This section provides guidance on how to schedule a file review and personal conference when we cannot approve the individual's waiver request after our initial review. This section also provides guidance to follow when:

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  The notice scheduling the file review and personal conference is returned as undeliverable;

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  An individual wants a representative to take their place at a personal conference;

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  An individual requests to conduct the personal conference on the same day as the file review; and

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  An individual does not appear for or declines the file review or personal conference.

NOTE: We do not need to schedule a file review or personal conference if the independent decisionmaker can approve the waiver request based on the evidence in file.

When we cannot approve the individual's waiver request after our initial review, we must provide the individual the opportunity for a file review and personal conference. At the file review, the individual has the opportunity to review all overpayment-related evidence in the claims file and the evidence we used to determine that we could not approve the individual's waiver request. The purpose of the personal conference is to give the individual the opportunity to appeal personally, to testify, and to provide additional evidence and arguments to support their waiver request.

We must send a notice to the overpaid individual that includes:

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  The fact that we cannot approve the waiver based on the information we have;

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  The dates, times, and location of the file review and personal conference. The date of the personal conference must be at least five workdays after the date of the file review. Refer to GN 02270.007F for an exception;

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  The procedure for reviewing the claims file prior to the personal conference;

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  The option to conduct the personal conference in the field office (FO), by telephone, or by video teleconference. We inform the individual that if they elect to conduct the personal conference by video teleconference, they will designate the location for their end of the video teleconference;

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  All other information necessary to fully inform the individual about the personal conference, including their right to be represented, present evidence, or bring witnesses to question.

Do not include this information in the notice:

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  Appeal rights (because you have not made an initial determination on the waiver request);

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  Overpayment recovery options (e.g., refund request or payment adjustment).

NOTE: If the overpaid individual's address is outside the United States, refer to GN 02215.010.

If the individual cannot come to the originally designated FO for a legitimate reason (e.g., the individual is incapacitated) and they are unable to appear meaningfully by telephone or video teleconference (e.g., the individual is hard of hearing ) the decisionmaker will make arrangements to travel as far as necessary to conduct the conference.

When an individual requests a face-to-face personal conference and the decisionmaker is from a FO other than the individual's servicing FO, the manager may arrange for an employee from another office to travel to the individual's servicing FO. For more information on who may be a personal conference decisionmaker, refer to GN 02270.003C.

After we schedule the file review and personal conference, the individual may choose to decline to attend the personal conference, or they may fail to appear at the personal conference. If the individual declines a personal conference, we will make a waiver determination based on the information in the file. If the individual does not appear for the scheduled personal conference, reschedule the personal conference. If the individual fails to appear for a second scheduled personal conference, we will make a waiver determination based on the information in the file, refer to GN 02270.007G.1.

NOTE: We will also make a waiver determination based on the information in the file if the individual is unable to come to the FO or participate in a telephone or video teleconference and the decisionmaker is unable to go to the individual's location (e.g., the individual is incarcerated and the facility does not allow any outside communication).

If you cannot fully approve the waiver request after initial review, do not send a waiver determination notice. Instead, prepare the Personal Conference & Folder Review (Waiver/Recon) notice found in the Document Processing System (DPS), under the national and overpayment tabs.

NOTE: For Title XVI, do not input a determination on the Modernized SSI Claims System (MSSICS) Direct SSR Update screens.

If the United States Postal Service (USPS) returns the notice scheduling the file review and personal conference as undeliverable, develop for a new address, refer to GN 02605.055 and GN 02605.060.

If you obtain a new address, send a new notice to the individual. If you cannot obtain a new address, document your efforts on the DMS Remarks (DMS RMKS) screen for Title II cases and on the Report of Contact for Title XVI cases. Process the waiver as if the individual declined the personal conference and follow the steps in GN 02270.007G.1.

If the individual requests that their representative take their place at the personal conference, explain that a representative may be present and participate in the conference. However, the overpaid individual must be present at the personal conference.

We must schedule the personal conference at least 5 workdays after the date of the file review. However, we can hold the personal conference on the same day if the individual requests to conduct the personal conference on the same day as the file review. You must document their request on the DMS RMKS screen for Title II cases and on the Report of Contact for Title XVI cases.

We will make a waiver determination based on the information in the file if the individual:

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  Declines the personal conference;

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  Fails to appear for the second scheduled personal conference; or

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  Is otherwise unable to appear at the personal conference by telephone, video teleconference, or in person, and the personal conference decisionmaker is unable to go to the individual for the personal conference.