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Important Information About Your Appeal, Waiver Rights, And Repayment Options

Download and Print the SSA-3105

Request may not be processed if the form is incomplete or illegible.

If you think we made a mistake when we decided that you were overpaid or in the amount of the overpayment, you have the right to ask us to look at the overpayment decision again within 60 days of this notice. This is called a RECONSIDERATION. (See next page for an explanation.)

Even if you agree that you were overpaid, you have the right to ask that we do not recover the overpayment. This is called a WAIVER. (See next page for an explanation.)

You have the right to ask for either Reconsideration, Waiver, or both. You may also wish to use one of the repayment options listed on page 4.


You or someone who will represent you should call, write or visit your local Social Security office to help you complete the necessary forms which are:

SSA-561-U2, Request for Reconsideration

SSA-632-F4 Request for Waiver of Overpayment Recovery or Change in Repayment Rate

You may find these forms online at If you want to request Reconsideration or Waiver, but do not want to call or visit an office, fill out the tear-off form on the last page of this notice. Return the completed form in the enclosed self-addressed envelope.

And much more...