Ssa 632 Bk Form PDF Details

Navigating the complexities of the Social Security Administration's forms can sometimes feel like an overwhelming task. Among these, the SSA-632-BK form plays a vital role for individuals facing the daunting situation of an overpayment recovery request. This form is essentially a lifeline for those who believe that the overpayment was not their fault or those who find themselves in financial straits and unable to return the overpaid amount. It encompasses a broad array of scenarios, from disagreements over the fault of overpayment to the fairness of the recovery process, and even includes an avenue for appeal through the SSA-561 form for those who dispute the overpayment decision itself. For individuals not seeking a waiver or those embroiled in more extensive appeals requiring an Administrative Law Judge, alternative forms like the HA-501-U5 or the SSA-634 are recommended. The form caters to a variety of situations — whether you're a representative payee inquiring on behalf of someone else, disputing the responsibility for a family member's overpayment, or simply struggling to determine how to navigate the aftermath of receiving an overpayment notice. Filling out the SSA-632-BK requires a thorough and accurate account of one's financial situation, with supporting documents that substantiate one's inability to reimburse the overpaid amounts. This process is not only about presenting one's financial distress but also involves an examination of the causes of overpayment, the individual's understanding and reporting of changes that might affect their benefits, and previous instances of overpayment. Understanding and correctly submitting the SSA-632-BK is crucial for individuals seeking relief from the financial burden of overpayment recovery, providing a detailed framework for the Social Security Administration to evaluate requests for waiver with fairness and diligence.

Question	Answer
Form Name	Ssa 632 Bk Form
Form Length	14 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	3 min 30 sec
Other names	social security waiver form ssa 632, ssa 632 bk, waiver form ssa 632, ssa 632

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Form SSA-632-BK (04-2019) UF
Discontinue Prior Editions	Page 1 of 14
Social Security Administration	OMB No. 0960-0037

Request for Waiver of Overpayment Recovery

When To Complete This Form

Complete this form if any of the following applies:

•

You think that you are not at fault for the overpayment and you cannot afford to pay the money back.

You think that you are not at fault and you think the overpayment is unfair for some other reason.

We will use your answers to decide if you have to pay the money back. If we decide you do not have to pay the money back, we call it a waiver. If you also think we made a mistake when we decided that you were overpaid, or if you disagree with the amount of your overpayment, please also complete the SSA-561, Request for Reconsideration. We call this action an appeal.

When Not To Complete This Form

•

If you do not wish to request a waiver, but you think we made a mistake when we decided that you were overpaid, or if you disagree with the amount of your overpayment. Instead, please complete the SSA-561, Request for Reconsideration.

You are requesting a hearing before an Administrative Law Judge. Instead, please complete the HA-501-U5, Request for Hearing by Administrative Law Judge.

You only want to change the amount of money you must pay us back each month. Instead, please complete the SSA-634, Request for Change in Overpayment Recovery Rate.

You have been convicted of fraud relating to this overpayment.

SECTION 1 - IDENTIFYING QUESTIONS

IMPORTANT: Please answer the following questions as completely as you can and submit any supporting documents with your waiver request. If you need more space for answers, use the "REMARKS" section on page 11.

A. What is the name, Social Security Number, and claim number (if any) of the overpaid person? Name:

SSN:		Claim Number:

B. Are you the overpaid person?	Yes (go to 4)		No (go to 1.C)

C. If you are filling out the waiver request for the overpaid person, what is your relationship to the overpaid person? (check all that apply)

I am the overpaid person's parent.	I am the overpaid person's representative payee.
I am the overpaid person's spouse.	I am the overpaid person's legal guardian.
Other, please explain:

(Options continue on next page)

Form SSA-632-BK (04-2019) UF

Page 2 of 14

D. If you are not the overpaid person, what is your name or the name of the organization you represent?

Name:

E. If you are the overpaid person's representative payee, were you the representative payee when

the overpayment occurred?

Yes

SECTION 2 - QUESTIONS FOR REPRESENTATIVE PAYEE

IMPORTANT: If you were the representative payee for the overpaid person when the overpayment occurred, complete Section 2 as it applies to you as the representative payee. Otherwise, go to Section 4.

A. Was the overpaid person living with you when he or she was overpaid?			Yes	No

B. Does the overpaid person currently live with you?	Yes	No

C. Are you requesting a waiver for a minor child?	Yes	No
D. Did you tell us about the change or event that caused the overpayment?			Yes	No

E. Do you still have any of the overpaid money?

Yes (go to 2.F)

No (go to 2.G)

F. How much of the overpaid money do you still have? $

G. Did you use the overpaid money for the beneficiary?

Yes

No (go to 2.H)

H. Explain how you used the overpaid money:

SECTION 3 - IF YOU ARE RESPONSIBLE FOR A FAMILY MEMBER'S OR ANOTHER INDIVIDUAL'S OVERPAYMENT

IMPORTANT: If we told you in the overpayment notice that you are responsible for a family member's overpayment, complete Section 3. Otherwise, go to Section 4.

A. Did we tell you in the overpayment notice that you are responsible for paying back another

individual's overpayment?	Yes (go to 3.B)		No (go to 4)

B. Was the overpaid person living with you when he or she was overpaid?				Yes	No

C. Did you receive any of the overpaid money?		Yes	No

SECTION 4 - INFORMATION ABOUT RECEIVING THE OVERPAYMENT

IMPORTANT: Please complete questions 4 through 26 as completely as you can. If you are answering the questions for someone else or if you are helping someone fill out the form, check the boxes and answer each question as it applies to the overpaid person.

What was your situation when the overpayment occurred? (Check all that apply) I was a child when the overpayment occurred.

I was an adult when the overpayment occurred.
I was receiving disability benefits from Social Security.	(Options continue on next page)

Form SSA-632-BK (04-2019) UF

Page 3 of 14

I was receiving retirement benefits from Social Security.

I was receiving Social Security benefits from a parent's record.

I was receiving Social Security benefits as a widow/widower.

I was receiving Social Security benefits as a spouse.

I was receiving Supplemental Security Income (SSI) payments.

None of the above, please explain:

5.What is your reason for requesting a waiver? (Check all that apply)

	A.	The overpayment was not my fault.
	B.	I cannot afford to pay the money back.
	C.	The overpayment is unfair for other reasons.
		Please explain:

	D.	I thought I still had a disability that would make me eligible for benefits. I filed an appeal and I
		fully cooperated with Social Security.
	E.	I was age 18 and receiving SSI when the overpayment occurred.
	F.	None of the above, please explain:

6.	Are you requesting a waiver for your entire overpayment amount?				Yes	No

7.	Have you previously filed a waiver request for this overpayment?				Yes	No

	Do you have the notice for this overpayment?		Yes	No (go to 11)
8.	If you have the notice for this overpayment, please provide the date on that notice.
							(MM/DD/YYYY)

If you have the notice for this overpayment, please provide the following information: First month you were overpaid

9.Last month you were overpaid

If you were overpaid only one month, please provide the month

10.If you have the notice for this overpayment, please provide the amount of the overpayment. $

11.What was the cause of the overpayment?

(Check all that apply)

A.	I received too much income.
B.	My household received too much income.
C.	My resources were over the amount for SSI.
D.	I received help for food and shelter.
E.	I received more than one benefit payment for the same month.
F.	The Social Security Administration determined that I was no longer disabled.
G.	My marital status changed.
H.	I received workers' compensation.
I.	I was in a nursing home.
J.	I was in jail or prison.	(Options continue on next page)

Form SSA-632-BK (04-2019) UF					Page 4 of 14

11.	K.	I lived outside the U.S. for 30 consecutive days.
	L.	My immigration status changed.
	M.	Another person became entitled on the same record.
	N.	My attorney fee was not withheld from my benefits.
	O.	I was no longer a student.
	P.	I no longer had a child under age 16 or a disabled child in my care.
	Q.	I was overpaid because:

	R.	I do not know why I was overpaid.

12. A. Do you understand that you are supposed to report changes to us, for example:
		• working		• a change in resources
		• marriage		• a change in income
		• divorce		• a change in school attendance
		• moving		• any other changes that may affect your benefits
			Yes
			No, explain:

B. Is there anything that prevents you from reporting your changes to us?

Yes, please explain:	No

C. Did you tell us about the change or event that led to the overpayment?

Yes, please check one or more reasons below		No, please explain:
I called in
I sent a fax or letter
I sent a fax or letter
I visited a local field office
I visited a local field office
I used electronic wage reporting
I used electronic wage reporting
Other, please explain:

Date(s) you told us about the change or event that led to the overpayment:

Do you have any documentation indicating that you told us about the change or event that led to the overpayment?

Yes, please send it with your waiver request

No, please explain:

D. Have you ever been overpaid before?

Yes (go to 12.E)

No (go to 12.F)

Form SSA-632-BK (04-2019) UF

Page 5 of 14

12.

E. If you were overpaid before, is this overpayment for the same reason?

Yes

I do not know

F. Are you currently receiving any of the following? (Check all that apply)

I am receiving Supplemental Security Income (SSI) payments.

I am receiving Temporary Assistance for Needy Families (TANF).

My claim number is:

I am receiving a pension based on need from the Department of Veterans Affairs (VA)

My claim number is:

IMPORTANT: If you checked any boxes in question 12.F, go to page 13. Please sign, date, provide your address and phone number(s), and proof that you receive TANF or VA pension, if applicable. If this statement does not apply, go to question 13.A.

SECTION 5 - YOUR FINANCIAL STATEMENT

Documents to Support Your Statements

IMPORTANT: To complete Sections 5 through 8 of this form, you should refer to certain documents to support your statements. Please answer all questions and submit any supporting documents with your request. Your supporting documents should be no older than 3 months from the date you are requesting a waiver. Submit similar documents for your spouse and your dependents. A dependent is a person who depends on you for support and whom you can claim on your tax return.

Examples of supporting documents are:

• Current Rent or Mortgage Information		• Recent Bank Statements (checking or
•	2 or 3 Recent Utility, Medical, Charge Card,	•	savings account)
	and Insurance Bills	•	Current Pay Stubs
•	Canceled Checks	•	Your Most Recent Income Tax Return

Please write only whole dollar amounts. Round any cents to the nearest dollar.

13.

14.

15.

A. Did you still have any of the overpaid money at the time you received the overpayment notice?

Yes Amount $	(go to 13.B)	No (go to 14)

B. Do you still have any of the overpaid money?
Yes Amount $			No

(If yes, return the money to SSA following the instructions in the
overpayment notice or contact SSA at 1-800-772-1213.)

Did you receive any real estate after you received the overpayment notice?

Yes (provide the value)

Value: $

A. Did you give away any real estate after you received your overpayment notice?

Yes (provide the value)

Value: $

B. Did you sell any real estate after you received your overpayment notice?

Yes (provide the amount)

Amount you received after selling: $

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With regards to the blanks of this specific document, here's what you should consider:

1. You should complete the waiver form ssa 632 properly, therefore be careful when filling out the sections containing these blank fields:

form 632 writing process described (portion 1)

2. Once your current task is complete, take the next step – fill out all of these fields - you represent, Name, E If you are the overpaid persons, the overpayment occurred, Yes, SECTION QUESTIONS FOR, IMPORTANT If you were the, A Was the overpaid person living, Yes, B Does the overpaid person, Yes, C Are you requesting a waiver for, Yes, D Did you tell us about the change, and Yes with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Yes, A Was the overpaid person living, and Name inside form 632

3. This next section will be focused on Yes go to F, No go to G, F How much of the overpaid money, G Did you use the overpaid money, Yes, No go to H, H Explain how you used the, SECTION IF YOU ARE RESPONSIBLE, INDIVIDUALS OVERPAYMENT, IMPORTANT If we told you in the, A Did we tell you in the, individuals overpayment, Yes go to B, No go to, and B Was the overpaid person living - type in all of these blanks.

Be very careful while filling in No go to and F How much of the overpaid money, because this is where many people make some mistakes.

4. To go ahead, this fourth section involves filling in several fields. Included in these are B Was the overpaid person living, Yes, C Did you receive any of the, Yes, SECTION INFORMATION ABOUT, IMPORTANT Please complete, What was your situation when the, I was a child when the overpayment, I was an adult when the, I was receiving disability, and Options continue on next page, which you'll find essential to carrying on with this form.

The right way to complete form 632 stage 4

5. To wrap up your form, this final subsection incorporates some extra blank fields. Entering Form SSABK UF, Page of, I was receiving retirement, I was receiving Social Security, I was receiving Social Security, I was receiving Social Security, I was receiving Supplemental, None of the above please explain, What is your reason for requesting, The overpayment was not my fault, I cannot afford to pay the money, The overpayment is unfair for, Please explain, D I thought I still had a, and fully cooperated with Social is going to finalize everything and you'll be done in the blink of an eye!

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