Looking for a Social Security Forms And Templates? Download it for free!

Form Ssa-632-Bk - Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate

62&,$/ 6(&85,7< $'0,1,675$7,21

A‚…€Ã6ƒƒ…‚‰rq

PH7ÃI‚Ã(%"&

5HTXHVW )RU :DLYHU 2I 2YHUSD\PHQW 5HFRYHU\ 2U &KDQJH ,Q 5HSD\PHQW 5DWH

)25 66$ 86( 21/<

52$5 ,QSXW

:H ZLOO XVH \RXU DQVZHUV RQ WKLV IRUP WR GHFLGH LI ZH FDQ ZDLYH

<HV

FROOHFWLRQ RI WKH RYHUSD\PHQW RU FKDQJH WKH DPRXQW \RX PXVW SD\ XV

EDFN HDFK PRQWK ,I ZH FDQ W ZDLYH FROOHFWLRQ ZH PD\ XVH WKLV IRUP

,QSXW 'DWH

WR GHFLGH KRZ \RX VKRXOG UHSD\ WKH PRQH\

:DLYHU

$SSURYDO

'HQLDO

3OHDVH DQVZHU WKH TXHVWLRQV RQ WKLV IRUP DV FRPSOHWHO\ DV \RX FDQ

:H ZLOO KHOS \RX ILOO RXW WKH IRUP LI \RX ZDQW ,I \RX DUH ILOOLQJ RXW

66,

<HV

WKLV IRUP IRU VRPHRQH HOVH DQVZHU WKH TXHVWLRQV DV WKH\ DSSO\ WR WKDW

$07 2) 23

SHUVRQ

3(5,2' '$7(6 2) 23

$ 1DPH RI SHUVRQ RQ ZKRVH UHFRUG

% 6RFLDO 6HFXULW\ 1XPEHU

WKH RYHUSD\PHQW RFFXUUHG

& 1DPH RI RYHUSDLG SHUVRQV PDNLQJ WKLV UHTXHVW DQG KLVKHU 6RFLDO 6HFXULW\ 1XPEHUV

&KHFN DQ\ RI WKH IROORZLQJ WKDW DSSO\ $OVR )LOO LQ WKH GROODU DPRXQW LQ % & RU '

7KH RYHUSD\PHQW ZDV QRW P\ IDXOW DQG , FDQQRW DIIRUG WR SD\ WKH PRQH\ EDFN DQGRU LW LV

XQIDLU IRU VRPH RWKHU UHDVRQV

, FDQQRW DIIRUG WR XVH DOO RI P\ PRQWKO\ EHQHILW WR SD\ EDFN WKH RYHUSD\PHQW +RZHYHU , FDQ

ZLWKKHOG HDFK PRQWK

DIIRUG WR KDYH

, DP QR ORQJHU UHFHLYLQJ 6XSSOHPHQW 6HFXULW\ ,QFRPH 66, SD\PHQWV , ZDQW WR SD\ EDFN

HDFK PRQWK LQVWHDG RI SD\LQJ DOO RI WKH PRQH\ DW RQFH

, DP UHFHLYLQJ 66, SD\PHQWV , ZDQW WR SD\ EDFN

HDFK PRQWK LQVWHDG RI SD\LQJ

RI P\ WRWDO LQFRPH

3DJH

APSHÃTT6%"!7FÃ#( ÃÃ@AÃ'((

Form Ssa-632-Bk - Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate