APPENDIX A. REFERENCES
The following is a list of the most used debt management cross references and background materials.
- The Federal Claims Collection Act of 1966, as amended
31 U.S.C. 3701, and 3711-3719 - Government-wide
- The Joint General Accounting Office/Department of Justice Regulations
4 CFR, Parts 101-105 - Federal Claims Collection Standards - Government-wide
- The Veterans' Rehabilitation and Education Amendment (VREA) of 1980 (Pub. L. 96-466) - VA
- Title 38 CFR 1.900-1.954 - VA
- GAO Policy and Procedures Manual for Guidance of Federal Agencies - Government-wide
Title 4 "Claims"
Chapter 9 "Debt Claims
Chapter 10 "Contract Debt Procedures"
Chapter 11 "Dual Compensation Debt Procedures"
Chapter 12 "Camage to or Loss of Government Property
Tortious Acts - Debt Collection
Chapter 14 "Debt Arising Out of Irregularities and Discrepancies"
Chapter 15 "Debtors Involved in Bankruptcy Proceedings"
- Statute of Limitations
28 U.S.C. Sections 2415-2416 - Government-wide
- U.S. Treasury Fiscal Manual - Government-wide
1 TFM Part 6 Chapter 8000
"Cash Management"
(Formerly 1 TFRM Part 6 Chapter 8000)
- Title 20 CFR "Employees' Benefits," - Government-wide
20 CFR Section 404.515 "Collection and Compromise of Claims for Overpayments"
- Federal Medical Care Recovery Act - Government-wide
42 U.S.C. Section 2651-2653
- 5 U.S.C. Sections 5514, 5522, 5705, 5724 (f), - Government-wide
"Collecting debt of offset of accrued pay, compensation derived from
- Title 31 U.S.C. Section 227 - Government-wide
"Offsets against judgments against United States
- Privacy Act of 1974, 5 U.S.C. Section 552a - Government-wide
"Public Information; agency rules, opinions, orders, records, and proceedings"
- Spending Reduction Act of 1984, Section 2653 (Pub. L. 98-369, 98 Stat. 1153) -
"IRS Tax Refund Offset Program" - Government-Wide
APPENDIX B. DEPARTMENT OF JUSTICE FORM NO. 1
PROMISSORY NOTE CONTAINING AGREEMENT FOR JUDGMENT
$7,500.00 May 15, l992
For value received, I/we (together and individually) promise to pay the sum of $7,500.00 with interest at the yearly rate of 6% in monthly payments of $200.00. The installments made payable to the Depart-ment of Veterans Affairs (VA), are to be delivered to 914 N. Capital St., Washington, DC 20421, or are payable at VA Regional Office, Washington, D.C. 20421, and are due on or before the 15th day of each month until the balance is fully paid.
If any installment payment is received more than ten (10) days after it is due, the entire amount of this debt will become immediately due and payable at the option of the Department of Veterans Affairs.
Any time after this debt becomes due and payable, I permit any United States Attorney, Assistant United States Attorney or attorney of record to appear for me and to have the court clerk administratively enter judgment against me in any court. The judgment will be for the entire amount of this debt, with interest, less payments actually made. IN ADDITION, I WAIVE BOTH THE RIGHT TO BE NOTIFIED AND TO BE GIVEN COURT PAPERS AND HEREBY CONSENT TO HAVE A JUDGMENT ENTERED AGAINST ME FOR THE UNPAID BALANCE OF THE DEBT. FURTHER, I AGREE TO WAIVE MY RIGHTS TO HAVE THE CASE BROUGHT IN MY LOCAL COURT, TO RELEASE ANY ERRORS WHICH MAY INTERVENE IN ENTERING A JUDGMENT AGAINST ME OR IN ISSUING JUDGMENT PAPERS OR PROCEDURES, AND TO CONSENT TO THE RIGHTS OF ENTRY AND ENFORCEMENT ON THIS JUDGMENT. I MAKE THIS WAIVER WITH KNOWLEDGE OF THE EVENTS DESCRIBED HEREIN, AND WITH ADVICE OF LEGAL COUNSEL. FURTHER, THIS WAIVER IS MADE KNOWINGLY, VOLUNTARILY, AND INTELLIGENTLY, AND WITHOUT ANY DEGREE OF DURESS OR COMPULSION WHATSOEVER.
Date: _________________________ _________________________
__________________________
WARNING: BY SIGNING THIS PAPER YOU GIVE UP YOUR RIGHT TO NOTICE AND A COURT TRIAL. IF YOU DO NOT PAY ON TIME, A COURT JUDGMENT WILL BE ENTERED AGAINST YOU WITHOUT YOUR PRIOR KNOWLEDGE. THE POWER OF A COURT CAN THEN BE USED TO COLLECT PAYMENT FROM YOU EVEN IF YOU HAVE CLAIMS AGAINST YOUR CREDITOR.
APPENDIX C. COLLECTION LETTERS
LETTERS TO BE USED BY REGIONAL OFFICES
VAFL NUMBER DESCRIPTION OF LETTER
4-326 Denial of waiver.
4-408 Second request for debt $25 and above. Interest
not being charged.
4-489 First demand letter for all other debts
(including
Chapter 31). Veteran in receipt of benefits.
Interest not being
charged.
4-490 First demand letter for all other debts
(including
Chapter 31). Veteran not in receipt of
benefits. Interest not
` being charged.
4-492a* First request for Chapter 32 receivable.
Veteran in receipt
of benefits. Interest being charged.
4-492b* First request for Chapter 32 receivable.
Veteran not in
receipt of benefits. Interest being charged
4-494a* (NR) Notice of intent to charge interest. In
repay/offset -
Chapter 32 receivable.
4-494b* (NR) Notice of intent to charge interest. Not in
repay plan -
Chapter 32 receivable.
4-497 Waiver received. VA requesting a completed VA
Form 4-5655.
4-409 Third request for debt over $1,200 ($5,000 for
certain DOJ
judicial districts). Compromise solicited.
Interest not being
charged.
4-409a Third request for debt between $600 and $1,200
($5,000 for
certain DOJ judicial districts). Compromise
solicited. Interest not
being charged.
4-410 Third request debt over $1,200 ($5,000 for
certain DOJ
judicial districts). Compromise not solicited.
Interest not
being charged.
4-411 Second request for debt under $25 or third
request for debt
between $25 and $599.99. Compromise solicited.
Interest not being charged.
4-482 Second request for debt $25 and above. Interest
being charged.
*Do not use these letters until further notice.
APPENDIX C. COLLECTION LETTERS (CONTINUED)
VAFL NUMBER DESCRIPTION OF LETTER
4-483 Second request for debt under $25 or third
request for debt between $25 and $599.99.
Compromise
solicited. Interest being charged.
4-483a Second request for debt under $25 or third request
for
debt between $25 and $599.99. Interest being
charged.
4-483b Second request for debt under $25 or third request
for
debt between $25 and $599.99. Compromise not
solicited.
4-484 Third request for debt between $600 and $1,200
($5,000
for certain DOJ judicial districts). Compromise
solicited.
Interest being charged.
4-485 Third request for debt over $1,200 ($5,000 for
certain
DOJ judicial districts). Compromise solicited.
Interest being
charged.
4-488 Third request for debt between $600 and $1,200
($5,000
for certain DOJ judicial districts). Compromise
not
solicited. Interest not being charged.
4-493a Third request for debt between $600 and $1,200
($5,000
for certain DOJ judicial districts). Compromise
not solicited. Interest being charged.
4-493b Third request for debt over $1,200 ($5,000
for certain DOJ judicial districts). Compromise
not
solicited. Interest being charged.
LETTERS TO BE USED BY MEICAL CENTERS
VAFL NUMBER DESCRIPTION OF LETTER
4-480 First demand letter for ineligible hospitalization
debt. Interest being charged.
4-481 First demand letter for emergency care debt. Interest
being charged.
4-513 First demand letter for Category C NSC Medical Care
debt.
APPENDIX C. COLLECTION LETTERS (CONTINUED)
LETTERS TO BE USED BY BOTH REGIONAL OFFICES AND MEDICAL CENTERS
VAFL NUMBER DESCRIPTION OF LETTER
4-512a Third Collection letter to Federal Employee.
4-512b Third collection letter to Federal Employee.
Interest being charged.
4-514 Request to employer to offset current salary of
Federal Employee to repay VA benefit debt.
Hearing not requested.
4-515 Request to employer to offset current salary
of Federal Employee - hearing provided.
4-516 Follow-up request to employer to offset current
salary of Federal Employee.
4-517 Request to employer to discontinue offset of
salary of Federal Employee.
4-518 Letter to employer requesting current address
of Federal Employee indebted to VA
4-519a Third Collection letter to Retired Federal
Employee.
4-519b Third Collection letter to Retired Federal
Employee.
FEDERAL SALARY OFFSET LETTERS FOR NONBENEFIT DEBTS
4-520a Demand letter for overpayments of Pay and
Allowances,
other nonbenefit debts, and also travel overpayments
created on or after 12/28/85 - Waiver r ights
provided.
4-520b First demand letter to Ex-Employee for overpayments
of
Pay and Allowances, other nonbenefit debts.
Also travel overpayments created on or after
12/28/85.
Waiver r ights provided.
4-520c Demand letter for travel overpayments created
before 12/28/85 - No waiver rights.
4-520d First demand letter to Ex-Employee for travel
overpayments created before 12/28/85 - No waiver
rights.
4-522 Letter advising VA Employee of a request from
another
government agency to offset current salary.
4-534 Letter advising Retired VA Employee of advanced sick
leave debt.
APPENDIX C. COLLECTION LETTERS (CONTINUED)
VENDOR DEBTS
VAFL NUMBER DESCRIPTION OF LETTER
4-521 First demand letter for Vendor debts.
APPENDIX D. ADDRESSES OF SECRETARIES OF STATE
The Secretaries of State listed below may be an aid in obtaining current corporate addresses, names, and addresses of corporate officers, the current legal status of a corporation in a given state. In the case of a dissolved corporation, the name and address of appointed receivers or trustees, disposition of corporate assets and the agent for service of process may be determined.
ALABAMA COLORADO
State of Alabama Department of State
Office of Secretary of State State Capitol Building
Montgomery, Alabama 36104 Denver, Colorado 80203
For more informative reply:
State of Alabama CONNECTICUT
Franchise Tax Division Secretary of State
Department of Revenue Department of State
Montgomery, Alabama 36102 Hartford, Connecticut 06115
ALASKA DELAWARE
Secretary of State Secretary of State
State Capitol Building State Capitol Building
Juneau, Alaska 99811 Dover, Delaware 19001
ARIZONA DISTRICT OF COLUMBIA
Secretary of State State Department
State Capitol Building Capitol Building
Phoenix, Arizona 85000 Washington, D.C. 20520
ARKANSAS FLORIDA
Secretary of State Secretary of State
State Capitol Building The Capital
Little Rock, Arkansas 72200 Tallahassee, Florida 32304
CALIFORNIA GEORGIA
Secretary of State Secretary of State
111 Capitol Mall 214 State Capitol
Sacramento, California 94857 Atlanta, Georgia 303334
$1.00 fee or:
Franchise Tax Board LOUISIANA
Sacramento, California 95857 State of Louisiana
Secretary of State
HAWAII Corporation Department
Secretary of State Baton Rouge, Louisiana 70815
State Capitol Building .
Honolulu, Hawaii 96800 .
.
APPENDIX D. ADDRESSES OF SECRETARIES OF STATE (CONTINUED)
IDAHO MAINE
Secretary of State State of Maine
State Capitol Building Department of State
Boise, Idaho 83700 Corporation and UCC Division
Augusta, Maine 04330
ILLINOIS
Secretary of State MARYLAND
State Capitol Building Secretary of State
Springfield, Illinois 62700 State Capitol Building
Annapolis, Maryland 21401
INDIANA
Secretary of State MASSACHUSETTS
State House Secretary of State
Indianapolis, Indiana 46204 State House
Boston, Massachusetts 02100
IOWA
Secretary of State MICHIGAN
State Capitol Building Department of Commerce
Des Moines, Iowa 50300 Corporation Division
Post Office Box Drawer C
KANSAS Lansing, MIchigan 48904
Secretary of State
State House MINNESOTA
Topeka, Kansas 66600 Office of the Secretary of State
St. Paul, Minnesota 55155
KENTUCKY
Secretary of State MISSISSIPPI
State Capitol Building Secretary of State
Frankfort, Kentucky 40601 State Capitol Building
Jackson, Mississippi 32900
MISSOURI NEW YORK
Secretary of State Department of State
State Capitol Building Division of Corporation and
Jefferson City Missouri 65101 State Records
162 Washington Avenue
MONTANA Albany, New York 12225
Secretary of State
State Capitol Building NORTH CAROLINA
Helena, Montana 59601 Secretary of State
. State Capitol Building
. Raleigh, North Carolina
APPENDIX D. ADDRESSES OF SECRETARIES OF STATE (CONTINUED)
NEBRASKA NORTH DAKOTA
Secretary of State Secretary of State
State of Nebraska State Capitol Building
Lincoln, Nebraska 68509 Bismarck, North Dakota 58501
NEVADA OHIO
Secretary of State Secretary of State
State Capitol Building State Capitol Building
Carson City, Nevada 89701 Columbus, Ohio 43216
NEW HAMPSHIRE OKLAHOMA
Secretary of State Franchise Tax Department
State Capitol Building Oklahoma Tax Commission
Concord, New Hampshire 03300 1606 North Broadway
Oklahoma City, Oklahoma 73105
NEW JERSEY
Secretary of State OREGON
State of New Jersey Secretary of State
Trenton, New Jersey State Capitol Building
Salem, Oregon 97300
NEW MEXICO
Secretary of State PENNSYLVANIA
State Capitol Building Secretary of State
Santa Fe, New Mexico 87503 State Capitol Building
Harrisburg, Pennsylvania 17100
RHODE ISLAND
Secretary of State VERMONT
State Capitol Building Secretary of State
Providence, Rhode Island 02900 State Capitol Building
Montpelier, Vermont 05602
SOUTH CAROLINA
Secretary of State VIRGINIA
State Capitol Building Commonwealth of Virginia
Columbia, South Carolina 29200 State Corporation Commission
Box 1197
SOUTH DAKOTA Richmond, Virginia 23209
Secretary of State
State Capitol Building WASHINGTON
Pierre, South Dakota 57501 Office of Secretary of State
. Corporations and Trademarks Division
. Legislative Building
. Olympia, Washington 98504
APPENDIX D. ADDRESSES OF SECRETARIES OF STATE (CONTINUED)
TENNESSEE WEST VIRGINIA
Secretary of State Secretary of State
State Capitol State Capitol Building
Nashville, Tennessee 37201 Charleston, West Virginia 25300
TEXAS WISCONSIN
State of Texas Department of State
Office of the Secretary of State Madison, Wisconsin 53702
Austin, Texas 78711 *$1 or $2 fee
UTAH WYOMING
Secretary of State Secretary of State
203 State Capitol Building State Capitol Building
Salt Lake City, Utah 84114 Cheyenne, Wyoming 82001
APPENDIX E. IRS TAXPAYER ADDRESS INFORMATION
DATE DD/MM/YY
IRS REGULATIONS RESTRICT THE USE OF THIS INFORMATION TO THE PURPOSE FOR WHICH REQUESTED--DEBT COLLECTION PURPOSES WITHIN VA-AND IT IS NOT TO BE RELEASED OUTSIDE THE VA FOR ANY REASON.
THE IRS TAX MASTER FILE SHOWS THE NAME AND ADDRESS GIVEN BELOW FOR THE INDIVIDUAL YOU IDENTIFIED. THE WORDS "NO RECORD SSN" APPEAR IF THE SOCIAL SECURITY NUMBER YOU FURNISHED IS NOT ON THE IRS MASTER FILE. THE WORDS "NO RECORD NC" APPEAR IF THE NAME CONTROL YOU FURNISHED IS NOT ON THE MASTER FILE.
____________________________________________________________
STATION INTERNAL CONTROL NAME CONTROL
999 XXXXXXX XXXXX
______________________________________________________________________________
SSN VA IDENTIFICATION NAME 999-99-9999 999999999 X X XXXXX
ADDRESS ZIP CODE
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXX
STATION NUMBER 999
APPENDIX F. PERCENTAGES FOR CURRENT VALUE OF FUNDS (CVFT) RATE
Percentages for the Current Value of Funds (CVFT) rate and the Contract Disputes Act (CDA) of 1978 rate (same rate used for the Prompt Payment Act) for the past several years are noted below.
1985 CVFT CDA
January-March 9.00 12.125
April-June 9.00 12.125
July-September 9.00 10.375
October-December 9.00 10.375
l986
January-March 8.00 9.750
April-June 8.00 9.750
July-September 8.00 8.500
October-December 8.00 8.500
l987
January-March 7.00 7.625
April-June 7.00 7.625
July-September 7.00 8.875
October-December 7.00 8.875
l988
January-March 6.00 9.375
April-June 6.00 9.375
July-September 6.00 9.250
October-December 6.00 9.250
l989
January-March 7.00 9.750
April-June 7.00 9.750
July-September 7.00 9.125
l990
January-March 9.00 8.500
April-June 9.00 8.500
July-September 9.00 9.000
October-December 9.00 9.000
l991
January-March 8.00 8.375
April-June 8.00 8.375
July-September 8.00 -
October-December 8.00 -
APPENDIX F. PERCENTAGES FOR CURRENT VALUE OF FUNDS (CVFT) RATE (CONTINUED)
l992 CVFT CDA
January-March 6.00 -
April-June 6.00 -
July-September 6.00 -
October-December 6.00 -
Notes:
The CVFT rate was published in the Federal Register on a quarterly basis until 1986. It is now published on an annual basis, January-December, subject to later changes(s). It is usually published a few weeks prior to the start of a new calendar year.
The CDA rate is published on a semi-annual basis (January-June and July-December) in the Federal Register prior to the start of each six month period. It is also the same rate that is used under the Prompt Payment Act.
APPENDIX G. FREEDOM OF INFORMATION ACT (FOIA)
LETTERS - FIRST NOTICE
Date:
Name
Street Address
City, State, Zip Code
SUBJECT: Freedom of Information Act (FOIA) Bill
Account Number____________________FIRST NOTICE
Dear
This notice is a bill for the materials that you received under the FOIA. The amount due the Government is $__________. Your check or money order should be made payable to the Department of Veterans Affairs and mailed to the address noted below. Your prompt attention to this matter is requested.
Department of Veterans Affairs
(Insert name and address of servicing Finance Office)
A copy of this letter should accompany your payment. Your account will become delinquent if full payment is not received in the finance office within 30 days from the date of this letter.
Please be advised that we must assess late payment charges on delinquent accounts, consisting of interest and administrative costs, under the authority of the Debt Collection Act of 1982.
Interest on delinquent accounts is assessed from the date of this letter at the Current Value of Funds to the Treasury rate which is now 6%. Administrative costs of $1.16/30 day period are assessed on delinquent accounts beginning 31 from the date of this letter. Each of these charges are assessed for every full or partial 30 day period that the account remains delinquent.
We must also advise you that delinquent accounts may also be referred to credit reporting bureaus, private collection agencies, and the IRS for further collection action. The costs incurred by the Government for these actions will be added to your bill and an additional late payment penalty charge will be assessed for accounts that are delinquent for more than 90 days. Additionally, we will not process additional FOIA requests if a prior request is in a delinquent payment status.
You may request an extended repayment plan. A request will be reviewed if the collection of the amount owed in a lump sum would cause extreme financial hardship and the amount owed exceeds $50. You must make your request, in writing, within 15 days of the date of this notice by fully completing the enclosed VA Form 4-5655, Financial Status Report, and mailing it to the above noted finance office. The form must be accompanied by a signed written statement explaining why a lump sum payment is not possible. If approved, by the finance office, the repayment agreement will take the form of a signed promissory note containing finance charges at the prevailing Current Value of Funds to the Treasury rate. Incomplete or unsigned financial statements will not be processed.
APPENDIX G. FOIA LETTERS (CONTINUED) - FIRST NOTICE
You may request a review of this matter. If you do not believe that the debt is valid or the amount is correct, you have the right to dispute it. You may also request a fee waiver if you believe that your request meets the criteria of 38 CFR 1.555, "Fees". Your request for review or fee waiver must be made within 30 days of the date of this letter, in writing, and sent to the address noted below. It must include a statement and documentation which substantiates your claim.
Department of Veterans Affairs
Freedom of Information Act Officer
Attn: (Insert name)
(Insert full mailing address)
If you dispute the debt or request a fee waiver, we will suspend collection action; however, late payment charges will continue to accrue and will be assessed on any amount not found in your favor. Any knowingly false or frivolous statements, representations or evidence subjects you to appropriate criminal or civil penalties. As interest and other late payment charges can be substantial, we recommend that you pay any portion of the debt which you are not disputing within 30 days of the date of this letter.
Considering the various late charges and administrative actions associated with delinquent accounts, we urge you to attend to this matter without delay. If you have any questions, please
call___________________________ at ( )____________.
Sincerely
John Doe
Freedom of Information Act Officer
APPENDIX G. FOIA LETTERS (CONTINUED) - SECOND NOTICE
Date:
Name
Street Address
City, State, Zip Code
SUBJECT: Delinquent Bill, Freedom of Information Act (FOIA) Fee
Account Number______________________SECOND NOTICE
Dear
A review of our records indicates that we have not heard from you regarding your payment for the materials that you received under FOIA. As we did not receive payment within 30 days of the date of our initial request for payment, your account is delinquent.
Our initial request for payment for the material stated that interest and administrative costs would be assessed if payment was not made within 30 days. Therefore, interest charges and administrative costs for handling a delinquent debt have now been assessed on your account under the authority of the Debt Collection Act of 1982. The total amount now due the Government is $___________ ($_________ principal, $___________ interest, and $__________ administrative costs).
Your prompt attention to this matter is requested. If you have already paid any or all of this bill, please provide us with a copy of your cancelled check. If you have not paid this bill, your check or money order should be made payable to the Department of Veterans Affairs and mailed to the address noted below.
Department of Veterans Affairs
(Insert name and address of serving finance office)
A copy of this letter should accompany your payment. If your payment is not received within 30 days from the date of this letter, additional interest and administrative costs will continue to accrue and further collection action will be initiated.
Additionally, if we do not receive payment, we will refer your delinquent account (name, address, social security number, amount owed, status and history of the claim) to national credit reporting bureaus. This action can have a potential serious impact on personal credit ratings even after payment is made on a delinquent account. You have 30 days from the date of this letter to dispute, in writing, our taking this action. Your letter (sent to the address above) must state the specific reasons why this action should not be taken.
Your account may also be referred to a private collection agency and/or the Internal Revenue Service (IRS). The costs incurred by the government for these action will be added to your bill. Furthermore, the FOIA Office has been notified of your delinquency and has been notified of you delinquency and has been instructed not to honor future FOIA requests until this account is settled.
APPENDIX G. FOIA LETTERS (CONTINUED) - SECOND NOTICE
You may request an extended repayment plan. A request will be reviewed if the collection of the amount owed in a lump sum would cause extreme financial hardship and the amount owed exceeds $50. You must make your request, in writing, within 15 days of the date of this notice by fully completing the enclosed, VA Form 4-5655, Financial Status Report. The form must be accompanied by a signed written statement explaining why a lump sum payment is not possible. If approved by this office, the repayment agreement will take the form of a signed promissory note containing finance charges at the prevailing Current Value of Funds to the Treasury rate. Incomplete or unsigned financial statements will not be processed.
Considering the various late charges and administrative actions associated with delinquent accounts, we urge you to attend to this matter without delay. If you have any questions, please
call__________________ at ( ) __________.
Sincerely,
John Doe,
Chief, Finance Service
APPENDIX G. FOIA LETTERS (CONTINUED) - THIRD NOTICE
Date:
Name
Address
City, State, Zip Code
SUBJECT: Delinquent Bill, Freedom of Information Act (FOIA) Fee
Account Number _____________ THIRD NOTICE
Our records show that we still have not heard from you regarding your payment for the materials that you received under the FOIA. Interest and administrative costs have continued to accrue on your delinquent account. The amount now due the Government is $_____________, ($__________ principal, $___________ interest, $___________, administrative costs).
Your prompt attention to this matter is requested. If you have already paid any or all of this bill, please provide us with a copy of your canceled check. If you have not paid this bill, your check or money order should be made payable to the Department of Veterans Affairs and mailed to the address noted below.
Department of Veterans Affairs
(Insert name and address of serving finance office)
A copy of this letter should accompany your reply. If your payment is not received within 30 days from the date of this letter, interest will continue to accrue and further collection action will be initiated.
As we stated in our previous correspondence to you, we will initiate further collection action. In accordance with Departmental regulations, interest and administrative costs have been assessed and will continue to accrue until full payment is made. If payment continues to be delinquent, we will assess and additional penalty of 6 percent and initiate action to recover the debt through the Internal Revenue Service.
We urge you to attend to this matter without delay. If you have any questions, please
call _________________________ at ( )_________.
Sincerely,
John Doe
Chief, Finance Service
APPENDIX H. VHA FISCAL DEBT MANAGEMENT MATRIX
DEBT TYPE DEBTOR ACCOUNTING
CLASSIFICATION
.
. GENERAL FUND RECEIPTS
.
NSC MEANS TEST NURSING HOME CAT C PATIENT* 36 2431 GEN FD RECEIPT
COPAY
NSC MEANS TEST OUTPATIENT COPAY CAT C PATIENT* 36 2431 GEN FD RECEIPT
NSC MEANS TEST INPATIENT COPAY CAT C PATIENT* 36 2431 GEN FD RECEIPT
$10 @ DAY HOSP PER DIEM CAT C PATIENT* 36 2431 GEN FD RECEIPT
$5 @ DAY NURSING HOME PER DIEM CAT C PATIENT* 36 2431 GEN FD RECEIPT
MCCR REVOLVING FUND
NSC TREATMENT WITH INSURANCE 3RD PTY INSURER 36X5014 REVING FUND
WORKERS' COMP 3RD PTY INSURER 36X5014 REVING FUND
NO-FAULT AUTO 3RD PTY INSURER 36X5014 REVING FUND
VICTIM OF VIOLENT CRIME 3RD PTY INSURER 36X5014 REVING FUND
PHARMACY COPAY VET NOT 50% SC 36X5014 REVING FUND
MEDICAL CARE APPROP
INELIGIBLE NON-VET PATIENT 36 0160 REIMBURSEMENT
TORT FEASOR LIABLE 3RD PARTY 36 0160 REIMBURSEMENT
EMERGENCY/HUMANITARIAN PATIENT-INSURER 36 0160 REIMBURSEMENT
SHARING AGREEMENTS SHARING PARTNER 36 0160 REIMBURSEMENT
*Category C nomenclature within computer program implies discretionary workload designation and definition.
APPENDIX I. LETTER TO BE SENT IF DISPUTE IS RECEIVED WITHIN
30 DAYS FROM DATE OF FIRST DEMAND LETTER
Mr. Sam Smith
704 NW 4th St.
Hollandale, FL 33009
Dear Mr. Smith
Shown below is an audit of your benefit payment account, reflecting only the periods shown:
The above audit, prepared as a result of your dispute of your indebtedness, verifies the existence and the amount of the overpayment of which you were previously notified. Any current benefit payments due to you will be withheld until the debt is paid in full.
Sincerely yours,
PAUL L. CROSSEN
Finance Officer
APPENDIX I. LETTER TO BE SENT IF DISPUTE IS RECEIVED AFTER 30 DAYS
FROM DATE OF FIRST DEMAND FOR REPAYMENT
Mr. Sam Smith
704 NW 4th St.
Hollandale, FL 33009
Dear Mr. Smith
Shown below is an audit of your benefit payment account, reflecting only the periods shown:
The above audit, prepared as a result of your dispute of your indebtedness, verifies the existence and the amount of the overpayment of which you were previously notified.
Sincerely yours,
PAUL L. CROSSEN
Finance Officer
APPENDIX I. LETTER TO BE SENT IF DISPUTE/WAIVER REQUEST IS RECEIVED
WITHIN 30 DAYS FROM DATE OF FIRST DEMAND FOR REPAYMENT
Mr. Sam Smith
704 NW 4th St.
Hollandale, FL 33009
Dear Mr. Smith
Shown below is an audit of your benefit payment account, reflecting only the periods shown:
The above audit, prepared as a result of your dispute of your indebtedness, verifies the existence and the amount of the overpayment of which you were previously notified. Your request for waiver has been forwarded to our Committee on Waivers and Compromises. Any current benefit payments due to you will not be withheld until a decision is reached on your waiver request.
Sincerely yours,
PAUL L. CROSSEN
Finance Officer
APPENDIX I. LETTER TO BE SENT IF DISPUTE/WAIVER REQUEST IS RECEIVED AFTER
30 DAYS FROM DATE OF FIRST DEMAND FOR REPAYMENT
Mr. Sam Smith
704 NW 4th St.
Hollandale, FL 33009
Dear Mr. Smith
Shown below is an audit of your benefit payment account, reflecting only the periods shown:
The above audit, prepared as a result of your dispute of your indebtedness, verifies the existence and the amount of the overpayment of which you were previously notified. Your request for waiver has been forwarded to our Committee on Waivers and Compromises.
Sincerely yours,
PAUL L. CROSSEN
Finance Officer
APPENDIX J. DOJ JUDICIAL DISTRICTS WHERE DOJ DELEGATED PRIMARY
RESPONSIBILITY TO THE VA FOR COLLECTION OF DEBTS $5,000 OR LESS
ARIZONA MASSACHUSETTS ARKANSAS, EASTERN MICHIGAN, EASTERN ARKANSAS, WESTERN MICHIGAN, WESTERN CALIFORNIA, CENTRAL MISSOURI, EASTERN CALIFORNIA, EASTERN MISSOURI, WESTERN CALIFORNIA, NORTHERN MONTANA COLORADO NEBRASKA CONNECTICUT NEVADA FLORIDA, MIDDLE NEW HAMPSHIRE FLORIDA, NORTHERN NEW JERSEY FLORIDA, SOUTHERN NEW MEXICO GEORGIA, MIDDLE NEW YORK, EASTERN GEORGIA, SOUTHERN NORTH CAROLINA, MIDDLE IDAHO NORTH CAROLINA, WESTERN ILLINOIS, NORTHERN NORTH DAKOTA IOWA, NORTHERN OHIO, NORTHERN IOWA, SOUTHERN OHIO, SOUTHERN KANSAS OKLAHOMA, EASTERN KENTUCKY, EASTERN OKLAHOMA, WESTERN KENTUCKY, WESTERN OREGON LOUISIANA, EASTERN PENNSYLVANIA, EASTERN LOUISIANA, MIDDLE PENNSYLVANIA, WESTERN LOUISIANA, WESTERN PUERTO RICO MAINE RHODE ISLAND MARYLAND SOUTH CAROLINA SOUTH DAKOTA UTAH TENNESSEE, EASTERN VERMONT TENNESSEE, WESTERN WASHINGTON, EASTERN TENNESSEE, MIDDLE WASHINGTON, WESTERN TEXAS, EASTERN WEST VIRGINIA, NORTHERN TEXAS, NORTHERN WEST VIRGINIA, SOUTHERN TEXAS, SOUTHERN WISCONSIN, WESTERN TEXAS, WESTERN WYOMING
APPENDIX K. CLAIMS COLLECTION LITIGATION REPORTS (CCLR)
APPENDIX K. CLAIMS COLLECTION LITIGATION REPORT (CCLR) (C0NTINUED)
APPENDIX K. CLAIMS COLLECTION LITIGATION REPORT (CCLR) (CONTINUED)
APPENDIX K. CLAIMS COLLECTION LITIGATION REPORT (CCLR) (CONTINUED)
APPENDIX K. CLAIMS COLLECTION LITIGATION REPORT (CCLR) (CONTINUED)
APPENDIX K. CLAIMS COLLECTION LITIGATION REPORT (CCLR) (CONTINUED)
APPENDIX L. INSTRUCTIONS FOR COMPLETING CCLR
APPENDIX L. INSTRUCTIONS FOR COMPLETING CCLR (CONTINUED)
APPENDIX L. INSTRUCTIONS FOR COMPLETING CCLR (CONTINUED)
APPENDIX L. INSTRUCTIONS FOR COMPLETING CCLR (CONTINUED)
APPENDIX L. INSTRUCTIONS FOR COMPLETING CCLR (CONTINUED)
APPENDIX L. INSTRUCTIONS FOR COMPLETING CCLR (CONTINUED)
APPENDIX M. DOJ AGENCY CODES
Station Number VBA Regional Offices DOJ Agency Code
301 Boston MA VRMA
304 Providence RI. VRRI
306 New York, NY VRNY
307 Buffalo, NY VRNB
308 Hartford, CT VRCH
309 Newark, NJ. VRNJ
311 Pittsburgh, PA VRPP
313 Baltimore, MD. VRMD
314 Roanoke, VA VRVA
315 Huntington, WV VRWV
316 Atlanta, GA VRGA
317 St. Petersburg, FL VRFL
318 Winston-Salem, NC.. VRNC
319 Columbia, SC VRSC
320 Nashville, TX VRTN
321 New Orleans, LA VRLA
322 Montgomery, AL VRAL
323 Jackson, MS VRMS
325 Cleveland, OH. VROH
326 Indianapolis, IN VRIN
327 Louisville, KY VRKY
328 Chicago, IL VRIL
329 Detroit, MI VRMI
330 Milwaukee, W VRWI
331 St. Louis, MO. VRMO
333 Des Moines, IA. VRIA
334 Lincoln, NE VRNE
339 Denver, CO. VRCD
340 Albuquerque, NM VRNM
341 Salt Lake City, UT VRUT
343 San Francisco, CA VRSF
344 Los Angeles, CA VRLS
345 Phoenix, AZ VRAZ
346 Seattle, WA VRWA
347 Boise, ID. VRID
348 Portland, OR.. VROR
349 Waco, TX. VRTW
350 Little Rock, AR VRAR
351 Muskogee, OK VROK
354 Reno, NV VRNV
359 Honolulu, H VRHI
362 Houston, TX VRTH
363 Anchorage, AK VRAK
372 Washington, DC VRDC
373 Manchester, NH VRNH
377 San Diego, CA VRCS
402 Togus, ME VRME
405 White River Junction, VT VRVT
436 Fort Harrison, MT VRMT
APPENDIX M. DOJ AGENCY CODES (CONTINUED)
Station Number VBA Regional Offices DOJ Agency Code
437 Fargo, ND VRND
438 Sioux Falls, SD VRSD
442 Cheyenne, WY VRWY
452 Wichita, KS VRKS
455 San Juan, PR VRPR
460 Wilmington, DE VRDE
Station Number VA Regional Offices and Insurance DOJ Agency Code
Centers (VARO&IC)
310 Philadelphia, PA VRPH
335 St. Paul, MN VASP
389 Debt Management Center, St. Paul DMC VASP
All Stations Medical Center and Domicilaries VATX
101 VACO Washington, DC..VA Central Office VAHQ
APPENDIX N. CERTIFICATE OF INDEBTEDNESS - EDUCATION LOANS
APPENDIX O. CERTIFICATE OF INDEBTEDNESS - REPS
APPENDIX P. CERTIFICATE OF INDEBTEDNESS - JOBS
APPENDIX P. CERTIFICATE OF INDEBTEDNESS - JOBS (CONTINUED)
APPENDIX P. CERTIFICATE OF INDEBTEDNESS - JOBS (CONTINUED)
APPENDIX Q. COMMANDING OFFICER LETTER FOR 57B ACCOUNTS RECEIVABLE
Jim Jones, SSN 123456789, a member of your drill unit, is indebted to the United States for an overpayment of Chapter 106 education benefits. This indebtedness is based on data obtained from Department of Defense (DOD) records indicating that he/she is not eligible for such benefits.
We request that you verify the member's eligibility status so that we may proceed with appropriate collection action.
Please complete the bottom portion of this letter and return it to the above address.
We would appreciate your reply within 30 days.
MEMBER'S NAME: JIM JONES FILE #123456789
____ Member is not eligible to receive Chapter 106 benefits.
____ Member is eligible to receive Chapter 106 benefits. Correction of the member's DOD eligibility records has been made.
____ Member was eligible from _______________ to ________________.
____ Member is no longer in this Member's home address,
unit, new unit address: if available.
_______________________________ ______________________________
_______________________________ ______________________________
_______________________________ ______________________________
_______________________________ ______________________________
_______________________________ ______________________________
Unit Commander's Name Signature
APPENDIX R. CERTIFICATE OF INDEBTEDNESS FOR 57B ACCOUNTS RECEIVABLE
Pursuant to the provisions of Chapter 106, Title 10 U.S.C., as amended, the Department of Veterans Affairs (VA) paid the above-named debtor, educational assistance benefits in the amount of $1,600.00 for the period 9/1/88 through 3/31/89. The payments was based on the school's statement that Mr. Jim Jones would be enrolled in a program of education as a full-time student during this period and Department of Defense certification that he/she was eligible for educational assistance benefits under Chapter 106.
VA was informed on 5/15/89 by the Department of Defense that the debtor had been determined to be ineligible to receive educational assistance benefits and therefore was not entitled to the amount paid to and received by him. As a result, the debtor is indebted to the United States in the total amount of $1,600.00 for the period 9/1/88 through 3/31/89.
Our third demand letter, which was sent to the above address, notified the debtor of our intent to pursue litigation action if he/she did not contact this office within 20 days. As of this date, the debtor has not responded.
APPENDIX S. INTERNAL REVENUE SERVICE CENTERS
If your station/facility is located Use the following Internal Revenue
in: Service Center Address:
Florida, Georgia, South Carolina Atlanta, GA 39901
New Jersey, New York (New York City, Holtsville, NY 00501
and
counties of Nassau, Rockland, Suffolk, .
and Westchester)
.
New York (all other counties), Andover, MA 05501
Connecticut, Maine, Massachusetts, .
New Hampshire, Rhode Island, Vermont .
.
Illinois, Iowa, Minnesota, Kansas City, MO 64999
Missouri, Wisconsin .
Delaware, District of Columbia, Philadelphia, PA 19255
Maryland, Pennsylvania, Virginia .
Indiana, Kentucky, Michigan, Cincinnati, OH 45999
Ohio, West Virginia .
Kansas, New Mexico, Oklahoma, Texas Austin, TX 73301
Alaska, Arizona, Colorado, Idaho, Ogden, UT 84201
Montana, Nebraska, Nevada, North .
Dakota,
Oregon, South Dakota, Utah, Washington .
Wyoming, California (counties of .
Alpine,
Amador, Butte, Calaveras, Colusa, .
Contra Costa, Del Norte, El Dorado, .
Glenn,
Humboldt, Lake Lessern, Marin, .
Mendocino,
Modoc, Napa, Nevada, Placer, Plumas, .
Sacramento, San Joaquin, Shasta, .
Sierra,
Siskiyou, Solano, Sonoma, Sutter, .
Tehama,
Trinity, Yolo, and Yuba) .
Hawaii, California (all other Fresno, CA 93888
counties)
Alabama, Arkansas, Louisiana, Memphis, TN 37501
Mississippi,
North Carolina, Tennessee .
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX T. INSTRUCTIONS FOR PREPARING SF 220-9 (CONTINUED)
APPENDIX U. QUARTERLY REPORT OF INDEBTEDNESS
APPENDIX V. CARS ACCOUNTS RECEIVABLE COLLECTION COSTS
Field Station: Phoenix, AZ . .
Station Number: 345 No. of Hrs. Dollars
Committee on Waivers and 75 $1,463.11
Compromises
Finance Activity 50 $ 481.69
Veterans Services Division
Field Examinations 35 $672.12
Telephone and Personnel Contacts 15 $111.63
Total VSD 50 $783.75
Administrative Activity 55 152.22
Adjudication Division 25 200.00
Loan Guaranty Division (do not . .
include cost
resolving an education overpayment . .
prior
to Loan Guaranty approving a home . .
loan)
Station Total 275 $3,199.44
Station Contact: . .
John Smith 555-5212 . .
APPENDIX W. DEPARTMENT OF JUSTICE DEBT COLLECTION REPORT