Download:
pdf |
pdfRequest For Waiver Of Overpayment Recovery Or Change In Repayment Rate - Form SSA-632-BK
noco t p i kS
Social Security Online
www.socialsecurity.gov
Social Security Forms
Home
Questions ?
Contact Us
Search
Forms Home Page
Request For Waiver Of Overpayment Recovery Or
Change In Repayment Rate - Form SSA-632-BK
When To Use this
Form
OVERPAYMENT: If SSA determines you have received
benefits to which you are not entitled we will request you
refund the overpayment. The letter we send will tell you that
if you believe you should not have to pay the money back
you should file a request for waiver of overpayment
recovery. To file a formal waiver request, you need to
complete a form SSA-632-BK, Request for Waiver of
Overpayment Recovery or Change In Repayment Rate.
RECONSIDERATION VS WAIVER: If you feel that the
overpayment amount is incorrect, or that you are not really
overpaid, you may file a form SSA-561-U2, Request for
Reconsideration. If you agree that you have been overpaid
but you feel you should not have to pay it back because you
did not cause the overpayment and you cannot afford to
refund it or repaying it would be unfair, you should file the
form SSA-632-BK, Request for Waiver of Overpayment
Recovery Or Change In Repayment Rate.
If you disagree with the overpayment decision and feel you
should not have to pay it back even if you were overpaid,
you can file both reconsideration and waiver.
EVIDENCE: When you file a request for waiver you need to
present any papers you have verifying your financial
statements. This would include items such as current bank
statements, utility bills, pay stubs, credit card payments,
loan payments, etc. If you do not have these records
immediately available, do not delay filing. You have up to
thirty days from filing the request to supply them.
The following section explains how to complete the SSA632-BK. The SSA-632-BK and supporting documents
should be either mailed or taken to your local Social
Security office. If you have further questions about the SSA632-BK, or any other Social Security matter, you may call 1800-772-1213 or contact your local SSA office.
How To Obtain the
Form
Below you will find the SSA-632-BK REQUEST FOR
http://www.ssa.gov/online/ssa-632.html[12/4/2008 2:39:50 PM]
GO
Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate - Form SSA-632-BK
both the balances and the income earned each month.
16. Be sure to list the vehicles and real property for both
yourself and your household members.
17. through 19. Read each question carefully, filling-in the
blanks with incomes for you, your spouse, and all other
individuals listed in #14. Make sure to list on a monthly
basis. The note on the top of page 5 tells you how to handle
weekly, bi- weekly and yearly amounts.
20. List the total household expenses, again converting to
monthly figures.
21. through 23. Complete as indicated.
Remarks: Use to continue answers to prior questions. Make
sure to put the question number, to which you are referring,
first . If you need more space continue on any blank sheet
of paper.
Sign and date- List your mailing address and the phone
number(s) 0where you can be reached.
Where To Send the
Form
For More Information
Print the PDF SSA-632-BK form on 8 1/2 x 11 inch paper,
complete and sign form, fold in thirds, insert it in a standard
size number 10 business envelope (4 1/8 x 9 1/2) and mail
to your closest Social Security office. If you are not sure
where your local office is located, try our Social Security
Office Locator service or call 1-800-772-1213.
Overpayment Information
Reconsideration Information
Form SSA-561-U2 Request For Reconsideration
Privacy Policy | Website Policies & Other Important Information | Site Map
Last reviewed or modified Monday Jan 14, 2008
http://www.ssa.gov/online/ssa-632.html[12/4/2008 2:39:50 PM]
Need
Larger Text?
Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate - Form SSA-632-BK
WAIVER OF OVERPAYMENT RECOVERY OR CHANGE
IN REPAYMENT RATE in Portable Document Format
(PDF) . The PDF permits you to print out a duplicate of the
original form using ANY graphics printer. The PDF was
developed by Adobe Systems, Inc. and allows the reader to
print a publication close in appearance to the original
printed version, preserving typography, columns, charts,
tables and graphics.
To read and print a PDF publication, you must have the
Adobe Acrobat Reader software installed on your PC.
Adobe Systems, Inc. permits the Social Security
Administration and other organizations to offer this software
to the public free of charge. You can download the Adobe
Acrobat Reader version suitable for your system by clicking
on this button .
After you download the Adobe Acrobat Reader, come back
to this page and download the PDF version of the SSA-632BK below. PDF files are printer independent and should
print easily on any graphics printer.
SSA-632-BK in
How To Complete the
Form
1. IDENTIFYING INFORMATION:
A. RECORD HOLDER'S NAME AND SOCIAL SECURITY
NUMBER- If you receive Social Security benefits because
of your own work or if you receive Supplemental Security
Income (SSI) payments, enter your own name and Social
Security number. If you receive Social Security benefits from
another person's work, enter that person's name and Social
Security number.
B. Names and Social Security numbers of all overpaid
individuals for whom a waiver is being requested.
2. Check as many blocks as apply and fill-in the dollar
amounts if you have checked blocks B., C., or D.
SECTION I: INFORMATION 3. through 7. Answer the
questions and fill-in the narratives in your own words
explaining those answers.
9., 10.,
10., and
12., 13.
and 13
SECTION II: FINANCIAL STATEMENT 9.,
Answer in all cases, filling in the narrative portions.
10. and 12.
11. Answer only if you are overpaid SSI.
11.
14. List your dependents who live with you regardless of
relation.
15. List for yourself and anyone listed in #14. Be sure to list
http://www.ssa.gov/online/ssa-632.html[12/4/2008 2:39:50 PM]
Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate - Form SSA-632-BK
noco t p i kS
Social Security Online
www.socialsecurity.gov
Social Security Forms
Home
Questions ?
Contact Us
Search
Forms Home Page
Request For Waiver Of Overpayment Recovery Or
Change In Repayment Rate - Form SSA-632-BK
When To Use this
Form
OVERPAYMENT: If SSA determines you have received
benefits to which you are not entitled we will request you
refund the overpayment. The letter we send will tell you that
if you believe you should not have to pay the money back
you should file a request for waiver of overpayment
recovery. To file a formal waiver request, you need to
complete a form SSA-632-BK, Request for Waiver of
Overpayment Recovery or Change In Repayment Rate.
RECONSIDERATION VS WAIVER: If you feel that the
overpayment amount is incorrect, or that you are not really
overpaid, you may file a form SSA-561-U2, Request for
Reconsideration. If you agree that you have been overpaid
but you feel you should not have to pay it back because you
did not cause the overpayment and you cannot afford to
refund it or repaying it would be unfair, you should file the
form SSA-632-BK, Request for Waiver of Overpayment
Recovery Or Change In Repayment Rate.
If you disagree with the overpayment decision and feel you
should not have to pay it back even if you were overpaid,
you can file both reconsideration and waiver.
EVIDENCE: When you file a request for waiver you need to
present any papers you have verifying your financial
statements. This would include items such as current bank
statements, utility bills, pay stubs, credit card payments,
loan payments, etc. If you do not have these records
immediately available, do not delay filing. You have up to
thirty days from filing the request to supply them.
The following section explains how to complete the SSA632-BK. The SSA-632-BK and supporting documents
should be either mailed or taken to your local Social
Security office. If you have further questions about the SSA632-BK, or any other Social Security matter, you may call 1800-772-1213 or contact your local SSA office.
How To Obtain the
Form
Below you will find the SSA-632-BK REQUEST FOR
http://www.ssa.gov/online/ssa-632.html[12/4/2008 2:39:50 PM]
GO
Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate - Form SSA-632-BK
both the balances and the income earned each month.
16. Be sure to list the vehicles and real property for both
yourself and your household members.
17. through 19. Read each question carefully, filling-in the
blanks with incomes for you, your spouse, and all other
individuals listed in #14. Make sure to list on a monthly
basis. The note on the top of page 5 tells you how to handle
weekly, bi- weekly and yearly amounts.
20. List the total household expenses, again converting to
monthly figures.
21. through 23. Complete as indicated.
Remarks: Use to continue answers to prior questions. Make
sure to put the question number, to which you are referring,
first . If you need more space continue on any blank sheet
of paper.
Sign and date- List your mailing address and the phone
number(s) 0where you can be reached.
Where To Send the
Form
For More Information
Print the PDF SSA-632-BK form on 8 1/2 x 11 inch paper,
complete and sign form, fold in thirds, insert it in a standard
size number 10 business envelope (4 1/8 x 9 1/2) and mail
to your closest Social Security office. If you are not sure
where your local office is located, try our Social Security
Office Locator service or call 1-800-772-1213.
Overpayment Information
Reconsideration Information
Form SSA-561-U2 Request For Reconsideration
Privacy Policy | Website Policies & Other Important Information | Site Map
Last reviewed or modified Monday Jan 14, 2008
http://www.ssa.gov/online/ssa-632.html[12/4/2008 2:39:50 PM]
Need
Larger Text?
Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate - Form SSA-632-BK
WAIVER OF OVERPAYMENT RECOVERY OR CHANGE
IN REPAYMENT RATE in Portable Document Format
(PDF) . The PDF permits you to print out a duplicate of the
original form using ANY graphics printer. The PDF was
developed by Adobe Systems, Inc. and allows the reader to
print a publication close in appearance to the original
printed version, preserving typography, columns, charts,
tables and graphics.
To read and print a PDF publication, you must have the
Adobe Acrobat Reader software installed on your PC.
Adobe Systems, Inc. permits the Social Security
Administration and other organizations to offer this software
to the public free of charge. You can download the Adobe
Acrobat Reader version suitable for your system by clicking
on this button .
After you download the Adobe Acrobat Reader, come back
to this page and download the PDF version of the SSA-632BK below. PDF files are printer independent and should
print easily on any graphics printer.
SSA-632-BK in
How To Complete the
Form
1. IDENTIFYING INFORMATION:
A. RECORD HOLDER'S NAME AND SOCIAL SECURITY
NUMBER- If you receive Social Security benefits because
of your own work or if you receive Supplemental Security
Income (SSI) payments, enter your own name and Social
Security number. If you receive Social Security benefits from
another person's work, enter that person's name and Social
Security number.
B. Names and Social Security numbers of all overpaid
individuals for whom a waiver is being requested.
2. Check as many blocks as apply and fill-in the dollar
amounts if you have checked blocks B., C., or D.
SECTION I: INFORMATION 3. through 7. Answer the
questions and fill-in the narratives in your own words
explaining those answers.
9., 10.,
10., and
12., 13.
and 13
SECTION II: FINANCIAL STATEMENT 9.,
Answer in all cases, filling in the narrative portions.
10. and 12.
11. Answer only if you are overpaid SSI.
11.
14. List your dependents who live with you regardless of
relation.
15. List for yourself and anyone listed in #14. Be sure to list
http://www.ssa.gov/online/ssa-632.html[12/4/2008 2:39:50 PM]
| File Type | application/pdf |
| File Title | S632(08).xft |
| Author | 348315 |
| File Modified | 2011-01-06 |
| File Created | 2011-01-06 |