Effective Dates: 05/11/2022 - Present Previous | Next

TN 95 (05-22)

GN 02406.147 Handling a Request for a Certified Payment Extract (CPE)

A. Introduction to CPEs

A CPE is a certified record of payments that may be used for legal purposes, including as evidence in a court of law. CPE requests may derive from local courts, private sector attorneys, or other entities seeking verification of benefit information (for example, for child support enforcement cases or fraud in the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps). CPE requests are priority cases and should be processed within 20 business days of receipt.

B. Requests for payment extracts from local courts, private sector attorneys, or other entities

To prepare correspondence for a CPE, prepare the following:

•

Cover memorandum (Follow the instructions in Exhibit 1 in GN 02406.147F.);
•

Authorization for certification of the extract (Swear Statement) (Follow the instructions in Exhibit 5 of GN 02406.147F in this section.); and,
•

CPE (follow the format shown in Exhibits 6 and 7 GN 02406.147F in this section.)

NOTE: Exact style may vary in the different processing centers and components.

Include the following items in the correspondence:

1.

A short introductory paragraph that includes the beneficiary's name and the timeframe covered by the extract;
2.
The payment history including:
- •
  
  Issue date of the check;
- •
  
  Exact amount of payment;
- •
  
  Explanation of the payment and payment period;
- •
  
  Extract of data relating to negotiated checks only; and
- •
  
  An explanation of any change in Hospital Insurance and Supplemental Medical Insurance (HI/SMI)
  
  IMPORTANT: Do not include non-negotiated checks (such as a returned check) in the extract.
3.

Annotate the check range in the “Represented Payment for” column for all prior month accruals (PMAs) and Critical Payment System (CPS) payments;
4.

An explanation of any check that represented an overpayment;
5.

If the beneficiary identification code (BIC) involved has a payee change, annotate the dates of the change in the opening paragraph; and
6.

If a financial institution is involved, show the name and address of that institution.

Mail or fax the completed request to the regional office address listed under GN 02406.147D.

C. Processing Office of the Inspector General (OIG) requests for CPEs

OIG requests CPEs for use in prosecuting fraud cases. These extracts are acceptable as evidence at fraud hearings in lieu of certified photocopies of checks and of testimony by the SSA official identified as the keeper of record.

OIG submits requests for all CPEs from the corresponding Payment Service Center’s Regional Center for Automation, Security and Integrity (CASI). You can identify these extract requests by the CASI flag. See Exhibit 2 in GN 02406.147F. For OIG requests, CASI will:

•

distribute copies of the CPE;
•

provide the address of the OIG contact requesting the CPE; and
•

provide a reference number, if applicable.

D. PSC Regional Office Mailing Addresses for Title II CPE Requests

To request Title II payment extracts, complete the request letter as appropriate. See GN 02406.147F for an example of the request letter. Email (preferred), mail or fax the information to the regional office of jurisdiction at the following address:

Address	Payment Service Center
Social Security Administration CASI Security and Integrity Team Center for Automation, Security and Integrity 26 Federal Plaza Room 4030–160A New York, NY 10278 Telephone: (212) 264-2604 Fax: (212) 264-0916 Email: \|\|NY CDPS	PSC 1 NEPSC
Social Security Administration Office of the Regional Commissioner Center for Automation, Security and Integrity Attn: Carmen Butler PO Box 8788 Philadelphia, PA 19101 Telephone: (215) 597-1014 Fax: (215) 597-5203 Email: \|\|PHI MOS Security and Integrity Team	PSC 2 MATPSC
Social Security Administration Center for Automation, Security and Integrity Birmingham Social Security Center 1200 Rev. Abraham Woods Jr. Blvd. Birmingham, Alabama 35285 Fax: (205) 801-1332 Email:\|\|ATL MOS CASI SECURITY	PSC 3 SEPSC
Social Security Administration Center for Automation, Security and Integrity P.O. Box 87479 Chicago, IL 60680 Telephone: (312) 575-4120 Fax: (312) 575-4121 Email: \|\|CHI ARC MOS CSI	PSC 4 GLPSC
Social Security Administration, SFRO Center for Automation, Security and Integrity, 6th FL PO Box 4206 San Francisco, CA 94804 Fax: (510) 970-2644 Email: \|\|SF MOS CASI	PSC 5 WNPSC
Social Security Administration Center for Automation, Security and Integrity MAMPSC PO Box 15625 Kansas City, MO 64106 Telephone: (816) 936-5555 Fax: (833) 914-1965 Email:\|\|KC SIT	PSC 6 MAMPSC
Social Security Administration Office of Central Operations Center for Automation, Security and Integrity 6401 Security BLVD Room 3253 Annex Baltimore MD 21235-0001 Fax: 410-597-0140 Email: \|\|OCO Integrity Branch	PC7 or PC8

E. Processing Title XVI requests for CPEs

To request Title XVI payment extracts, complete the request letter as appropriate. See GN 02406.147F for an example of the request letter. Email (preferred), mail or fax the information to the regional office of jurisdiction at the following address:

Address	Region
Social Security Administration JFK Federal Building Room 1925 Boston, MA 02203 Fax: (617) 565-9359 Email:\|\|BOS CPS RSI SSI	1 Boston
Social Security Administration Center for Disability and Program Support 26 Federal Plaza Room 4060 New York, NY 10278 Telephone: (212) 264-1461 Fax: (212) 264-2071 Email: \|\|NY CDPS	2 New York
Office of the Regional Commissioner/Seventh Floor Center for Programs Support P.O. Box 8788 Philadelphia, PA 19101 Fax: (215) 597-2989 Email: PHI.MOS.Ctr.Disability.and.Programs@ssa.gov	3 Philadelphia
Social Security Administration Center for Disability and Program Support Atlanta Regional Office 61 Forsyth St, Suite 23T42 Atlanta, GA 30303 Fax: (404) 562-1325 Email: \|\|ATL MOS CDPS SSI	4 Atlanta
CRSI/SSI PO Box 8280 Chicago, IL 60680-8280 Fax: (312) 575-4245 Email : CHI.ARC.MOS.CRSI.SSI@ssa.gov	5 Chicago
SSA, MOS, CPS, SSI 1301 Young St, Ste 670 Dallas, TX 75202-5433 Fax: (214) 767-1348 Phone: (214) 767-4224 Email: \|\|DA SSI	6 Dallas
Center for Disability and Programs Support ATTN: Certification Request Room 1002, 601 E 12th St Kansas City, MO 64106 Fax: (833) 914-1965 Email: \|\|KC CPS	7 Kansas City
Social Security Administration - CPS 1961 Stout Street Suite 06-145 Denver, CO 80294 Fax: (303) 844-4280 Email: \|\|DEN CPS	8 Denver
Social Security Administration, SFRO Center for Disability and Programs Support, 6th Fl PO Box 4206 Richmond, CA 94804 Fax: (833) 914-2045 Attn: Regional Privacy Act Coordinator Email:^SF CA RO CDPS Disclosure Controls	9 San Francisco
Social Security Administration, SPST Suite 2900, MS 303A 701 5th Avenue Seattle, WA 98104-7075 Email: \|\|SEA CPS	10 Seattle

F. Example of formats to use when requesting payment extracts

Use these examples as a guide to format your request for CPEs. OIG uses one form to request CPEs for both Title II and Title XVI.

1. Exhibit 1 Example of Extract Cover Note

Social Security Administration

Regional Office- __________________

Date:

Special Agent's Name

Special Agent's Title

SSA/OIG

6401 Security Boulevard

Baltimore, MD 21235

Dear (Agent's Name):

This is in reference to your letter dated ____________, about payments made to ___________(Recipient's Name), Social Security number _____________ for the period _____________ through _______________ . Please see enclosed extract.

If you have any further questions regarding this, please contact __________________, Region _____, at _________________ .

Sincerely,

(Name)____________

(Title)____________

Regional Office ____________

Enclosure

2. Exhibit 2 OIG Payment Extract Request Format for Title II and Title XVI

Office of the Inspector General

Office of Investigations

Social Security Administration

Date: _______

To: Social Security Administration (Regional Offices addresses)

Fax:

From: _______________________________________

_______________________________________

Subject: Request for: __________________________________________________

RE: SSA OIG OI File Number (SSN) ________________________________

In conjunction with an official investigation being conducted by this office, this is a request for (if requesting payment extract, provide period of time covered):

_________________________

_________________________

_________________________

Please forward the documents identified above to _______________________ at the following address no later than ___________

_________________________________________________

(Requester phone number: _____________________)

3. Exhibit 3 Form to Request Title II Payment Extract

Request of Title II (SSA) Benefit Payments

Send to:

Social Security Administration

Center for Security and Integrity

(Insert the Processing Center of jurisdiction address )

Requests involving all Foreign Claims and Disability Claims under Age 55

Please prepare:

(check one)

(a) Certified extract (court date scheduled for)

(b) Extract (no court date scheduled)

of benefits for all payments issued to the following beneficiary (ies) under the following Social Security number(s) during the listed period:

Social Security Number (SSN):

Beneficiary (ies):	1) /
	2) /
	3) /
	Name Own SSN:

Time Period for record of payments (only months/years involved in investigation)

(After 12/83)	From Thru:
	(MM/YY) (MM/YY)

This request is part of an investigation of a possible fraud/violation of the _______________________________________________ program(s).

Case Number: _______________

Name of Requester: _______________

Title of Requester: _______________

Office of Requester: _______________

Requester Phone NO: _______________

Date: _____________ Signature _____________

4. Exhibit 4 Cover Memorandum to the Office of Investigation

Letterhead Memorandum Paper

To	: Requesting Office
From	: Authoring Component
Subject	: 000-00-0000,

(Claimant's name), Request for Certified Extract (Request dated ______) (Include reference number in the subject line)

Attached are the authorization for certification of extract records, certified extract of benefits for payments issued to all beneficiaries on this account from _________through__________.

Payments certified for the period______through______were for payment via direct deposit to (Bank’s name and address), for deposit to checking/savings account number ______and identified by the routing and transit number

(RTN) .

(Complete only if applicable)

(Director's Signature)

(Director’s Name)

Process Division__________

Attachments

5. Exhibit 5 Authorization for Certification of Extract from Records

Baltimore, Maryland 21241

Refer to:

(Requesting office Name and Address)

CERTIFICATION OF EXTRACT FROM RECORDS

In accordance with provisions of Title 42, United States Code (USC), Section 904, and the authority vested in me by 42 U.S.C. 902, I hereby certify that I have legal custody of certain records, documents, other information established and maintained by the Social Security Administration, pursuant to Title 42, United States Code, Section 405, and that the annexed is a true extract from such records in my custody as aforesaid.

I further certify that all signatures of the Social Security Administration officials on the annexed document(s) are genuine and made in accordance with the signers’ official capacity

IN WITNESS WHEREOF, I have set my hand and caused the seal of the Social Security Administration to be affixed this ________day of_______.

(Director's Signature)

(Director's Name)

6. Exhibit 6 Extract Request Format

Social Security Administration

Refer to: ________

To Whom It May Concern:

The following Social Security benefits in the chart below were certified for payment to John Doe and Jane I. Doe under Social Security claim number 000-00-0000 for the period July 3, 1997 through June 3, 1998 and have not been reported as non-receipt items.

Approximate Date of Payment	Amount	Represented Payment for
July 3, 1998	$604.20	June 1998 minus supplemental medical insurance premiums of $9.60
August 1, 1997	$604.20	July 1997
September 3, 1997	$604.20	August 1997
October 3, 1997	$604.20	September 1997
November 3, 1997	$604.20	October 1997
December 3, 1997	$604.20	November 1997
January 2, 1998	$604.20	December 1997
February 3, 1998	$604.20	January 1998
March 3, 1998	$638.90	February 1998
April 3, 1998	$638.90	March 1998
May 3, 1998	$638.90	April 1998
June 3, 1998	$638.90	May 1998
	$7,389.20	Total amount paid to John Doe and Jane I. Doe for July 3, 1997 through June 3, 1998

7. Exhibit 7 Request for Title XVI Payment Extract

Social Security Administration

Request for Title XVI Payment Extract

To: Social Security Administration (Regional Offices addresses)

Fax:

From:

Subject: Request for: (check one)

____(a) Certified extract (court date scheduled for) ______ or ______ (b) Extract (no court date scheduled) of benefits for all payments issued to (Recipient's Name)_____________ , (Payee's Name, if appropriate)____________ , (Recipient's SSN) ______________ for the period of ________ through (use MM/YY format).

Please forward the materials requested to the following name and address

by__________________.

_______________________________

Phone: ___________________

Requester's Signature: _________________ Date: _______________

Thank you for your assistance in this matter.

8. Exhibit 8 Example of Title XVI Payment Extract

Social Security Administration

Regional Office ______________

I, _________________________, Social Security Administration, Region ___, hereby certify that the following business system records of the Social Security Administration pertain to the record of (Recipient's Name ) ________________ , Social Security number _________________ .

I further certify that the records of the Social Security Administration show that eligibility for the Supplemental Security Income (SSI) payments as of (Date)____________ , under Section 1602 of the Social Security Act were paid to (Recipient's Name) __________________ .

Below is the record of the SSI payment(s) for the period you requested. I further certify that the current representative payee is (Representative Payee's Name, when appropriate) ___________________.

DATE	AMOUNT
06/01/1990	$418.40
06/02/1990	5548.79
07/01/1990-12/01/1990	418.40 PER MONTH
01/01/1991-12/01/1991	439.40 PER MONTH
01/01/1992-12/01/1992	454.40 PER MONTH
01/01/1993-12/01/1993	466.40 PER MONTH

Sincerely,



(Name)



(Title)



Regional Office _____________________

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202406147

GN 02406.147 - Handling a Request for a Certified Payment Extract (CPE) - 05/11/2022
Batch run: 10/09/2024
Rev:05/11/2022

Program Operations Manual System (POMS)