SSA - POMS: GN 02402.020 - Reimbursement Process Due to Alleged Fraud and Other Unauthorized Redirection of Reoccurring Payments

A. Purpose of the Electronic File Transfer (EFT) Claim Form

If a Title II (TII) or Title XVI (TXVI) unauthorized redirected payment results from an Automated Enrollment (ENR), Treasury will pursue the liable Financial Institution (FI) in an attempt to recover lost payments. Treasury will issue EFT Claim Forms (See Section J., Exhibit 1) to FIs sponsoring the automated enrollments (ENR) of redirected payments, associated with SSA beneficiaries, recipients, or representative payees.

B. Overview of Treasury's Recovery Process Using EFT Claim Forms

When the technician selects the fraud alleged option, within the non receipt screen, it initiates the process for Treasury to recover unauthorized redirected payments. If this recovery effort is unsuccessful, Treasury mails the EFT Claims Form, Treasury notifies the receiving financial institution (RFI) and attains the requested funds.

NOTE: If the beneficiary, recipient, or representative payee does not complete a return the EFT Claim Form, the individual may be at fault for the overpayment (See section C for more information).

C. Instructions if a Beneficiary, Recipient, or Representative Payee has not Received or Completed the EFT Claim Form After Claiming Nonreceipt

If the beneficiary, recipient, or representative payee filed nonreceipt and then visits the FO, they can fill out the EFT Claim Form. The Treasury Check Information System (TCIS), Integrated View, has a print option for the EFT Claim Form. Please follow the below instructions for filling out an EFT Claim Form:

1.

Query the TCIS Integrated View.
2.

Print the EFT Claim Form.
3.

Request the beneficiary, recipient, or representative payee complete the EFT Claim form in its entirety.
4.

Mail the EFT Claim form to the address located at the bottom of page 1 in the EFT Claim Form.
5.

Place a copy of the EFT Claim Form in the Electronic Folder (EF) or Non-Disability Repository for Evidentiary Documents (NDRED).

For individuals with Direct Express, the EFT Claim Form is not sent, nor stored in TCIS for printing. The technician must complete the R16 request for Direct Express redirected payments.

NOTE:

If TCIS ENR Status shows "Reprint Date: MM/DD/YYYY" for the claim form, an SSA technician may have been in contact with the beneficiary and the form may be complete. Verify the beneficiary's EF or NDRED before reprinting.

D. Instructions for Handling Treasury Responses After EFT Claim is Sent

The following chart explains the ENR Status Codes, as well as, the actions and the explanations to provide to the beneficiary, recipient, or representative payee.

ENR Disposition Chart

ENR Status	Description	Action	How to handle inquiries: Explain the following
Payment Returned (ENR Match and TeleTrace (TT) Status Payment Returned)	Treasury has returned the redirected payment in full.	If there is an overpayment on the record due to a duplicate payment, reduce or recover the overpayment with the returned funds. Title II- If we have not repaid the beneficiary, the PC technician will issue the funds to the beneficiary using the DR or RC Special Entry in Manual Adjustment Credit Award Data Entry (MACADE). Title XVI - Office of Benefit Accounting and System Analysis (OBASA) posts remittances for partial payments to the Overpayment Refund Data (OPRR) segment of the Supplemental Security Record (SSR) with a DOC of 534 and updates the credit for a full remittance to the appropriate payment in the payment history (PMTH) segment.	If the beneficiary, recipient, or representative payee received a replacement payment(s): Explain we have updated the record and there is no further action for them to take. If they did not receive replacement payment, explain that they should receive the payment within 10 business days.
Comerica as seen in TCIS Claim Details tab (ENR Match and RTN is Comerica, enrollment was erroneously established).	Treasury has contacted Comerica for return of the redirected payment.	Refer to GN 02406.008 for guidance related to nonreceipt of a Direct Express card payment.	Refer to GN 02406.008 for guidance related to nonreceipt of Direct Express card payment.
Claim Form Sent (Full payment not returned from FI)	The ENR Status Date shown in TCIS or the paperless alert shows the date Treasury sent the EFT Claim Form to the beneficiary.	No action is required at this time.	The beneficiary, recipient, or representative payee states that they have an EFT Claim Form. Instruct them to complete the form within 30 days and to return to the address shown on the bottom of page 1 of the EFT Claim Form.
Undeliverable resent referral (Form returned undeliverable and new address is on the Master Benefit Record (MBR) or SSR)	Treasury resent the EFT Claim Form to the beneficiary, recipient, or representative payee. The TCIS Resent Date shows the date Treasury resent the form. The individual has 30 days to return the form.	No action is required at this time.	The beneficiary, recipient, or representative payee states that they have an EFT Claim Form. Instruct them to complete the form within 30 days and to return to the address shown on the bottom of page 1 of the EFT Claim Form.
Undeliverable NOT resent (Form returned undeliverable and NO new address is on the MBR or SSR)	Treasury sent the EFT Claim Form to the beneficiary, recipient, or representative payee. The Post Office has returned the form to Treasury because of an invalid address. Treasury does not resend the form.	Check to see if address has been recently updated. If the address is updated: • Print the EFT Claim Form from TCIS and send to the beneficiary, recipient, or representative payee’s new address. • If TCIS ENR Status shows “Reprint Date: MM/DD/YYYY” for the claim form, an SSA technician may have already resent the form. Verify the form is not currently present in the EF or NDRED before reprinting. • If the address has not been recently updated: • Develop for current address GN 02605.055. • If unable to contact beneficiary, recipient, or representative payee to update address, continue to follow GN 02605.055 Section B.	Phone Call Requests • Verify the Title II and Title XVI address on the record. If the address is correct: • Print the EFT Claim Form from TCIS and send to the beneficiary, recipient, or representative payee’s address. • Explain that they should receive the form within 10 business days. • Instruct them to complete the form within 30 days and return to the address shown on the bottom of page 1 of the EFT Claim Form. If the address is incorrect: IMPORTANT: If there is a (Direct Deposit Fraud Block (DDFP) on the record, follow GN 02402.023. If there is no DDFP block on the record: • Verify their identity and change the address. • Print the EFT Claim Form from TCIS and send to their new address. • Explain that they should receive the form within 10 business days. • Instruct them to complete the form within 30 days and return to the address shown on the bottom of page 1 of the EFT Claim Form. • In-Office Requests Verify the Title II or Title XVI address on the record. If the address is correct: • Print the EFT Claim Form from TCIS and have them complete the form. • Mail the form to the address shown on the bottom of page 1 of the EFT Claim Form. If the address is incorrect: • Verify their identity and change the address. • Print the EFT Claim Form from TCIS and have them complete the form. • Mail the form to the address shown on the bottom of page 1 of the EFT Claim Form.
Incomplete Resent (Form returned incomplete)	The beneficiary, recipient, or representative payee submitted an incomplete EFT Claim Form. The TCIS Resent Date shows the date Treasury resent the EFT Claim Form. Treasury sends a Denial Notice and a blank EFT Claim Form to the beneficiary, recipient, or representative payee. The beneficiary, recipient, or representative payee must return the form within 30 days.	No action is required at this time.	Customer states that they have a Denial Notice. Treasury sends the Denial Notice because they submitted an incomplete EFT Claim Form. Instruct the beneficiary, recipient, or representative payee to complete the form within 30 days and to return to the address shown on the bottom of page 1 of the EFT Claim Form.
No Response (No response)	Beneficiary, recipient, or representative payee has not returned the EFT Claim Form within 60 days.	Upload Treasury response into the EF or NDRED. If there is an overpayment on the record due to a duplicate payment, the overpayment recovery process begins (see Section F). NOTE: The overpayment recovery process begins 60 days after Treasury mailed the original EFT Claim Form. See ENR Claim Details Tab in TCIS.	• Customer did not return the EFT Claim Form and therefore may be overpaid. • Explain that we can provide the EFT Claim Form. • If the claimant states that they will complete the form, print the EFT Claim Form from TCIS and mail or hand them the form. TII - Place the overpayment in protest status of “E” (explanation). TXVI - Stop overpayment collection with an NT TAC. (See GN 02402.017 for further instructions.) Previous instructions involved the use of the MO TAC (SM 01311.220) which created a BZ diary. Correct any MO TAC input with NT TAC if it meets the criteria in this section.
Approved - Debit Notice Sent (Claim form is returned complete and Treasury has the authority to debit the FI.)	Treasury received the EFT Claim Form and submitted it to the FI. NOTE: The FI has 30 days to respond.	No action is required at this time.	Treasury has received the beneficiary, recipient, or representative payee’s EFT Claim Form and Treasury will make a determination within 30 days.
Denied - Payee received payment (The beneficiary, recipient, or representative payee returned the completed EFT Claim Form)	Treasury received the EFT Claim Form and determined the beneficiary, recipient, or representative payee received the payment. Treasury sends a denial notice.	Upload Treasury status to the EF or NDRED. If there is an overpayment on the record due to a duplicate payment, the overpayment recovery process begins.	Explain that Treasury determined that they deposited their funds into the correct account and that they received the payment. Explain that they should contact Treasury regarding the Denial Notice. The Denial Notice will have the contact number included for questions.
Denied - Benefited from Payment (The beneficiary, recipient, or representative payee returned the completed EFT Claim Form)	Treasury received the EFT Claim Form and determined the beneficiary, recipient, or representative payee benefited from the payment. Treasury sends a denial notice.	Upload Treasury status to NDRED. If there is an overpayment on the record due to a duplicate payment, the overpayment recovery process begins (see section F).	Explain that Treasury determined that the beneficiary, recipient, or representative payee deposited their funds into the correct account and that they benefited from the payment. Explain that they should contact Treasury regarding the Denial Notice.
Denied - Someone Else Benefited (The beneficiary, recipient, or representative payee returned the completed EFT Claim Form)	Treasury received the EFT Claim Form and determined the beneficiary, recipient, or representative payee authorized someone to use their personal information to receive the payment. Treasury sends a denial notice.	Upload Treasury status to NDRED. If there is an overpayment on the record due to a duplicate payment, the overpayment recovery process begins (see section F).	Explain that Treasury determined that the beneficiary, recipient, or representative payee deposited their funds into the correct account and an authorized person benefited from the payment. Explain that they should contact Treasury regarding the Denial Notice.
Appeal – Pending (The beneficiary, recipient, or representative payee submitted an appeal)	Treasury received the EFT Claim Form and denied the original claim. The beneficiary, recipient, or representative payee has submitted an appeal through Treasury.	Upload Treasury status to the EF or NDRED. TII- If there is an overpayment on the record due to a duplicate payment and SSA has begun recovery, then place the overpayment in protest status of “E” (explanation). TXVI - Stop overpayment collection with an NT TAC.	Treasury has received the beneficiary, recipient, or representative payee’s appeal. We will take no further action on collection of the debt until Treasury makes a determination on the appeal.
Appeal – Denied (Appeal submitted, reviewed and denied.)	Treasury received the appeal and made a determination to deny the claim.	Upload Treasury status to the EF or NDRED. If there is an overpayment on the record due to a duplicate payment, the overpayment recovery process begins (see section F).	Treasury has received the beneficiary, recipient, or representative payee’s appeal and denied the claim. If they wish to protest the overpayment, mail or hand them the appropriate appeal forms. see GN 02201.021, GN 02201.025, GN 02210.030, GN 02406.310, SI 02220.001, SI 02260.001, SI 02220.017

Financial Institution Debit Process

ENR Status	Description	Action	How to handle inquiries: Explain the following
FI Debit (FI Responds authorizing debit)	SSA receives credit from FI	For actions necessary Title XVI, see SI 02201.007 Section C	If the beneficiary, recipient, or representative payee received a replacement payment: • Explain that we have updated the record and there is no further action for them to take. If they did not receive replacement payment: • Explain that they should receive the payment within 10 business days.
Auto debit (FI does not respond within 30 days)	SSA receives credit from FI	For actions necessary Title XVI, see SI 02201.007 Section C	If the beneficiary, recipient, or representative payee received a replacement payment: • Explain that we have updated the record and there is no further action necessary for them to take. If they did not receive replacement payment: • Explain that they should receive the payment within 10 business days.
FI Protest-Denied (Protest is denied) See section J., Exhibit 2.	SSA receives credit from FI	For actions necessary Title XVI, see SI 02201.007 Section C	If the beneficiary, recipient, or representative payee received a replacement payment: • Explain that we have updated the record and there is no further action for them to take. If they did not receive replacement payment: • Explain that they should receive the payment within 10 business days.
FI Protest (FI Responds with protest)	SSA is awaiting Treasury response on FI protest.	No action is required at this time.	We are awaiting a Treasury response.
FI Protest – Approved (Protest approved)	Treasury received FI protest and determined that the beneficiary, recipient, or representative payee benefited from the payment. Treasury sends a denial notice.	Treasury determined that the beneficiary, recipient, or representative payee benefited from the payment. Upload Treasury status to the EF or NDRED. If there is an overpayment on the record due to a duplicate payment, the overpayment recovery process begins.	Explain that Treasury determined that the beneficiary, recipient, or representative payee deposited their funds into the correct account and that they benefited from the payment. Explain thatthey should contact Treasury regarding the Denial Notice.

E. Overpayment Posting Instructions for Non-Returned or Incomplete EFT Claim Forms and SSA Issued a Replacement Payment

1. For FO instructions regarding Title XVI recipients, follow the below instructions and then choose the applicable option listed under subsection “c”:

a.

Check TCIS for the status of the EFT Claim Form.
b.

Prepare and mail a manual overpayment notice and ensure that appeal rights are included in the notice.
c.
Change the NT TAC and review the record to begin overpayment recovery (follow instructions in SM 01311.285). In addition, please follow one of the following applicable scenarios:
- •
  
  If the Title XVI record is in current pay (i.e., the SSR shows payment status C01), follow the C01 instructions in SM 01311.285 to change the decision on the (Overpayment Decision) UOPD screen from 7 = Erroneous to 3 = RECOVERY BY CHECK ADJUSTMENT, and send to the Supplemental Security Record (SSR). If the overpayment has no notice date posted, then input the notice date using the MSSICS UOSD Screen, see MS 00304.006. Update Sequence Data (UOSD). A manual overpayment notice maybe necessary.
- •
  
  If the Title XVI record is in non-pay status or if the Title XVI record is in terminated status, follow the applicable instructions under SM 01311.225.B.

2. For Processing Center procedures regarding Title II beneficiaries, please follow the below instructions:

a.

Check TCIS or Paperless for the status of the EFT claim form
b.

Delete the non-entitled debtor overpayment.
c.

Establish the overpayment on the beneficiary’s record via the Debt Management System (DMS) Establish Debt (SMED) screen.
d.

Prepare and mail a manual overpayment notice and include an appeal rights in the notice.

F. Field Office (FO) Instructions for Handling Title XVI Financial Institution (FI) Return Payments, Due to Unauthorized Direct Deposit Changes

If the suspected overpayment is the result of fraud, follow SI 02201.007C on handling Title XVI overpayment fraud. After following “SSI: Overpayment Fraud” policy, review the PMTH and OPRR segment of the SSR to determine if SSA applied a credit. Please follow the below applicable scenario:

•

If the credit (returned payment) covers the full overpayment amount, the system reduces the overpayment balance to zero.
•

If the credit (returned payment) does not fully recover the overpayment (i.e., the FI returned a partial payment), then reduce the overpayment by the credit amount or the partial payment remittance found in the OPRR. OBASA posts the partial payment remittance to the OPRR segment, of the SSR, with a District Office Code (DOC) code of 534. In addition, balance the overpayment on the SSR, if applicable.

NOTE:

For any remaining overpayment balance resulting from the A-OTP: Do not send the overpayment notice. Stop overpayment collection with an NT TAC. See GN 02402.017.

G. Processing Center Instructions for Handling Title II Financial Institution (FI) Return Payments, Due to Unauthorized Direct Deposit Changes.

When the FI returns redirected payments to Treasury, Treasury will fax an ENR Recovery Debit Detail Report (see section J., Exhibit 3.). This report will have one of the following TOEL combination codes:

1.

TOEL 1: CHECK
2.

TOEL 2: DIRDEP
3.

TOEL 3: FRAUD
4.

TOEL 4: FIDEBIT

Once SSA receives this information into paperless, use the following steps to process:

1.

Review the ENR Recovery Debit Detail Report to determine the amount of the returned credit.
2.

Apply the credit or remittance by reducing or removing the overpayment with the subscript of X (via DMS RRRE screen).
3.

On the next business day, review the record to make sure the overpayment reduced or removed correctly.
4.

Post a Special Message to the MBR: “FI DEBIT RECEIVED FOR FRAUD REDIRECTED PAYMENT – OVERPAYMENT WAS REMOVED OR REDUCED IN THE AMOUNT OF $$$.$$.” If an overpayment balance remains, then terminate collections and ensure the *119 listing code has been annotated before sending the ACR to FIN.

NOTE:

If there is no NED overpayment on ROAR, follow the applicable instructions under section SM 01311.225.B.

H. Instructions for Handling Protests of Overpayments Resulting from Incorrectly Processed Redirected Payments, After the Overpayment Recovery Process

If the beneficiary, recipient, or representative payee protests the overpayment and alleges fraud, after SSA begun recovery efforts for the redirected payment, refer the case to Office of the Inspector General (OIG) via the Allegation Referral Intake System (ARIS).

1.

For Title XVI, follow SM 01311.220.
2.

For Title II, reestablish the overpayment back on the Non-Entitled Debtors (NED) record and follow the steps in SM 01311.225.B.

If the account holder failed to respond to the EFT Claim Form and protests the overpayment posted, then take the following applicable action:

1.

For Title XVI, follow SI 02220.017
2.

For Title II, follow GN 02201.025

NOTE:

If a FO receives a case involving Title II, they must refer the case to the PC via MDW or RQFA.

I. Instructions for Handling Reports of Incorrect SSA-1099 Forms (Social Security Benefit Statement) Due to Unauthorized Redirected Payments Initiated Through Auto-Enrollments (ENR)

1.

If a beneficiary, recipient, or representative payee alleges the inflation of payments on the SSA-1099, because of nonreceipt of one or more payments due to alleged fraud, then issue a corrected benefit statement.
2.

If the beneficiary did not receive payments during the related tax year in question, then the PC will follow the process to prepare a manual SSA-1099, showing $0.00 in all boxes. (For the processing of the manual SSA-1099, see SM 00630.070.)
3.

If the real beneficiary filed for cash benefits during the related tax year, the SSA-1099 will reflect the amount of benefits that the real beneficiary received.

NOTE:

The FO must contact the PC via MDW or RQFA regarding requests for a manual SSA-1099.

Direct all program–related and technical questions to your RO support staff or PSC OA staff. RO support staff or PSC OA staff may refer questions or problems to their CO contacts.

J. Exhibits

Exhibit 1-Sample EFT Claims Form.pdf

Exhibit 2-FI Protest Denial.pdf

Exhibit 3-ENR Recovery Debit Detail Report.pdf

K. References

•

GN 02605.055 Title II Undeliverable Mail — Change of Address (COA)
•

GN 02402.023 Direct Deposit Fraud Prevention Policy
•

SM 01311.220 Bankruptcy and Referral to Another Agency - MJ, MO, MS and MT TAC
•

GN 02201.021 Field Office (FO) Actions Title II Overpayment Waiver Request
•

GN 02402.025 Direct Deposit Post Entitlement Interview
•

GN 02210.030 Request for Change in Overpayment Recovery Rate, Form SSA-634-BK
•

GN 02406.310 Request for Reconsideration of DCN Overpayment or Forgery Determination
•

SI 02220.001 Recovery Procedures for SSI Overpayments- General
•

SI 02260.001 Basic Requirements Concerning Supplemental Security Income (SSI) Overpayment Waiver
•

SI 02220.017 SSI Overpayment- Request for a Different Rate of Adjustment, a Reconsideration or a Waiver
•

SM 01311.285 Deleting or Correcting the N TAC or the NT TAC
•

MS 00304.006 Update Sequence Data (UOSD)
•

SI 02201.007 Supplemental Security Income (SSI): Overpayment Fraud
•

GN 02201.025 Title II Overpayment Reconsideration Request
•

SM 00630.070 Issuing Replacement, Correction, and Manual Form SSA-1099 or SSA-1042S (Social Security Benefit Statement)

Social Security

Program Operations Manual System (POMS)

GN 02402.020 Reimbursement Process Due to Alleged Fraud and Other Unauthorized Redirection of Reoccurring Payments

A. Purpose of the Electronic File Transfer (EFT) Claim Form

B. Overview of Treasury's Recovery Process Using EFT Claim Forms

C. Instructions if a Beneficiary, Recipient, or Representative Payee has not Received or Completed the EFT Claim Form After Claiming Nonreceipt

D. Instructions for Handling Treasury Responses After EFT Claim is Sent

E. Overpayment Posting Instructions for Non-Returned or Incomplete EFT Claim Forms and SSA Issued a Replacement Payment

1. For FO instructions regarding Title XVI recipients, follow the below instructions and then choose the applicable option listed under subsection “c”:

2. For Processing Center procedures regarding Title II beneficiaries, please follow the below instructions:

F. Field Office (FO) Instructions for Handling Title XVI Financial Institution (FI) Return Payments, Due to Unauthorized Direct Deposit Changes

G. Processing Center Instructions for Handling Title II Financial Institution (FI) Return Payments, Due to Unauthorized Direct Deposit Changes.

H. Instructions for Handling Protests of Overpayments Resulting from Incorrectly Processed Redirected Payments, After the Overpayment Recovery Process

I. Instructions for Handling Reports of Incorrect SSA-1099 Forms (Social Security Benefit Statement) Due to Unauthorized Redirected Payments Initiated Through Auto-Enrollments (ENR)

J. Exhibits

K. References