File within 10 days of receiving the notice to protect your current benefit amount during review

You can request reconsideration of the overpayment amount AND request a waiver at the same time

Keep detailed records of all income and changes reported to SSA to prove you were not at fault

Social Security Disabilityvery hard

Plan to Achieve Self-Support (PASS)

SSA-545-BK · SSA

13-page form allowing SSI recipients to set aside income/resources toward a specific work goal without reducing SSI benefits. Must detail work goal, expenses, timeline, and milestones.

Form Details

Total fields: 65
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Filled by: patient
Frequency: one time

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Where to Submit This Form

📬

Mail to your local SSA office

https://secure.ssa.gov/ICON/main.jsp

🏢

In person at local SSA office

https://secure.ssa.gov/ICON/main.jsp

Filing Deadline

Submit within 10 days of the overpayment notice to avoid benefit reduction while reconsideration is pending.

Required Attachments

📎 Copy of the overpayment notice
📎 Evidence supporting why the overpayment amount is incorrect or that you do not owe it
📎 Financial records if claiming inability to repay

Processing Time

30-60 days for reconsideration of the overpayment decision.

What Happens Next

SSA will review the overpayment determination. If you filed within 10 days, your benefits will not be reduced while the review is pending.

Tips for This Form

✓ File within 10 days of receiving the notice to protect your current benefit amount during review
✓ You can request reconsideration of the overpayment amount AND request a waiver at the same time
✓ Keep detailed records of all income and changes reported to SSA to prove you were not at fault

More Social Security Disability Forms

SSDI Application

SSA-16-BK · SSA

Application for Social Security Disability Insurance Benefits. Requires detailed work history, earnings record, and medical condition documentation.

SSI Application

SSA-8000-BK · SSA

Application for Supplemental Security Income for aged, blind, and disabled individuals with limited income and resources. Must be completed via SSA interview.

Adult Disability Report

SSA-3368-BK · SSA

The most complex patient-facing disability form. 15 pages requiring complete medical history, all diagnoses, medications, treating providers, hospitalizations, and work history.

Work History Report

SSA-3369-BK · SSA

10-page report requiring detailed descriptions of all jobs held in the past 15 years including physical demands, tools used, supervision, and lifting requirements.

Function Report

SSA-3373-BK · SSA

10-page functional assessment covering ADL capacity, daily routines, social functioning, cognitive abilities, and physical limitations.

Authorization to Disclose Information

SSA-827 · SSA

Authorization allowing SSA to collect medical and other information from providers, hospitals, and other sources for disability determination.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the SSA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.