If you think the overpayment wasn’t your fault and you can’t afford to repay it, you can complete a Request for Waiver of Overpayment Recovery form. Even though Form SSA-632-BK looks long, it should not be too hard to finish, if you have some basic information.
Section 1, Question 1 — Identification
At the bottom of the first page, write your name, Social Security number, and a claim number (if there is one on the Notice of Overpayment). If you are filling out the form for another person, also write your name and your relationship to them (Question 1B).
Section 2, Question 2 — Amount and Reason for Waiver
- The amount of the overpayment can be found on the Notice of Overpayment you received from Social Security. If it’s $2,000 or less, call your local Social Security office to see if they can waive it without the form.
- Check the boxes saying that the overpayment is not your fault (2A) and that you can’t afford to pay it back (2B). It could also be unfair for other reasons (2C), such as because you receive public assistance like SSI, repaying it will put you into debt or make you unable to pay your bills, or you lost money or a right because you believed what Social Security told you. Social Security calls this last situation “against equity and good conscience.”
- Most people ask Social Security to say they don’t have to pay back any of the overpayment.
Section 2, Question 3 — Date of Notice
Write the date on the Notice of Overpayment that Social Security sent you.
Section 2, Question 4 — Full or Remaining Balance
Most people ask Social Security to waive the entire overpayment, including any amount already paid back. If you have already paid some of it back, you can instead ask them to waive only the remaining balance.
Section 2, Question 5 — Why Did the Overpayment Happen?
Write a sentence or two about why you think the overpayment happened. It could be that:
- You didn’t know you had to give Social Security certain information.
- You reported new information, but Social Security didn’t change your check.
- You didn’t know the information you gave Social Security was wrong.
- You thought the checks you received were correct.
Section 3, Question 6 — Public Benefits
Are you or a dependent receiving SSI, TANF (Family Employment Program in Utah), SNAP, Medicare Part D Extra Help, or a pension based on need from the Department of Veterans Affairs? If the answer to any item in Question 6 is “yes,” go to page 9, sign it, and write the date along with your contact information. Remember to turn the form in with proof of your benefit or veterans’ pension, if you have one.
Section 4, Question 7 — Household Information
- If you have a spouse or dependents, put their information in the table (Question 7A). If the waiver request is for a child under 18 whose money helps pay for rent or food, include information for the child’s parents and their other dependents.
- Does someone live with you that you can’t claim on your taxes (Question 7B)? If yes, do they help pay for rent, food, or other bills? If so, write down about how much they pay each month.
Section 5, Question 8 — Cash and Financial Accounts
Write down how much cash you, your spouse, and your dependents have on hand (Question 8A). Also list all financial accounts, including checking, savings, CDs, IRAs, stocks, bonds, prepaid debit cards, and any other accounts (Question 8B).
- Some definitions that may help:
- “Type of Account”: Checking or Savings, for example.
- “Institution”: The name of the place where the money is, like a bank.
- “Name”: The person who owns the account.
- “Balance or value”: How much money is in the account.
- “Income”: Money the bank adds to the account each month (there may not be any).
- Don’t forget to include a copy of the newest statement for each account you list. Highlight or write a short note next to things you want to make sure Social Security sees or understands.
Section 5, Question 9 — Vehicles, Property, and Valuables
- Do you, your spouse, or your dependents own more than one family vehicles (Question 9A)? Include the year, make/model, present value (how much it can be sold for), loan balance (how much is still owed), and its main purpose or use.
- Do you co-own any real estate with someone other than your spouse or dependents (Question 9B)? Include a description, market value (how much it can be sold for), and income amount (rent or other earnings after expenses).
- Do you, your spouse, or your dependents own valuables (like gold, jewelry, or coins) or own part or all of a business (Question 9C)? If so, include those as well.
- Can you sell any of the vehicles, valuables, property, or businesses listed to repay the overpayment (Question 9D)?
Section 6, Questions 10–11 — Employment and Other Income
- Do you, your spouse, or your dependents have a job (Questions 10A–10C)? Write down each employer’s contact information and monthly take-home pay. Include copies of at least one month of paychecks.
- Question 11 is a table covering all other sources of income, including Social Security benefits, pensions, child support, and more. Write down how much each household member receives each month from each source. If none of you receive anything from a listed source, put a zero or leave the line blank. If any of you receive money from a source not listed, write how much on the “Other” line and explain what it is in the Remarks section on page 7. Add it all up and write the total at the bottom. Attach copies of checks or bank statements for anything not already included.
Section 7, Question 12 — Monthly Expenses
- Write down about how much you, your spouse, and your dependents spend on each item in the table each month (rent, utilities, food, insurance, medical, transportation, and more). If you don’t spend anything on an item, put “0” or leave the line blank. Add it all up at the bottom and attach copies of receipts, checks, or bank statements as proof. Highlight or write a short note next to things you want to make sure Social Security sees or understands.
- If you are spending more than you make each month, write a little about how you pay your bills in the Remarks section (for example, credit card, help from family or friends, help from church or a charity). Tell Social Security if there are any bills you can’t pay.
Page 8 — Financial Records Authorization
Mark the first box to authorize Social Security to obtain your financial account records, sign, write your address, and add the date.
Page 9 — Certification and Signature
Sign, date, and write your contact information to certify that everything on the form is true and correct.
This communication is funded through a Social Security Administration grant agreement at taxpay expense. Although SSA reviewed this document for accuracy, it does not constitute an official SSA communication.