Sample Letter Explained Form (Page 3 of 3) in pdf

To:

Department of the Treasury

Office of D.C. Pensions

Attn: Employee Relations Team

U.S. Department of the Treasury

Washington, D.C. 20220

Re:

Request for Reconsideration and Waiver of Debt – Name of Retiree _____________________________

I am a retired member of the District of Columbia Fire and Emergency Medical Services ("DCFEMS"). I was

appointed to DCFEMS on ______________. I retired on _______________. I am ___ years old; my date of birth is

________________. My pension is ___(not) my sole source of income.

On ________________ I received a letter from ODCP informing me that the Government had over paid my

pension and that ODCP was taking action to collect $___________ in alleged overpayments. A copy of the letter I

received is enclosed herewith.

Also enclosed is the completed Request for Reconsideration of Benefit

Determination Cover Sheet sent to me with the collection letter. I hereby request reconsideration of the ODCP

decision and a waiver of the collection action. I also request that I be provided with all documentation which is the

basis for the collection action.

Basis for reconsideration and waiver request:

(1)

The alleged overpayment did not involve fraud, misrepresentation or lack of good faith on my

part; the overpayment was entirely due to a mistake(s) by the Government.

(2)

I am not at fault in causing or contributing to the alleged overpayment. I did not provide any

fraudulent or incorrect information, nor was I aware of any mistake in my pension payments. I completed all

the information required to retire from DCFEMS and I trusted the Government to make the correct

calculation of my retirement benefits. If I had known that my pension payments were incorrect, I would have

notified DCFEMS or the D.C. Retirement Board. I do not manage the retirement system, the Government does.

The alleged error was not obvious and is not one I would have easily detected.

(3)

Collecting this alleged debt from me would be against equity and good conscience. A

collection action against me would cause me a severe personal and financial hardship.

(4)

I am ___ years old. I have ____ (no) other sources of income. I have the following health

conditions and limitations ____________________________________________________. I need substantially all

of my pension payments to meet my current financial obligations and my current and anticipated ordinary and

necessary living expenses, which include rent/mortgage payments of $_______ per month, utilities of $________

per month, home maintenance of $______ per month, transportation costs of $_______ per month, food costs of

$______ per month, clothing costs of $______ per month, life insurance costs of $______ per month, health

insurance costs of $_______ per month, accident insurance of $_______ per month and the following expenses

which are ordinary and necessary __________________________________________________________.

________________________________________________________________________________ I do ___ (not)

have any substantial liquid assets or other income from which I could pay this alleged debt.

_______________________________

Signature

_______________________________

Printed Name

Identifying Information on ODCP letter

_______________________________

________________________________________

Address

Date Request for Reconsideration sent to ODCP

Sample Letter Explained Form Page 3

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