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. I want to convey my heartfelt gratitude to all the members of the foundation who work tirelessly to make the world a better place for individuals like me. We pay benefits only if you are eligible on all requirements for each week you request payment. Completing an online form and writing a signature on a computer. This form is used to notify an employer to withhold wages from a noncustodial parent when they have past-due child support.