARTMENT OF LABOR
EMPLOYMENT STANDARDS ADMINISTRATION
OFFICE OF WORKERS' COMP PROGRAMS
PO BOX 8300 DISTRICT 52
LONDON, KY 40742-8300
Phone: (202) 693-0045
May 11, 2006
Date of Injury: 04/07/1963
Employee:

Dear Mr. :
The Office of Workers' Compensation Programs (OWCP) has made a preliminary determination that
you were overpaid in the amount of $ because . It appears that you were with fault in the creation of
this overpayment, because
The attached memorandum fully explains the basis for this preliminary finding.
If you agree that you were overpaid this amount, you may send a check or money order for the full
amount to the address shown below. Make the check payable to the U.S. Department of Labor,
OWCP, and include your FECA file number on the check.
U.S. Dept. of Labor
DFEC National Office
P.O. Box 403356
Atlanta, GA 30384-3356
If you are unable to pay the full amount now, submit a completed form OWCP-20 (enclosed) so that
we may determine a fair repayment method.
If you disagree with this preliminary overpayment finding, you may contest it. You have a right to
submit evidence or arguments which you believe will affect these preliminary findings if:
1. You disagree that the overpayment occurred;
2. You disagree with the amount of the overpayment; or
3. You believe that the overpayment occurred through no fault of your own and request a
waiver.
OWCP may overturn the preliminary finding of fault based on new evidence or arguments you
submit, either at a hearing or through the mail. If OWCP finds that you are without fault in the
occurrence of the overpayment, waiver may be considered. Following review of all relevant
information provided, OWCP will issue a final decision regarding this overpayment. If it is
determined that you were with fault in creating this overpayment, we cannot waive recovery of the
overpayment. Collection of the overpayment will be pursued after the final decision is issued.
ACTIONS YOU MAY TAKE

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You may take any one of the following actions by completing the attached "Overpayment Action
Request" and Form OWCP020 and mailing it to the appropriate address within 30 days:
1. Request a telephone conference with the district office. Send your written request to the
address listed in the letterhead along with completed form OWCP-20 and supporting documents. We
will then contact you to arrange a convenient time for the conference, allowing enough time for you to
prepare. Include any supporting evidence or arguments with your written request.
2. Request that the district office issue a final decision based on the written evidence only. Send
your written request to the address listed in the letterhead along with completed form OWCP-20 and
supporting documents.
3. Request a pre-recoupment hearing before a representative of the Branch of Hearings and
Review by sending your written request marked "Overpayment Hearing Request" on the outside of
the envelope along with completed form OWCP-20 and any supporting evidence within 30 days, to:
Branch of Hearings and Review
Office of Workers' Compensation Programs
P.O. Box 37117
Washington, D.C. 20013-7117
The hearing will be held at a time and place convenient to you. You may have a representative
present at the hearing, and you should be prepared to present any new evidence or arguments to
dispute the occurrence or amount of the overpayment and/or to support your belief that you are
without fault in creating the overpayment and that the overpayment should be waived.
OWCP-20:
In order for OWCP to consider the questions of fault or waiver, or to determine a reasonable method
for collection, you must complete and submit the enclosed Form OWCP-20. Attach supporting
documents to Form OWCP-20, including copies of income tax returns, bank account statements, bills
and canceled checks, pay slips, and any other records which support the income and expenses
listed. Under 20 CFR 10.438, failure to submit the requested information within 30 days will result in
the denial of waiver, and no further request for waiver shall be considered until the requested
information is furnished.
PLEASE NOTE:
In your case, this Office has made a preliminary finding that you were with fault in regard to the
creation of this overpayment. If you wish to argue that you were without fault, you should consider
the following:
When the claimant is without fault in creating an overpayment, the law found at 20 C.F.R. 10.434
states that OWCP may not recover the overpayment if the recovery would either 1) defeat the
purpose of the Federal Employees' Compensation Act (FECA), which is to provide at least a basic
income for beneficiaries (20 C.F.R. 10.436), or 2) the recovery would be against equity and good
conscience (20 C.F.R. 10.437).
Recovery would be against equity and good conscience when:
1. A claimant, acting on incorrect information from OWCP, gives up a valuable right; or
2. A claimant, acting on incorrect information from OWCP, spends or commits funds in ways
which he or she otherwise would not have done, and suffers a financial loss as a result; or

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3. A claimant would suffer severe financial hardship in trying to repay the debt.
If you have any questions or require any assistance in responding to this letter, please contact the
district office. If we do not receive a reply from you within 30 days of the date of this letter, we will
issue a final decision based on the information in file.
Sincerely,

Michelle Walker
Enclosures: Memorandum for the File, Form OWCP-20
US DEPT OF COMMERCE
OHRM OLER RM H1624
WORKERS COMPENSATION BRANCH
14TH AND CONSTITUTION AVE NW
WASHINGTON, DC 20230

File Number: 250281977
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HENRY M. EMERICK, JR
OVERPAYMENT ACTION REQUEST
PART 1:
You may choose only one option. Your request must be submitted to the appropriate
address within 30 days of the date of this letter.
____ I request a telephone conference with the District Office on the issues of fault
and possible waiver of this overpayment. My completed OWCP-20 and supporting
financial documents are enclosed. If you checked this option, mail this request to our
London, KY address.
____ I request that the District Office make a decision based on the written
evidence on the issues of fault and possible waiver of this overpayment. My completed
OWCP-20 and supporting financial documents are enclosed. If you checked this option,
mail this request to our London, KY address.
____ I request a pre-recoupment hearing on the issues of fault and a possible
waiver of this overpayment with the Branch of Hearings and Review. My
completed OWCP-20 and supporting financial documents are enclosed. Depending on
your geographical location and the number of hearing requests in your area, we may be
able to expedite your appeal by offering you a telephone hearing at the discretion of the
hearing representative. If OWCP deems your case suitable for teleconference and
you are open to this option, please check here. _____
Please write "Overpayment Hearing Request" on the envelope and mail this request
directly to the Branch of Hearings and Review at the following address:
Branch of Hearings and Review
Office of Workers' Compensation Programs
P.O. Box 37117
Washington, D.C. 20013-7117
PART 2:
I WISH TO CONTEST THIS OVERPAYMENT BECAUSE:
(Check as many as apply. Please explain, in detail, why you are challenging this
overpayment.)
____ I disagree that the overpayment occurred.
____ I disagree with the amount of the overpayment.
____ I believe the overpayment occurred through no fault of my own and request a
waiver.
Explain:_______________________________________________________________
______________________________________________________________________
______________________________________________________________________

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Signed________________________________________Date:__________________
HENRY M. EMERICK, JR
MEMORANDUM FOR THE FILE
ISSUE: The issue for determination is whether the claimant was overpaid compensation
for the period through in the amount of $ and whether or not the claimant was with fault
in the creation of the overpayment.
BACKGROUND:

CALCULATION OF OVERPAYMENT:
BASIS FOR DECISION: Under Section 10.433 of Title 20 of the Code of Federal
Regulations, a recipient will be found with fault with respect to creating an overpayment
who:
(1) Made an incorrect statement as to a material fact which he or she knew or
should have known to be incorrect; or
(2) Failed to provide information which he or she knew or should have known to
be material; or
(3) Accepted a payment which he or she knew or should have known to be
incorrect. (This provision applies only to the overpaid individual.)
The office has made a preliminary finding that the claimant is with fault in the creation of
the overpayment because they were aware or should have reasonably been aware

CONCLUSION: We have made a preliminary finding that an overpayment in the amount
of $ occurred, covering the period through , and that the claimant is with fault in its
creation, because they knowingly accepted compensation to which they were not
entitled.

Michelle Walker
May 11, 2006