Important Information About Your Appeal, Waiver Rights and Repayment Options (Phone Call Leading to SSA Intranet Entry)

Important Information About Your Appeal, Waiver Rights and Repayment Options

DMS Screen

Important Information About Your Appeal, Waiver Rights and Repayment Options (Phone Call Leading to SSA Intranet Entry)

OMB: 0960-0779

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DMS TRANSFER TO: XXXX PROTEST/STOP RECOVERY REQUEST (FO) DRPF


[1-D] [2-D] [3-D] [4-D]


SSN: SSSSSSSSS SSSSSS S SSSSSSSSSSss ssss BIC: SSS SSSSSs s SSSSSSSSSSss ssss


[5-D] [6-D] [7-D] [8-D]


DEBT NUMBER: SSS DEBT REASON: SS DEBT AMT: SSSSSsSSS DEBTOR AMT: SSSSSSSSS


[9-M]


REQUEST: 99


PROTEST REASONS STOP RECOVERY ACTIONS ECO PROTEST ONLY


1. EXPLANATION 10. FULL REFUND MADE 19. NON-ENFORCEMENT


2. INFORMAL WAIVER 11. WORKSHEET NEEDED 20. REVIEW DEBT


3. INITIAL WAIVER 12. COMPROMISE OFFER MADE 21. FSO REVIEW


4. RECON FACT/AMOUNT 13. SSI CORRECTION NEEDED


5. WAIVER AND RECON FACT/AMT 14. LEG/COURT DECISION


6. RECON - CASE REVIEW


7. HEARING FACT AMOUNT 16. MISCELLANEOUS


8. HEARING WAIVER 17. ALLEG NON-RCPT OF CK



[10-O]


DELETE (Y): X


File Typeapplication/msword
File TitleDMS TRANSFER TO: XXXX PROTEST/STOP RECOVERY REQUEST (FO) DRPF
AuthorLarwood, Debbie
Last Modified ByLarwood, Debbie
File Modified2010-01-29
File Created2010-01-29

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