OMB control number
Important Information About Your Appeal, Waiver Rights and Repayment Options
OMB 0960-0779 · SSA.
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 can be found here.
Document Name |
|---|
Form and Instruction |
Form and Instruction |
Public Comments |
Supporting Statement A |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
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 Form | Revision of a currently approved collection | 2022-01-13 | ||
|
Approved without change |
Revision of a currently approved collection | 2018-11-14 | |
|
Approved without change |
Revision of a currently approved collection | 2015-10-16 | |
|
Approved without change |
Revision of a currently approved collection | 2013-01-15 | |
|
Approved without change |
Existing collection in use without an OMB Control Number | 2010-03-02 |
Important Information About Your Appeal, Waiver Rights and Repayment Options - Debt Management System
Federal Enterprise Architecture: Income Security - General Retirement and Disability