We have identified the following overpayment and are in good faith voluntarily refunding all monies collected in error. 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. Adjustment Process for Overpayments​​ Via an overpayment letter, explaining the cause of the overpayment and requesting a refund. No refunds are processed on withdrawn classes. The salary overpayment resulted because . A new electronic Payment Adjustment Request form for fee-for-service Medicaid claims is now available for issues regarding overpayment and credit balance. We respectfully request that you refund 2023 personal property taxes in the amount of. SLC has provided customers with an easier way of requesting a below threshold refund. Associate District Counsel, Salt Lake City. CC:WR:RMD:SLC.