TN 18 (11-24)

GN 02270.013 Conducting the File Review and Personal Conference - Title II and Title XVI

CITATIONS:

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

A. Introduction

We cannot deny a waiver request until we provide an opportunity for the individual to have a file review and personal conference. This section provides guidance on conducting the file review and personal conference after we have sent the individual a notice of the file review and personal conference. For information on scheduling a file review and personal conference and issuing the notice, refer to GN 02270.007.

This section also provides specific instructions on these aspects of conducting a personal conference:

  • How the individual submits evidence for a telephone or video teleconference;

  • The scope of the personal conference;

  • Keeping a record of the personal conference;

  • Actions to take during the personal conference;

  • Obtaining information from the individual during the personal conference;

  • Handling a difficult personal conference; and

  • Closing the personal conference.

B. Policy for conducting the file review

Prior to scheduling the file review, we must gather overpayment and waiver information (e.g., SSA-632, pay stubs or proof of income, resource information, etc.). For more information about gathering evidence, refer to GN 02270.003D. At the file review, the personal conference decisionmaker must provide the individual and their representative with copies of any evidence in the claim file and pertinent sections of the law and regulations. Do not charge the individual for any of these documents.

At the file review, the individual must have the opportunity to review the claims file and applicable law and regulations with the personal conference decisionmaker, who is prepared to answer questions from the individual or their representative.

C. Policy for conducting the personal conference

1. Submitting evidence for a telephone or video teleconference

We must provide the individual the opportunity to submit evidence at the personal conference. If the overpaid individual requests to conduct the conference by telephone or video teleconference:

  • The individual may provide the evidence prior to the conference; or

  • If the individual did not submit evidence by mail, fax, or in person prior to the conference, continue with the personal conference and give them 15 days to submit any new evidence. Let the individual know that if they do not provide the evidence within 15 days, you will make your determination based on the evidence in the file.

    NOTE: We must offer the overpaid individual a face-to-face conference unless the Division of International Operation (DIO) in PC 8 has jurisdiction of the overpaid individual living outside of the U.S., refer to GN 002215.010.

    We will provide a suitable private space for the conference if it is in-person. As in-person conference usually takes place at the individual's servicing field office. However, there may be circumstances that the conference will take place at an alternative location, refer to GN 02270.007.

2. scope of the conference

By the time we conduct the conference, there may be other overpayments for the same individual. Restrict the conference to the waiver request for the overpayment for which you have scheduled the conference, even though recovering the other overpayments may involve similar issues.

3. Keep accurate records

During the personal conference, take notes about information pertinent to the waiver determination so that there is an accurate record of the conference to reference when making the determination.

4. Actions taken during the conference

Complete these steps at the personal conference:

  • At the beginning of the personal conference, check the identity of everyone who is present and have them explain their role;

  • Explain that you are the sole decisionmaker on the waiver, that you were not previously involved in deciding the waiver request, and that you will base your determination only on the evidence presented or reviewed at the personal conference, including the claims file and any new evidence presented at the personal conference. Explain that the conference gives the individual the opportunity to present their case, bring witnesses and furnish any new evidence to support their waiver request;

  • Explain the provisions of the law and regulations that are applicable to the waiver determination;

  • State whether the individual reviewed the claims file;

  • Present the claims file and any other evidence that you have reviewed related to the overpayment and waiver request for the individual and representative to review;

  • Briefly summarize the evidence that is already in the file that you will consider in making the waiver determination;

  • Ask the individual if the information presented is correct and whether they fully understand it;

  • Remind the individual that they did not provide additional evidence if they stated that they would provide more evidence.

5. Information obtained during the conference

Obtain the following information and evidence during the personal conference:

  • The presentation of the individual's case and any arguments to support their waiver request from the individual and their representative, if any;

  • Any additional evidence that the individual or representative presents;

  • Updated financial information and verification from the individual if information in file is more than three months from the date we received the waiver request and if advantageous to the individual;

  • Information from each witness and the witness' answers and statements in response to questions from you, the overpaid individual, and their representative.

6. Handling a difficult personal conference

You may encounter difficulties during the conference that prevent you from completing the conference. For example, the overpaid individual or their representative may be disruptive, unruly, or uncooperative. Inform them that you will end the conference if this behavior continues. If the conference remains unmanageable, end the conference. Document the efforts that you made to continue with the conference. Make the personal conference decision based on the information in the file and any other evidence and information you were able to obtain during the conference, following instructions in GN 02270.015.

7. Closing the personal conference

  • Determine if there is any additional evidence that you need from the individual and ask them to submit the evidence within 15 days;

  • Allow the individual and their representative, if any, to present any final summary or closing statement;

  • Explain that you will make a decision and notify them in writing; and

  • Explain repayment options and appeal rights in the event the decision is adverse to the individual.

    NOTE: Do not provide the decision at the conference.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202270013
GN 02270.013 - Conducting the File Review and Personal Conference - Title II and Title XVI - 11/22/2024
Batch run: 11/22/2024
Rev:11/22/2024