Regional Application (NY Debt Management-NYDM)

MSSICS                   OVERPAYMENT DECISIONS                UOPD

123‑45‑6789      JOHN     SMITH

SEQUENCE NUMBER   001   AMOUNT      800.00   UNRESOLVED AMOUNT      800.00

SELECT: 01

 

1=WAIVER                            10=RECOVER BY INSTALLMENTS

2=APPEAL                            11=COMPROMISE SETTLEMENT

3=RECOVER BY CHECK ADJUSTMENT       12=INCORRECT OVERPAYMENT

4=UNWILLING TO REPAY                13=RECOVER FROM TITLE II BENEFITS

5=UNABLE TO REPAY                   14=REFERRAL TO DOJ (CIVIL SUIT)

6=UNCOLLECTABLE                     15=REFERRAL TO OIG

7=ERRONEOUS                         16=REFERRAL TO TREASURY

8=UNABLE TO LOCATE/OUT OF COUNTRY   17=BANKRUPTCY

9=OVERPAYMENT TO BRING FORWARD

 

DECISION AMOUNT:    300.00

NEGOTIATED RATE:                          OR TEN PERCENT (Y):

FEDERAL (Y):                              OR STATE CODE:  

ANOTHER DECISION (Y): Y

 

MSSICS                         WAIVER                      UOWV

 123-45‑6789   JOHN      SMITH

SEQUENCE NUMBER 001   AMOUNT    800.00   UNRESOLVED AMOUNT    800.00

WAIVER REQUEST DATE (MMDDYY): 092801

IF WAIVER DECISION MADE,

   REASON: 5   1=DENIED   ‑ AT FAULT

               2=DENIED   ‑ ABLE TO REPAY

               3=APPROVED ‑ PRIOR TO 9/2001 (SYSTEMS DERIVED)

               4=APPROVED - ADMINISTRATIVE

               5=APPROVED - EXCESS RESOURCES WITHIN TOLERANCE

               6=APPROVED - DEEMED TO DEFEAT THE PURPOSE OF TITLE XVI

               7=APPROVED - DEFEATS THE PURPOSE OF TITLE XVI

               8=APPROVED - AGAINST EQUITY AND GOOD CONSCIENCE

   DATE (MMDDYY): 092801

DECISION AMOUNT:   300.00

 

MSSICS                 OVERPAYMENT DECISIONS               UOPD

123‑45‑6789       JOHN       SMITH

SEQUENCE NUMBER   001   AMOUNT   800.00   UNRESOLVED AMOUNT   500.00

SELECT: 01

 

1=WAIVER                            10=RECOVER BY INSTALLMENTS

2=APPEAL                            11=COMPROMISE SETTLEMENT

3=RECOVER BY CHECK ADJUSTMENT       12=INCORRECT OVERPAYMENT

4=UNWILLING TO REPAY                13=RECOVER FROM TITLE II BENEFITS

5=UNABLE TO REPAY                   14=REFERRAL TO DOJ (CIVIL SUIT)

6=UNCOLLECTABLE                     15=REFERRAL TO OIG

7=ERRONEOUS                         16=REFERRAL TO TREASURY

8=UNABLE TO LOCATE/OUT OF COUNTRY   17=BANKRUPTCY

9=OVERPAYMENT TO BRING FORWARD

 

DECISION AMOUNT:    500.00

NEGOTIATED RATE:                       OR TEN PERCENT (Y):

FEDERAL (Y):                           OR STATE CODE:  

ANOTHER DECISION (Y): Y

 MSSICS                           WAIVER                       UOWV

 123-45‑6789   JOHN      SMITH

SEQUENCE NUMBER 001   AMOUNT    800.00   UNRESOLVED AMOUNT    500.00

WAIVER REQUEST DATE (MMDDYY): 092801

IF WAIVER DECISION MADE,

   REASON: 2   1=DENIED   ‑ AT FAULT

               2=DENIED   ‑ ABLE TO REPAY

               3=APPROVED ‑ PRIOR TO 9/2001 (SYSTEMS DERIVED)

               4=APPROVED - ADMINISTRATIVE

               5=APPROVED - EXCESS RESOURCES WITHIN TOLERANCE

               6=APPROVED - DEEMED TO DEFEAT THE PURPOSE OF TITLE XVI

               7=APPROVED - DEFEATS THE PURPOSE OF TITLE XVI

               8=APPROVED - AGAINST EQUITY AND GOOD CONSCIENCE

   DATE (MMDDYY): 092801

 

DECISION AMOUNT:   500.00

MSSICS                OVERPAYMENT DECISIONS                 UOPD

123‑45‑6789       JOHN       SMITH

SEQUENCE NUMBER   001   AMOUNT   800.00   UNRESOLVED AMOUNT   500.00

SELECT: 03

 1

1=WAIVER                            10=RECOVER BY INSTALLMENTS

2=APPEAL                            11=COMPROMISE SETTLEMENT

3=RECOVER BY CHECK ADJUSTMENT       12=INCORRECT OVERPAYMENT

4=UNWILLING TO REPAY                13=RECOVER FROM TITLE II BENEFITS

5=UNABLE TO REPAY                   14=REFERRAL TO DOJ (CIVIL SUIT)

6=UNCOLLECTABLE                     15=REFERRAL TO OIG

7=ERRONEOUS                         16=REFERRAL TO TREASURY

8=UNABLE TO LOCATE/OUT OF COUNTRY   17=BANKRUPTCY

9=OVERPAYMENT TO BRING FORWARD

 

DECISION AMOUNT:    500.00

NEGOTIATED RATE:                          OR TEN PERCENT (Y): Y

FEDERAL (Y):                              OR STATE CODE:  

ANOTHER DECISION (Y):

MSSICS              MISCELLANEOUS DATA             PAGE 1 OF CMSC

123‑45‑6789    JOHN  SMITH                                TRANSFER TO:

  REASON EFFECTIVE FILING DATE IS OVER 90 DAYS OLD:

         1=PROTECTIVE FILING DATE              4=ADMINISTRATIVE DELAY

         2=APPEAL REVERSAL                     5=CASE ESTAB AFTER T30/NO

         3=REOPENED PRIOR CLAIM                  START DATE REQUIRED

  OVERRIDE MBR INTERFACE EDITS (Y):            FORCE MBR INTERFACE (Y):

  OVERRIDE NUMIDENT INTERFACE EDITS (Y):       FORCE NUMIDENT INTERFACE (Y):

  GRANT REIMBURSEMENT CODE:                 DELETE GRANT REIMBURSEMENT CODE (Y):

MSSICS           MISCELLANEOUS DATA                 PAGE 2 OF CMSC

123‑45‑6789   JOHN  SMITH                                TRANSFER TO:

 

CASE RELATED DATA: WARE

  EAP OR IP PAYMENT AMOUNT:                  REDUCE EAP/IP AMOUNT:

                    EAP/IP ACTION DATE (MMDDYY):

  EXCLUDED STATISTICS CODE:

 

H.              RESULT

   CRZD CG:  WARE

   OPSQ C OPB   OPE   OPA     AX  TS  SQD   NTD     SQR    SBL    BAL

     01   0401  0801   800.00     AN 082801 A‑090401      .00     .00

   OPDD DTE        AMT      USD    SCD   DOC TR1  OSN FIL      L DEC      R

        09/28/01   300.00    .00         033 W    01

        09/28/01   500.00    .00         033 WX   01

        09/28/01   500.00    .00         033 D    01