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The Waiver Submission page provides information about the waiver submission process on the MSPRP. Submitting a waiver allows you to submit a request to the Medicare program to waive, or dismiss, recovery of the demand amount owed. A waiver is "forgiveness" of a party's obligation to satisfy Medicare's claim, in whole or in part, Medicare may waive all or part of its recovery where the following conditions are met:
- You are not at fault for Medicare making conditional payments
- Paying back the money would cause financial hardship or would be unfair for some other reason
- A demand letter has been sent for the case
To support your request, you must provide supporting information or submit documentation. If you are claiming financial hardship, it is recommended that you complete and submit the SSA 632 Request for Waiver form (which is available as a hyperlink on this page). The form requires you to fill out specific information about your (the beneficiary's) income, assets, expenses, and the reasons why a waiver should be granted. You will also have the opportunity to submit additional documents to support your request, such as:
- Current rent or mortgage statements
- Pay stubs
- Utility or medical bills
- Charge card statements
- Most recent tax return
- Cancelled checks
Once a decision has been made, you will receive a letter explaining the reason(s) for the decision. The letter will also include steps you can take to appeal the decision if it is less than fully favorable.
To submit a waiver request:
- Download and complete the SSA 632 Request for Waiver form (hyperlink on this page), if you are claiming financial hardship. Save the form to your computer. You will upload it on the next page.
- Click Continue on this page to display the Waiver Verification page.
- Enter an explanation for your request and/or upload supporting documentation.
- Click Continue on the Waiver Verification page to submit the request.
Waiver Submission Fields
| Field | Description |
| Case ID | Displays the current Case ID. |
| Demand Amount | Displays the Demand Amount as shown on the Demand Letter. |
| Demand Letter Mail Date | Displays the date the Demand letter was sent. |
| SSA 632 Request for Waiver | Hyperlink used to download the SSA 632 Request for Waiver submission form. |
Click Continue to proceed to the Waiver Verification page.
Click Cancel to return to the Case Information page.
Click Print this Page to print a copy of this page for your records.
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