Your letter must include your name, address, Social Security number, and why you disagree with the determination. You may ask for a monthly repayment plan if you are not able to pay the full amount.This model letter as a legally approved form for a client to use when informing an employee about correcting a wage overpayment. The salary overpayment resulted because . A sample form for an employee to agree to repayment of a wage overpayment error. The key is to ensure you have a voluntary agreement in writing with the employee before any deductions are taken. This form cannot be utilized until after receipt of notification from the employee's servicing payroll office indicating the amount due. File Form SSA-632, Request for Waiver of Overpayment Recovery.