We have identified the following overpayment and are in good faith voluntarily refunding all monies collected in error. The salary overpayment resulted because .Please download the form, complete each field and print. Include the form with your refund so we can properly apply the refund and record the receipt. Please fill in all the information required on the enclosed form then sign and date where indicated. This form allows patients to request a refund for services provided. When you identify a Medicare overpayment, use the Overpayment Refund Formto submit the voluntary refund. Thank you, Senator Thompson. 1040X is used, state the request for audit reconsideration in the cover letter. Another example of transformation would be having tools such as Where's My Refund?