If you agree that you were overpaid and you’re willing to pay it back, but you can’t afford to pay it back at the rate Social Security has told you, you can complete a Request for Change in Overpayment Recover Rate, SSA-634 Form. You will have to provide financial information, and you may need to submit supporting documents like paystubs, tax returns, rental agreement, and bank statements.
Section 1 - Identifying questions & overpayment information. List your personal information, the total amount you owe, and the amount you can afford to pay. Enter the total amount from your most recent notice. For the amount you can afford to pay, we recommend entering $10. This is the lowest amount allowed. You can pay more, if you can afford it. You will not be approved for a monthly payment lower than $10.
Section 2 - Assets. List out things that you own and their value.
Section 3 - Income. List out sources and amounts of income.
Section 4 - Expenses. List out amounts spent in each category.
Section 5 - Income & expense comparison. Calculate how much you have left after you pay your expenses. Explain how you get by if you have more expenses than income.
Section 6 - Expected inheritance. Provide information about any inheritances you are expecting. Leave it black if you are not expected any inheritance.
There is a Remarks Space where you can enter any information you did not have room elsewhere.
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If it applies to your situation, complete the Request for Change in Overpayment Recovery Rate form. For question 4, put $10, unless you can afford to pay more.
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