1

Collect the queries.

1. a. 

   Obtain an SSR Full History query, which will contain the Computation History Segment (CMPH) for the individual(s). ( SM 01601.790)

2. b. 

   Obtain a FULL MBR (FACT) for the Title II benefits the individual(s) would have received in the windfall offset period if the Title II benefits had been paid when due.

2

Gather the form(s) from the inForm Library

1. a. 

   Obtain a copy of the SSA-4346-U2 – SSI Offset Summary.

2. b. 

   Obtain a copy of the SSA-4968 – SSI RMA Payment Worksheet.

3

Complete the following cells at the top of the SSA-4346-U2 form:

1. a. 

   SSN-NUMBER HOLDER

   • •

     The SSN of the insured or deceased person on the Title II record from which the individual is eligible to receive Title II benefits. It may be the individual’s own record, a parent’s, or a spouse’s Title II record.

2. b. 

   NAME-NUMBER HOLDER

   • •

     The name of the insured or deceased person on the Title II record from which the individual is eligible to receive Title II benefits. It may be the individual’s own record, a parent’s, or a spouse’s Title II record.

3. c. 

   SSN-OFFSET CLAIMANT

   • •

     The SSN of the individual(s) who received (or will receive) SSI benefits in the windfall offset period.

4. d. 

   NAME-OFFSET CLAIMANT

   • •

     The name of the individual(s) who received (or will receive) SSI benefits in the windfall offset period.

5. e. 

   STATE CODE

   • •

     This is only required when the individual(s) resided in a state that provides a state supplementary payment during the windfall offset period. The SSI Claims System will prefill a State and county code in the CMPH segment based on the residence ZIP code, see SM 01601.790. For more information about state supplementary payments, see SI 01400.000.

4

Complete the SSI OFFSET PERIOD cell and the “1 COMP” column on form SSA-4346-U2:

1. a. 

   Locate the SSI OFFSET PERIOD cell at the top of the table.

2. b. 

   Record the month of the windfall offset begin date (WOBD) after the word “FROM”.

3. c. 

   Record the month of the windfall offset end date (WOED) after the word “THRU”.

4. d. 

   Locate the “1 COMP” column directly below the SSI OFFSET PERIOD cell.

5. e. 

   List the months in the windfall period in column "1 COMP" in chronological order from top to bottom.

For definitions of WOBD & WOED, see GN 02610.022 .

5

Collect the FAM data from the SSR.

Locate the SSI federal amount due (FAM) for each month of the windfall period in the CMPH field of the SSR.

6

Record the SSR FAM data on SSA-4346-U2.

1. a. 

   If the individual would have received (or already received) DIB in the windfall offset period, then enter the FAM for each month of the offset period in column "2 DIB".

2. b. 

   If the individual would have received (or already received) RSI benefits in the windfall offset period, then enter the FAM for each month of the offset period in column "3 RSI".

3. c. 

   If the individual would have received (or already received) both DIB and RSI benefits in the same month, DIB is the primary benefit. Enter the FAM for each month of the offset period in column “2 DIB”.

4. d. 

   If the individual would have received (or already received) DIB and RSI benefits in different months of the windfall offset period, then enter the FAM under the “2 DIB” or “3 RSI” column for the appropriate months.

To determine the type(s) of Title II benefit(s) the individual is receiving or due, you may need to review:

• •

  the information sent by the PC to the FO through the e4345 application or on a paper SSA-4345-U2,

• •

  the UMIH section of the SSR ( SM 01601.760), or

• •

  lines on the Full MBR(s) (FACT) from which the individual is receiving benefits, such as the INSURED line ( SM 00510.071) or the BENE ENT line ( SM 00510.190).

7

If necessary, collect the SAM data from the SSR record the SAM data on the SSA-4346-U2.

Locate the state amount due (SAM) for each month of the windfall period in the CMPH field of the SSID.

If the individual also received payments from a federally administered state supplement program, record the SSR SAM data on SSA-4346-U2. Follow the same procedure from Steps 3 through 4 above to complete state amount due (SSR SAM) for columns "4 DIB" and "5 RSI" on the SSA-4346-U2.

8

Compute the NEW FAM & NEW SAM.

To compute the NEW FAM/NEW SAM amounts, follow the instructions in SI 02005.090 and complete form SSA-4968 (SSI RMA Payment Worksheet) for each month in the offset period. Completing the SSA-4968 for each month in the windfall period will provide you with the new monthly SSI federal amount due (NEW FAM) and new monthly state supplement amount due (NEW SAM) for each month. The NEW FAM and NEW SAM are the federal and state SSI amounts that would have been due to the individual if the individual’s Title II benefits had been issued when they were due.

General Reminders:

• •

  Count the Title II benefits as income in the months the payments would have been received even if the individual has not yet received the payments. ( SI 00830.010B.1)

• •

  Account for any legal expenses, such as representative’s fees (GN 03920.001) or certain out of pocket legal expenses ( GN 03920.010A.4.), as is required by SI 00830.100. SI 02006.210 provides instructions about how to deduct legal expenses from the amount of retroactive Title II benefits counted as income.

Title II Payment Data:

• •

  Use the Title II payment information sent by the PC to the FO through the e4345 application or a paper SSA-4345-U2 to complete these computations.

• •

  If you do not have the retroactive Title II benefit information from the PC, review the HISTORY data line on the MBR to determine the Title II benefits that would have been paid in the windfall offset period if Title II benefits had been paid when they were due. ( SM 00510.585 & SM 00510.175) Keep in mind the HISTORY data line will only show a new line when something changes, so a benefit from one line will continue each month at the same rate until a new line is posted, indicating a change. Also, remember the MBR will show the month for which the Title II benefit is due, not the month in which the individual(s) received (or would have received) the Title II benefit payment.

9

Record the NEW FAM & NEW SAM amounts on the SSA-4346-U2.

1. a. 

   Enter the NEW FAM amounts into the appropriate columns ("2 DIB" and "3 RSI") on the SSA-4346-U2 for each of the months for which you computed a new benefit amount using the SSA-4968 (or eComps).

2. b. 

   If the individual also received payments from a federally administered state supplement program, enter NEW SAM amounts into the appropriate columns ("4 DIB" and "5 RSI") on the SSA-4346-U2 for each of the months for which you computed a new benefit amount using the SSA-4968 (or eComps).

10

Compute the FOA and SOA for each month listed on the SSA-4346-U2.

1. a. 

   In columns "2 DIB" through "5 RSI" on the SSA-4346-U2, subtract the NEW FAM or NEW SAM amount from the SSR FAM or SSR SAM amount for each row. The results will be the federal offset amount (FOA) and state offset amount (SOA) for each month.

   • •

     (SSR FAM – NEW FAM = FOA)

   • •

     (SSR SAM – NEW SAM = SOA)

2. b. 

   Record the results in the appropriate FOA or SOA columns under columns "2 DIB" through "5 RSI" on the SSA-4346-U2, even if the result is a negative number.

11

Compute the FOA and SOA totals.

Total the FOA's and SOA's on bottom of their respective columns on the SSA-4346-U2.

12

Complete the last row on the form with your information.

1. a. 

   Record your name on the box labeled DETERMINED BY.

2. b. 

   Record your job title in the box labeled TITLE.

3. c. 

   Record the date you completed the form in the box labeled DATE.

13

Update the SSR.

Follow steps in SM 01320.201 to post the results of the manual Title II offset computations to the SSR for the individual or both members of a couple’s case. Make sure you fill out every field in SM 01320.201B that applies to your case.

14

Save copies of the worksheets.

1. a. 

   Open eView and locate the individual’s electronic file using the SSN in the SSN-OFFSET CLAIMANT cell at the top of the SSA-4346-U2 worksheet. If the individual does not have an electronic file in eView, use Evidence Portal (EP). Open the EP application, select Store Evidence, and enter the individual’s SSN to create NDRED fax cover sheets for the forms. You can access EP at View Evidence - Evidence Portal (ssa.gov)

   • •

     Both eView and NDRed have specific fax cover sheets for the SSA-4968 and SSA-4346-U2.

2. b. 

   Print the appropriate fax cover sheet for each document you used to complete these computations.

3. c. 

   Store copies of the SSA-4346-U2, SSA-4968 (or a printout of the eComps RMA computation results), and any other documents you filled out to complete these computations into the individual(s) electronic folder