OMB control number
Important Information About Your Appeal, Waiver Rights and Repayment Options
OMB 0960-0779 · SSA.
OMB 0960-0779
This collection is a voluntary, one-time collection, for the respondents to let SSA know that they want to request a lower rate of benefit withholding, installment payments, an explanation of the overpayment, an appeal, or a waiver. Respondents can complete the form and return it to an SSA office, or they may also contact SSA via telephone or via an in-office visit. The respondent is not required to complete this form; however, they may complete this form alone or with help. The respondents are individuals who are overpaid Social Security payments.
The latest form for Important Information About Your Appeal, Waiver Rights and Repayment Options expires 2027-11-30 and is listed under ICR 202108-0960-002.
Latest Forms, Documents, and Supporting Material
Form SSA-3105 Important Information About Your Appeal, Waiver Rights, and Repayment Options
Supporting Statement - 0779 (Final).docx
Important Information About Your Appeal, Waiver Rights, and Repayment Options - Paper FormAll Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202108-0960-002 | Revision of a currently approved collection | 2022-01-13 | ||
| 201807-0960-017 | Revision of a currently approved collection | 2018-11-14 | Approved without change | |
| 201507-0960-010 | Revision of a currently approved collection | 2015-10-16 | Approved without change | |
| 201210-0960-005 | Revision of a currently approved collection | 2013-01-15 | Approved without change | |
| 200910-0960-008 | Existing collection in use without an OMB Control Number | 2010-03-02 | Approved without change |
OMB Details
Important Information About Your Appeal, Waiver Rights and Repayment Options - Debt Management System
Federal Enterprise Architecture: Income Security - General Retirement and Disability