FECA Form Letter 2

File Number: 250281977
opprelimnofault-NO-0

U.S. DEPARTMENT OF LABOR
EMPLOYMENT STANDARDS ADMINISTRATION
OFFICE OF WORKERS' COMP PROGRAMS
PO BOX 8300 DISTRICT 52
LONDON, KY 40742-8300
Phone: (202) 693-0045
May 11, 2006
Date of Injury: 04/07/1963
Employee:
Preliminary Determination
Dear Mr.:
The Office of Workers' Compensation Programs (OWCP) has made a preliminary determination that
you have been overpaid benefits in the amount of $ because . This Office has found that you were
without fault in creating the overpayment. If you disagree with the fact or the amount of the
overpayment, you have a right to submit new evidence in support of your belief. The attached
memorandum fully explains the basis for this preliminary finding.
If you agree that you were overpaid this amount, you may send a check or money order for the full
amount to the address shown below. Make the check payable to the U.S. Department of Labor,
OWCP, and include your FECA file number on the check.
U.S. Dept. of Labor
DFEC National Office
P.O. Box 403356
Atlanta, GA 30384-3356
If you are unable to pay the full amount now, submit a completed form OWCP-20 (enclosed) so that
we may determine a fair repayment method.
If you disagree with this preliminary overpayment finding, you may contest it. You have the right to
submit evidence or arguments which you believe will affect these preliminary findings if:
1. You disagree that the overpayment occurred;
2. You disagree with the amount of the overpayment; or
3. You believe that OWCP should waive recovery of the overpayment and request a waiver.
When the claimant is without fault in creating an overpayment, the law at 20 C.F.R. 10.434 states
that OWCP may not recover the overpayment if the recovery would either 1) defeat the purpose of
the Federal Employees' Compensation Act (FECA), which is to provide at least a basic income for
beneficiaries (20 C.F.R. 10.436), or 2) the recovery would be against equity and good conscience (20
C.F.R. 10.437).
Recovery would be against equity and good conscience when:
1. A claimant, acting on incorrect information from OWCP, gives up a valuable right; or

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2. A claimant, acting on incorrect information from OWCP, spends or commits funds in ways which
he or she otherwise would not have done, and suffers a financial loss as a result; or
3. A claimant would suffer severe financial hardship in trying to repay the debt.
Collection of the overpayment will be pursued after the final decision is issued.
ACTIONS YOU MAY TAKE
You may take any one of the following actions by completing the attached "Overpayment Action
Request" and Form OWCP-20 and mailing it to the appropriate address within 30 days:
1. Request a telephone conference with the district office. Send your written request to the
address listed in the letterhead along with completed form OWCP-20 and supporting documents. We
will then contact you to arrange a convenient time for the conference, allowing enough time for you to
prepare. Include any supporting evidence or arguments with your written request.
2. Request that the district office issue a final decision based on the written evidence only. Send
your written request to the address listed in the letterhead along with completed form OWCP-20 and
supporting documents.
3. Request a pre-recoupment hearing before a representative of the Branch of Hearings and
Review by sending your written request (marked "Overpayment Hearing Request" on the envelope)
along with completed form OWCP-20 and any supporting evidence within 30 days, to:
Branch of Hearings and Review
Office of Workers' Compensation Programs
P.O. Box 37117
Washington, D.C. 20013-7117
The hearing will be held at a time and place convenient to you. You may have a representative
present at the hearing, and you should be prepared to present any new evidence or arguments to
dispute the occurrence or amount of the overpayment and/or support your belief that you are without
fault in creating the overpayment and that the overpayment should be waived.
OWCP-20:
In order for OWCP to consider the question of waiver or to determine a reasonable method for
collection, you must complete and submit the enclosed Form OWCP-20. Attach supporting
documents to Form OWCP-20, including copies of income tax returns, bank account statements, bills
and canceled checks, pay slips, and any other records which support the income and expenses
listed. Under 20 CFR 10.438, failure to submit the requested information within 30 days will result in
the denial of waiver, and no further request for waiver shall be considered until the requested
information is furnished.
If you have any questions or require any assistance in responding to this letter, please contact the
district office. If we do not receive a reply from you within 30 days of the date of this letter, we will
issue a final decision based on the information in file.

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Sincerely,

Michelle Walker
Enclosures: Memorandum for the File, Form OWCP-20
US DEPT OF COMMERCE
OHRM OLER RM H1624
WORKERS COMPENSATION BRANCH
14TH AND CONSTITUTION AVE NW
WASHINGTON, DC 20230

File Number: 250281977
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HENRY M. EMERICK, JR
OVERPAYMENT ACTION REQUEST
PART 1:
You may choose only one option. Your request must be submitted to the appropriate
address within 30 days of the date of this letter.
____ I request a telephone conference with the District Office on the issues of fault
and possible waiver of this overpayment. My completed OWCP-20 and supporting
financial documents are enclosed. If you checked this option, mail this request to our
London, KY address.
____ I request that the District Office make a decision based on the written
evidence on the issues of fault and possible waiver of this overpayment. My completed
OWCP-20 and supporting financial documents are enclosed. If you checked this option,
mail this request to our London, KY address.
____ I request a pre-recoupment hearing on the issues of fault and a possible
waiver of this overpayment with the Branch of Hearings and Review. My
completed OWCP-20 and supporting financial documents are enclosed. Depending on
your geographical location and the number of hearing requests in your area, we may be
able to expedite your appeal by offering you a telephone hearing at the discretion of the
hearing representative. If OWCP deems your case suitable for teleconference and
you are open to this option, please check here. _____
Please write "Overpayment Hearing Request" on the envelope and mail this request
directly to the Branch of Hearings and Review at the following address:
Branch of Hearings and Review
Office of Workers' Compensation Programs
P.O. Box 37117
Washington, D.C. 20013-7117
PART 2:
I WISH TO CONTEST THIS OVERPAYMENT BECAUSE:
(Check as many as apply. Please explain, in detail, why you are challenging this
overpayment.)
____ I disagree that the overpayment occurred.
____ I disagree with the amount of the overpayment.
____ I believe the overpayment occurred through no fault of my own and request a
waiver.
Explain:_______________________________________________________________
______________________________________________________________________
______________________________________________________________________

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Signed________________________________________Date:__________________

File Number: 250281977
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HENRY M. EMERICK, JR
MEMORANDUM FOR THE FILE
ISSUE: The issue for determination is whether the claimant was overpaid compensation
for the period to in the amount of $ and whether or not the claimant was at fault in the
creation of the overpayment.
BACKGROUND:

CALCULATION OF OVERPAYMENT:

BASIS FOR DECISION:
Under Section 10.433 of Title 20 of the Code of Federal Regulations, a recipient will be
found with fault with respect to creating an overpayment who:
(1) Made an incorrect statement as to a material fact which he or she knew or should
have known to be incorrect; or
(2) Failed to provide information which he or she knew or should have known to be
material; or
(3) Accepted a payment which he or she knew or should have known to be incorrect.
It is recommended that the claimant be found without fault in the creation of the
overpayment because the claimant was not aware nor could the claimant reasonably
have been expected to know that OWCP had paid compensation incorrectly.

CONCLUSION: We have made a preliminary finding that an overpayment in the amount
$ occurred, covering the period to , and the claimant is found without fault in its creation.

Michelle Walker
May 11, 2006