Effective Dates: 01/28/2025 - Present Previous | Next

TN 21 (05-25)

GN 02270.015 Initial Waiver Determination After the Personal Conference - Title II & Title XVI

CITATIONS:

Social Security Act §§ 204(b), 1631(b)(1)(B)
20 C.F.R. §§404.502a, 404.506, 404.904, 416.551, 416.557, 416.558, 416.1404

A. Introduction

Following the personal conference, the decision-maker documents the waiver determination and issues a written decision to the individual. This is the initial determination on the waiver request, and it is subject to the appeals process.

B. Policy

After the personal conference, we must provide a written decision to approve or deny the waiver request and inform the individual of their right to appeal the waiver determination. As the decision-maker, you are responsible for independently and thoroughly examining all evidence related to the overpayment and the waiver request that was presented or reviewed at the personal conference. When making and documenting a waiver determination, you must support your findings by ensuring you identify and discuss the proper documentation and relevant facts.

NOTE: These instructions apply even if the individual declined the personal conference, the individual did not appear for a rescheduled personal conference, or we were not able to complete the personal conference. For more information about an individual declining a personal conference, or not appearing for a rescheduled conference, refer to GN 02270.007G. For more information about handling a difficult conference, refer to GN 02270.013C.6.

1. Review the evidence before preparing the waiver determination

As the decision-maker, prior to making your waiver determination, you must review all the evidence presented or reviewed at the personal conference, including any new information obtained during the personal conference.

Your decision must be based only on the evidence or information presented or reviewed at the conference. You may not discuss the waiver issues or your decision with the employee who conducted the initial waiver review. If you need to obtain or review additional evidence, you must allow the individual the opportunity to review the additional evidence and respond before making your determination.

2. The contents of a written waiver determination

Your written waiver determination must include:

  • •

    The individual's allegations;

  • •

    Information discussed and obtained at the personal conference that is relevant to the individual's waiver request, or, if appropriate, the fact that we offered the individual an opportunity for a personal conference and the reason we did not hold the conference (e.g., individual declined the conference or did not appear for a rescheduled conference);

  • •

    If you are making an at fault determination, your rationale for that decision;

  • •

    If you are making a not at fault determination, your rationale for that decision and your rationale for your findings on the remaining waiver provisions;

3. The waiver determination

You must first make the fault determination, refer to GN 02250.005 through GN 02250.025.

NOTE: For information regarding Title XVI overpayments caused by resources exceeding the limit by $50 or less, refer to GN 02250.090.

a. Waiver approval

If you determine the overpaid individual was not at fault, approve the waiver if any of these provisions apply:

If the amount you are waiving is over $2,000, you must:

  • •

    Obtain the required second PIN (2-PIN) review before effectuating the waiver approval;

  • •

    Complete any final systems inputs; and

  • •

    Release the (Title II) approval notice. Refer to GN 02270.015C.1.b if the (Title XVI) notice is excluded from automation. The notice should include the information in GN 02270.015B.2 and the information in GN 02250.370B. For more information about the waiver approval notice, refer to GN 02250.370.

NOTE: To determine the level of review for a waiver approval, refer to GN 02250.301. After receiving the 2-PIN approval, release the waiver approval notice to the individual.

b. Partial waiver approval

If you determine that you can only waive a portion of the overpayment, you must still obtain the required 2-PIN review if the amount that you are waiving is over $2,000. You do not need a 2-PIN review for the portion of the overpayment that you are denying.

The Partial Waiver Approval (Initial Waiver Determination) notice is located in the Document Processing System (DPS) under the national and overpayment notice tabs. This notice must include the information in GN 02270.015B.2 and this information:

  • •

    The overpayment amount;

  • •

    The portion we waived and the reason we are unable to approve the entire overpayment amount;

  • •

    A statement that the individual who requested waiver does not have to repay the amount that we waived;

  • •

    A statement that the individual is responsible for repaying the part of the overpayment that we did not waive;

  • •

    Repayment options; and

  • •

    The appropriate appeal language. To determine the correct level of appeal, refer to GN 02250.380.

c. Waiver denial

When we deny a waiver, the overpaid individual must repay the overpayment because evidence in the file indicates they are at fault, or they do not meet the defeats the purpose provision or the against equity and good conscience provision.

The waiver denial notice must include the information in GN 02270.015B.2. and this information:

  • •

    The overpayment amount;

  • •

    The reason for denial, including a fault determination and, if the individual is not at fault, why recovery would not be against equity and good conscience, and would not defeat the purpose of the Social Security Act; and

  • •

    The appropriate appeal language. To determine the correct level of appeal, refer to GN 02250.380.

If you determine that recovery does not defeat the purpose after retrieving information from Accuity through Access to Financial Institutions (AFI), use the Waiver Denial for Defeats the Purpose notice. This notice is located under the national and overpayment tabs in DPS.

If you are denying the waiver request because the individual did not authorize us to access their financial institution information, prepare the Waiver Denial notice, located in DPS under the national and overpayment tabs.

d. Processing the waiver determination

As the decision-maker, you must process the waiver determination and complete the required systems inputs. Despite any systems inputs, we have not made an initial determination on a waiver request until we notify the overpaid individual of our determination and their appeal rights in writing.

NOTE: Hold any paper files for 65 days after sending the personal conference notice, unless your office's procedures allow more time for retaining paper files, in case the overpaid individual requests a hearing.

C. Procedure for documenting and processing the initial waiver determination

1. Documenting and processing the waiver determination

Complete all required fields on Form SSA-635, Waiver Determination. For instructions on how to prepare the SSA-635, refer to GN 02250.315.

a. Title II

On the DMS Remarks Index (RMKI) screen, select 5=OTHER and title the remark "Initial Waiver Determination." For additional information about DMS, complete the Process Personal Conference (DRPC) screen in the DMS after you have conducted the personal conference and prepared your decision, refer to MS 01106.009.

You must annotate the initiate waiver determination (approval, partial approval or denial) on the Debt Management System (DMS) Remarks (RMKS) screen,by stating “Refer to the SSA-635 dated mm/dd/yyyy documenting the waiver determination in the Evidence Portal (EP), name and title of deciding or reviewing official, office code and date of the decision.” For more information on EP, refer to MS 09701.001.

If you are denying a Title II waiver that we completely recovered, request the payment center (PC) repost the overpayment to the Recovery of Overpayments Accounting and Reporting (ROAR) system. Document DMS Remarks. Explain that once you deny the waiver request, we will ask the PC to take another action to correct the balance of the new overpayment to $0 after posting the waiver denial. Once reposted, enter the waiver request and denial.

Prepare and send the waiver determination notice using the DPS. You must complete all Title II waiver determination notices manually.

NOTE: The decision-maker must complete the Waiver Disposition (DRWD) screen for the corresponding overpayment event to complete the DRPC screen. The decision-maker cannot complete the DRPC screen if they also completed the DRWD screen. For instruction on completing these screens, refer to MS 01106.000, MS 01106.004, and MS 01106.009.

Fax any new documents, including the SSA-635, into the Non-Disability Repository for Evidentiary Documents (NDRed) using the Evidence Portal (EP).

b. Title XVI

You must annotate the initial waiver determination (approval, partial approval or denial) on the Report of Contact (DROC) screen in CCE as follows “Refer to the SSA-635 dated [mm/dd/yyyy] documenting the waiver determination in the Evidence Portal, name and title of deciding or reviewing official, office code and date of the decision." For additional information about the Report of Contact, refer to MS 08122.010. Fax any new documents, including the SSA-635, into NDRed using the EP.

Complete the Direct SSR Update screens: Overpayment Decisions (UOPD), Add/Change/Delete Overpayment Decisions (UODC), and Waiver (UOWV).

For instructions on completing the direct SSR input for a waiver decision and the Direct SSR Update screens, refer to MS 00304.007 through MS 00304.009. Waiver approval notices are automated, unless an exclusion to systems-generated notices applies. We complete waiver denial notices manually in DPS. Refer to NL 0803.205 and NL 00803.210. For a list of exclusions to systems-generated notices, refer to NL 00801.010.

Send the manual notice of waiver decision to the overpaid individual (for waiver denials, include the SSA-4017 (SSI payment stub) with a refund envelope). If the overpaid individual has a representative payee (payee), send the payee a copy of the notice with the appropriate payee cover letter (for waiver denials, include the SSA-4017 (SSI payment stub) to the payee with a refund envelope).  Additionally, if the overpaid individual has a legal guardian or appointed representative who is not the payee, send a copy of the notice with the cover letter SSA-L4031, located in the Cover Letter section of the Document Processing System (DPS).

Refer to NL 00803.225 for notice distribution information.

2. Processing waiver approval, partial approval, and denial determinations

a. Waiver approval

Title II procedure

After completing the approval notice, post the waiver approval to the ROAR. If the case requires review, the reviewer will process the approval by completing the Review Personal Conference (DRPW) screen in DMS, refer to MS 01106.010.

If the waiver approval covers months in which we withheld or recovered benefits to recover the waived overpayment, the jurisdictional PC will refund the amount we withheld or recovered. Do not refund any amounts if there is another overpayment for a different overpayment period or an unresolved overpayment.

Title XVI procedure

Process the initial waiver determination using Modernized SSI Claims System (MSSICS) Direct SSR Update and the UOWV screen to post the approved waiver decision to the SSR. For waiver input instructions, refer to MS 00304.009. For instructions on sending the approval notice, refer to GN 02250.370.

If the waiver approval covers months in which we withheld or recovered benefits to recover the waived overpayment, refund the amount we withheld or recovered. Use the automated one-time payment (A-OTP) process to refund the recovered amount. For instructions on the A-OTP process, refer to SM 01901.005 and MS 00304.003 through MS 00304.009 and MS 00303.022. Do not refund any amounts if there is another overpayment for a different overpayment period or an unresolved overpayment.

b. Partial waiver approval

When we approve waiver of recovery for a portion of the overpayment, we relieve the overpaid individual from the obligation to repay that part of the overpayment. The individual is still responsible for repaying the remainder of the overpayment. For the portion of the overpayment that we are waiving, refer to GN 02250.370D. For the portion of the overpayment we are denying, send a manual waiver denial notice. For more information about which denial notice to send, refer to GN 02270.015C.3.c.

Title II procedure

Prepare the Partial Waiver Approval (Initial Waiver Determination) notice in DPS as described in GN 02270.015C.3. and complete the DRPC screen to process the decision to the ROAR.

Title XVI procedure

Process the partial approval using the UOWV screen to issue the notice for the waived amount and to post the partial waiver approval to the SSR. Refer to GN 02270.015C.3. for instructions on issuing the notice for the overpayment amount not waived.

c. Waiver denial

Complete the applicable systems waiver denial screens and issue a notice of waiver denial per GN 02270.015B.2.

Title II procedure

Complete the DRPC screen to post the waiver denial decision to the ROAR.

Title XVI procedure

Complete the UOWV screen to post the waiver denial decision to the SSR.

3. Notice distribution and document storage

Store the initial waiver determination notice in the Online Retrieval System (ORS).

a. Case involves a paper folder

Title II procedure

Include a copy of the SSA-635 Waiver Determination in the folder returned to the jurisdictional PC and fax a copy of the SSA-635 to NDRed via EP. Annotate DMS with the date you return the paper folder to the PC.

Title XVI procedure

Include a copy of the SSA-635 Waiver Determination in the folder and fax a copy of the form to NDRed via EP.

b. Case involves an electronic folder

If the case has an electronic folder (EF), fax the SSA-635 into the EF via EP (non-disability) or eVIEW (disability). For eDIB claim folders, refer to DI 81010.090 Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202270015
GN 02270.015 - Initial Waiver Determination After the Personal Conference - Title II & Title XVI - 01/28/2025
Batch run: 08/21/2025
Rev:01/28/2025