SSA must:

1. a. 

   Obtain the necessary information/evidence to determine an individual's eligibility.

2. b. 

   Offer assistance to individuals and their personal representatives in obtaining information/evidence needed to determine the individual's eligibility. The offer must be made during the initial contact with the individual and all subsequent contacts that involve requests for additional information/evidence.

The individual or personal representative is responsible for:

1. a. 

   Answering all application questions to the best of their knowledge.

2. b. 

   Providing the necessary information, documents, or evidence to prove that the eligibility requirements for the subsidy are met.

The evidentiary standards in GN 00301.000 do not apply to subsidy cases (except as explained in HI 03020.030D.1. regarding verification of alleged higher IRWE or BWE). For subsidy purposes only:

• •

  SSA will only request documentary evidence if an individual's explanation of a discrepancy between the application or redetermination form and data obtained from other Federal agencies does not seem reasonable in the CR's judgment. Most issues or discrepancies should be resolved by a phone call and documented in MAPS as described in HI 03035.006, HI 03035.010, HI 03035.020, and HI 03035.030.

• •

  If the CR believes that documentary evidence is required, original documents are not required. We will accept photocopies or FAXed documents.

Do not retain any paper documents. Annotate MAPS to indicate the evidence received. Do not annotate subsidy documentation on the Shared Process EVID screen

EXCEPTION: If an issue affects Title II or XVI as well as the subsidy, follow the evidentiary rules in GN 00301.000 to document the Title II or XVI case.

Take these steps when obtaining information/evidence:

• •

  Request information/evidence directly from the individual or personal representative.

• •

  Explain what information/evidence is needed and why.

• •

  Advise that we will attempt to obtain the information/evidence by phone and, if unsuccessful, we will send a notice stating that the information/evidence must be provided within 15 days after the date of the notice.

• •

  Explain that timely cooperation in providing the information/evidence is important.

• •

  Assist in obtaining necessary information/evidence if the individual has difficulty obtaining it himself. The extent of SSA's assistance in obtaining information/evidence is determined on a case by case basis.

If an SSA-1020-OCR is received with required questions unanswered, inconsistent answers (e.g., both “Yes” and “No” blocks are checked for the same question for the same person), or illegible answers, WBDOC will attempt to contact the individual to obtain the answer.

WBDOC employees will make two telephone attempts to obtain the information. If those attempts are unsuccessful, WBDOC will send a written request (HI 03010.040F). The notice is generated from the MAPS Exception screen and will ask each question on the SSA-1020 for which a response is needed. If the individual calls the 800 number after receiving the WBDOC notice, advise the caller to mail back the requested information in the envelope WBDOC provided, or to call the WBDOC Benefits and Records Branch at the telephone number listed on the letter for assistance (1-800-775-7802). If the individual contacts the FO after receiving the notice, a CR should obtain the information.

Document the results of the contact on the MAPS Exception Screen. If the individual does not respond to the letter within 15 days plus 5 days mail time, the WBDOC will annotate Failure to Cooperate per MSOM INTRANETMAPS 006.007. This will generate the pre-decisional notice and, if no timely response is received, the formal denial notice with appeal rights (see HI 03035.050).

If a FO or WSU completes a MAPS application but the applicant is unable to answer one or more questions at the time of the interview or if a case with unanswered questions is transferred from the WBDOC to the FO, the FO/WSU will attempt two phone contacts to obtain the information. Document the results of the contact on the MAPS Exception Screen.

If those attempts are unsuccessful, send a written request (HI 03010.040G). The notice is generated from the MAPS Exception screen and will ask each question on the SSA-1020 for which a response is needed. See HI 03010.038C.17. for signature requirements for partially completed MAPS claims.

Document the responses in MAPS per HI 03010.040D. If no response is received within 15 days plus 5 days mail time after the notice is sent, annotate Failure to Cooperate per MSOM INTRANETMAPS 006.007 . This will generate the pre-decisional notice and, if no timely response is received, the formal denial notice with appeal rights (see HI 03035.050).

If a case is sent to the FO for verification as described in HI 03035.006, HI 03035.010, HI 03035.020, or HI 03035.030, contact the individual per those sections to resolve the issue(s).

Attempt two phone contacts to obtain the information. If those attempts are unsuccessful, send a written request (HI 03010.040H) from the MAPS verification screens.

Document the response in MAPS per HI 03010.040D. If no response is received within 15 days, annotate Failure to Cooperate per MSOM INTRANETMAPS 006.005 . This will generate the pre-decisional notice and, if no timely response is received, the formal denial notice with appeal rights (see HI 03035.050).

Follow the procedures in HI 03040.001 through HI 03040.400 if there was no response to the pre-decisional notice and the claimant contacts SSA within the 60-day appeals period following the receipt of the denial notice.