SSA - POMS: GN 02607.760 - Beneficiary Protests Suspension of Title II Benefits

A. Procedure FO/PC/OCO-ODO Processing Beneficiary Contests Suspension Action

See GN 03001.025 for general processing information on protests against advance notice of benefit reduction or suspension. See also GN 02210.006 for information on processing protested cases where overpayments are involved.

1. SSA suspends benefits via PUPS

SSA will generally take action to stop the beneficiary's title II benefits based on information that we received from a third party source; e.g., computer match, etc. The SSA technician inputs the suspension action through PUPS to suspend the title II benefit. PUPS will place the record in *PENDING until the due process period ends and then place the beneficiary in suspension.

2. Beneficiary protests prisoner/NGRI suspension PUPS record is *PENDING/MBR shows LAF C

If the beneficiary protests the suspension of their benefits before the end of the 30 day due process period (the PUPS record is *PENDING and the MBR shows LAF C). Process the protest to the prisoner/NGRI suspension as indicated in GN 02607.760A.2.a.

a. Actions necessary on PUPS record to post the protest and to stop the suspension of benefits

FO or PC/OCO-ODO-BA Instructions:

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Update the PUPS record with a type of action of “4 - PROTEST” and add the date the protest was received to the PUPS record.
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Add REMARKS to the PUPS record to explain why the beneficiary is protesting the suspension.
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Forward the case to FO CR or PC/OCO-ODO CA for evaluation of protest and determination of suspension or non-suspension.

FO CR or PC/OCO-ODO CA Instructions:

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Evaluate the protest received from the beneficiary/representative payee. If benefits should be suspended based on the protest received from the beneficiary without further development on the case, forward the case back to FO staff or PC/OCO-ODO BA to use the instructions in GN 02607.760A.2.b. to continue processing the suspension action.
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If the protest received from the beneficiary/representative payee will require development, forward the case to FO for development and notify FO to see GN 02607.760B. for instructions on resolving the protest issues.

NOTE: Do not update PUPS using any other Type of Action (e.g., “CLEAR CONTROL - NO SUSPENSION NECESSARY) until you have input the “4” PROTEST Type of Action through PUPS

CAUTION: You cannot post two PUPS transactions in the same day. If you post the protest action in 1 day, you must wait until the next day to post the suspension action. Two PUPS transactions posted in the same day will cause an exception.

b. Decision on the protest FO or PC/OCO-ODO processing instructions

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If the suspension of the benefits is appropriate after the protest from the beneficiary is evaluated, let the T2R processing system continue processing the suspension action by re-inputting the Type of Action “1 – SUSPENSION” over the protest.
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If the suspension of the benefits should not occur until the protest is fully evaluated, i.e., FO must develop for additional information, leave the PUPS record in *PENDING as indicated in GN 02607.760A.1.a. and process the protest per GN 02607.760B.

NOTE: If SSA receives a timely protest, but does not process the protest until after the suspension occurs (the T2R suspension transaction is gone) the PUPS action will not trigger a reaction to reinstate the title II benefits. The PUPS action merely documents the fact that the beneficiary filed a protest. You must reinstate the benefits per GN 02607.760D.1.b.

B. Procedure Processing Protest Request for Review of Suspension Action

1. FO CR processing protest request for review of suspension action

When the prisoner/NGRI beneficiary/inmate disputes a report of confinement from an institution, develop for additional information if necessary, and process the rebuttal of the suspension as follows.

a. Beneficiary alleges release from confinement

If the individual alleges being released, also request:

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the official release documentation; or
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a copy certified by the custodian of record that the individual has been released and is not a prisoner/inmate of that institution.

Process per GN 02607.760C.1. if the inmate was released.

b. Beneficiary alleges never being in the institution

If the beneficiary alleges that they was never an inmate of an institution:

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get a signed statement regarding the protest from the individual on an SSA-795 (Statement of Claimant or Other Person); and
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prepare a Report of Contact (RPOC) screen in the Modernized Claim Systems (MCS) that records the beneficiary's verbal statement and the facts and types of evidence presented during the beneficiary's face-to-face interview; and
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contact the appropriate official of the correctional facility/institution that reported the information to SSA, court authorities, or prosecuting attorney's office to request assistance in verifying the identity of the individual and date of confinement; and
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determine if the individual is participating in a work-release or home monitoring program or if they are conditionally released from a mental health institution; and
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request SSA-795 signed and dated statements from reliable sources that can attest to the whereabouts of the individual (e.g., employers, neighbors, community leaders, local law enforcement community, or church groups, etc.).

2. Processing returned protest development

After receiving and evaluating the facts, evidence, and information obtained from your development and the beneficiary, process using the information below,

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If SSA discovers evidence during the investigation that indicates another individual is fraudulently using the SSN reported by the correctional facility, follow the instructions in GN 04110.010.
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If the evidence corroborates the individual's allegation for the situations in GN 02607.760B.1., and GN 02607.760B.2., document the facts and the final determination on the RPOC associated with the file, and process per GN 02607.760C.1.
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If the evidence is discrepant, appears to be fraudulent, altered, or cannot satisfactorily prove that the individual is not a prisoner/inmate:
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  photocopy both sides of the documents submitted;
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  record information about the discrepant documents (e.g., how, when and where they were obtained). Develop all available information per GN 04110.010;
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  prepare a summary of the situation. Document the facts and the final determination on the RPOC associated with the file;
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  use the Allegation Referral Intake System (ARIS) to refer the program fraud allegation to the Office of the Inspector General, Office of Investigations Field Division; and
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  take the necessary steps to suspend benefits per GN 02607.760C.2.
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If the issue involves interpretation of State law or policy or you have questions concerning these instructions, contact your Regional Prisoner Coordinator listed in GN 02607.990.

C. Procedure FO or PC/OCO-ODO BA Instructions PUPS Processing of Decision on Protested Suspension Action Suspension has not Occurred PUPS is *pending

1. Protest is upheld, SSA will not suspend benefits

Update PUPS as indicated below

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Beneficiary provides evidence that they were “officially released”

Update the PUPS report with TYPE OF ACTION 2- CLEAR CONTROL – NO SUSPENSION. Add a RELEASED DATE to the PUPS record. Add remarks to the PUPS record to reflect that SSA reviewed the beneficiary's/representative payee's protest. SSA will not suspend benefits because the beneficiary was officially released from the correctional institution.

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Beneficiary provides evidence that causes SSA not to suspend benefits

Update the PUPS report with 2 - CLEAR CONTROL - NO SUSPENSION. Include in the REMARKS field the rationale behind the determination.

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Beneficiary is not the inmate

If the suspension will not occur because the inmate is not the SSA beneficiary, close the PUPS record as 3- CLEAR CONTROL – ERRONEOUS PERSON. See MSOM PRISON 003.001 and MSOM PRISON 003.006 for processing instructions. Include in the REMARKS field the rationale behind the determination.

2. Protest Denied, Suspend Benefits—PUPS Record is *PENDING, Beneficiary is LAF C on MBR

Update PUPS with TYPE OF ACTION 1 - SUSPEND BENEFITS (see MSOM PRISON 003.006 for additional information on suspending benefits via PUPS after a protest is determined). Post the CONFINEMENT TYPE of prison/mental institution, if needed. Annotate an ACTION EFFECTIVE DATE equal to the date the suspension is effective; a NOTICE DATE equal to the date the advance notice was mailed, a T2 PROTEST DATE equal to the date the protest was filed, and a CONVICTION/CONFINEMENT DATE equal to the date the inmate was convicted or confined in the institution after conviction, choose whichever date is later. (These entries are only necessary if the PUPS record does not have them.) Add REMARKS to explain why SSA did not agree to the protest.

NOTE: Do not input the protest action to PUPS and the Suspension action on the same day. Wait until the next day to input the suspension action or an exception will occur.

D. Procedure FO or PC/OCO-ODO Instructions Beneficiary Protests Suspension of Benefits After Adverse Action Occurs Due Process Period Has Expired LAF S7 PUPS Record is in Suspense

1. Beneficiary protests prisoner/NGRI suspension after suspension action has already occurred (Prisoner/NGRI Suspension is suspended LAF S7 on MBR) PUPS record is no longer pending

In some instances, the beneficiary will not file a timely protest (beneficiary sends SSA a letter, fax, or they file a formal protest with an SSA office) 35 or more days (30 days due process period plus 5 mailing days) after the date that SSA sent an adverse notice to the beneficiary.

Process the protest to the prisoner/NGRI suspension as indicated in below.

FO CR or PC/OCO-ODO CA

a. Protest to suspension of benefits

Consider the protest to the suspension of benefits from the beneficiary/representative payee. Evaluate the rebuttal using the steps in GN 02607.760B.

Process the results of your evaluation per the instructions in GN 02607.760D.1.b. Once a decision on the protest is made, forward to FO technician or PC/OCO-ODO BA for further processing action.

FO Technician or PC-OCO/ODO BA

b. Decision on the protest

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If the suspension of the benefits is appropriate, send a notice of your decision to allow the suspend benefits to stand to the beneficiary per GN 03001.025B.4. and give them the next level of appeal (reconsideration level) on the notice. Do not annotate PUPS with any change of information for this post-suspension action protest.
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If the suspension of the benefits should not have occurred based on the protest and the information provided by the beneficiary:
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  reinstate benefits to the beneficiary effective with the suspension effective date per GN 02607.870A;
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  send a written notice to the beneficiary notifying them that we will not suspend their benefits because of the additional information they provided to SSA to support their claim for reinstatement of benefits, and,
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  annotate the PUPS record with REMARKS about the protest of the suspension and the decision not to suspend the benefits.

2. Suspension is done in error without Advance Notice

See instructions in GN 03001.025B.4. for processing if a suspension (LAF S7) was taken without the required advance notice. See GN 02607.970A for instances where an advance notice is required for prisoner suspension processing.

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

E. Procedure PUPS Processing of Decision on Protested Suspension Action Benefits were Reinstated Pending Decision on Protest

1. Suspension of Benefits After Protest is Resolved

a. FO Process

If suspension still applies after protest is resolved, process as follows:

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Send a notice to beneficiary of our decision on the protest. Notify them that we will suspend benefits shortly. Do not give any additional time for rebuttal. Treat any further rebuttal as a request for reconsideration. (See GN 03001.025B.4. for instructions.)

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.
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Prepare an SSA-2790 Prisoner Fax form and notify PC/OCO-ODO to suspend benefits effective with the original date of prisoner suspension annotated to the PUPS record.
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Notify the PC/OCO-ODO to send reconsideration level of appeal on the suspension notice. (Beneficiary has already received first level of appeal on the initial determination.)
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Update the PUPS record “6 - CHANGE INFORMATION ONLY” and remove the released date from the PUPS record.
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Add REMARKS to the PUPS record to explain why SSA did not agree to the protest after the adverse action matured and that we suspended benefits effective with the original date of conviction or confinement annotated to the PUPS record.

NOTE: You cannot use PUPS to suspend the benefits because you will generate an incorrect notice to the beneficiary based on the automated suspension action.

b. PC/OCO-ODO process

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Suspend benefits (LAF S7) using MADCAP/MACADE.
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Notify beneficiary of the suspension. Send reconsideration level of appeal on the suspension notice. (Beneficiary has already received first level of appeal on the initial determination.)

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

2. FO or PC/OCO-ODO process protest resolved do not suspend benefits

a. Annotations on the protested PUPS report

Leave the beneficiary in current payment status on the MBR and annotate the PUPS report as indicated below.

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Beneficiary Provides Evidence That Proves They Were Officially Released

Update the PUPS report with TYPE OF ACTION 6 - CHANGE INFORMATION ONLY. Add a released date to the PUPS report. Add REMARKS to the PUPS report to document the reinstatement of benefits because of the release from the institution if still necessary. Make sure you add a RELEASED DATE to the PUPS record.
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Beneficiary Provides Evidence That Causes SSA Not to Suspend Benefits

Update the PUPS report with TYPE OF ACTION 6 - CHANGE INFORMATION ONLY. Include in the REMARKS field the rationale behind the determination not to suspend the benefits.
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Beneficiary is Not the Inmate

Update the PUPS report with TYPE OF ACTION 6 - CHANGE INFORMATION ONLY. Include in the REMARKS (PMRK screen) field the rationale behind the determination; ire., “Erroneous Person.”

b. Notice of decision on the protest

Send the beneficiary a letter notifying them that SSA has reviewed their protest and we will not suspend benefits because of our review of our initial determination.