TN 49 (09-00)
GN 00204.020 Scope of the Application
A. Policy – general
Generally, applications under Titles II, VIII, XVI, and XVIII (Part A) cover all classes of benefits for which the claimant is eligible on all SSNs regardless of the title of the application unless it is specifically limited by the claimant. See SI 00601.010D.1 for scope of a SSI application. See GN 00204.020B.4. for a list of exceptions. In most situations, a valid application for one class of benefits (e.g., SSA-1 for Retirement Benefits) is deemed an application for another class of benefits (e.g., Spouse Benefits). See GN 00204.020F for deemed filing policy and procedures.
NOTE: A Title II application filed after December 1999 is also an oral inquiry for Title VIII, Special Veterans Benefits (SVB).
GN 00204.022 requires interviewers to explore potential entitlement to another class of benefits or entitlement on another ER. If a claimant is also eligible for another class of benefits, a supplemental application may be required to obtain additional information necessary for adjudication (see GN 00205.020). GN 00204.020B.5. lists situations where a separate application is required.
After effectuation, the scope of an application cannot be restricted. The application must be withdrawn following the guidelines outlined in GN 00206.000 and MSOM MCS 009.001 if the claim was taken via MCS. Withdrawal is not always in the best interest of an individual because the claimant forfeits all rights flowing from the application. In addition, a subsequent application may not cover the same retroactive period. See GN 00204.010F.1. for protection which is afforded claimants who become entitled to other benefits during the appeal period of an application.
B. Policy – expanding/restricting the scope
Prior to adjudication, the claimant may need to complete appropriate items on the application form or furnish supplemental information as outlined in GN 00205.020 concerning other SSN's or classes of benefits for which he or she may be eligible.
2. SSA-10-BK (Application for Widow's and Widower's Benefits)
The SSA-10-BK serves as an application for all benefits to which the widow(er) or surviving divorced spouse could become entitled within the effective life of the application, including the LSDP, RIB, survivors' benefits under the Railroad Act and Department of Veterans Affairs payments. When a widow(er) is eligible for WIB on more than one record but does not restrict the application to one record, see RS 00615.301A.1. The application must be restricted to allow the widow(er) to apply for a higher benefit subsequently payable on the other record because of lesser reduction for age.
NOTE: For more information on the validity and scope of an iClaim Medicare-only application, see GN 00204.059K.2.
3. Survivor cases
An application for survivor's benefits also may be an application for auxiliary benefits within the 6 months retroactive period (or to month of death) and up to 12 months retroactivity for prior disabled number holders. For example, where a NH was last entitled to a RIB or DIB prior to death, a survivor may be entitled to retroactive auxiliary benefits if he or she does not restrict the scope of the application and if he or she meets all the factors of entitlement. An application for survivor benefits is also an application for Department of Veterans Affairs (DVA) payments. See the note in RS 01702.410A. for the policy and effect on the DVA application process when a SSA life claim is converted to a survivor claim.
The scope of an application is determined by the wording on its face. Applications under Titles II, VIII, XVI, and XVIII (Part A) contain an introductory paragraph which covers all classes of benefits for which the claimant is eligible on all SSN's regardless of the title of the application, except:
a. Application for lump sum death payment
In 2/78, the SSA-8-F4 (Application for Lump Sum Death Payment) was limited to benefits on the deceased NH's SSN. Prior to that edition, the scope of the application was for all Title II benefits, including DIB, to which the claimant may have been entitled on any E/R.
b. Oral inquiry for SSI
Title II and Title XVIII applications are not applications for Title XVI. However, under certain circumstances an application for Title II is an oral inquiry for SSI which must be closed out. (See GN 00201.005F, SI 00601.027 and SI 00601.025A.)
c. Application for SVB
A Title VIII application for SVB is also an application for Title II and Title XVI benefits (see VB 00201.010D.1). A Title VIII application is not an application for Title XVIII (Part A).
Title II and XVI applications are also applications for Title VIII even though the application wording does not mention Title VIII. The wording will be revised as the forms are scheduled for OMB clearance.
5. When separate applications are required
a. Separate PCs involved
Obtain separate applications whenever the claims will be processed or maintained in separate PCs (e.g., the spouse is simultaneously entitled to DIB).
NOTE: Although one signed application establishes the individual's application date for all benefits within the scope of the application, in some situations more than one application is obtained for record keeping purposes or due to systems limitations.
b. Concurrent DIB/DWB claims
Take an application for DIB when a claimant for disabled WIB benefits also meets the disability earnings requirement on his or her own E/R.
c. MCS claims
When adjudicating via MCS, there are situations where the scope of the application cannot be expanded by taking supplemental statements, etc. The filing of a separate application for each claim type may be required.
C. Examples – scope of the application
1. SSA-1 (Application for Retirement Insurance Benefits)
John, age 64, filed a SSA-1 for RIB. He states that his wife died. The SSA-1 covers widower's benefits and LSDP on his wife's SSN.
2. SSA-8-F5 (Application for Lump Sum Death Payment)
James, age 62, filed an SSA-8-F4 for the LSDP on his deceased wife's account. The SSA-8-F4 is an application for widower's benefits but does not cover RIB on his own SSN.
D. Policy - restricting the scope of the application
A claimant may choose to limit or restrict the scope of the application to exclude a class of benefits he or she may be eligible to on one or more SSNs for any reason (except where deemed filing applies). The reason may be to receive higher current benefits or to maximize the amount of benefits over a period of time, including the effect of delayed retirement credits (DRCs). (See RS 00615.480 for information on adjustment of the reduction factor.)
a. Before adjudication
The claimant must restrict the application before it is adjudicated.
b. Unequivocal statements
The claimant may restrict the application by completing appropriate blocks on the application or by signing an unequivocal statement that he or she does not wish to file for a specific benefit as follows:
“I filed on (DATE) for all benefits for which I may be eligible except ___________”; or
“I wish to exclude ________ benefits from the scope of this application.”
Only unequivocal statements are acceptable. Qualifying phrases such as “at this time” or he or she plans to file in the future are not acceptable.
a. HI (Part A) filing
A claimant age 65 must file for HI if filing for any monthly benefit.
b. Deemed filing rule
A claimant cannot file for reduced RIB or reduced spouse's benefits without filing for the other benefit if eligibility for both benefits exists in the first RIB MOET or the first AUXSPO MOET. (See GN 00204.020F which further explains the “deemed filing” rule. Also, see GN 00204.004 for policy and procedure on determining if RIB entitlement exists when a spouse claim is filed.)
NOTE: Deemed filing is not applicable for a claimant who is full retirement age.
A claimant may choose to limit the scope of a SSI application to exclude Title II benefits (see SI 00601.010D.2.). However, a SSI claimant must be told that restricting Title II benefits will affect his or her eligibility to receive Title XVI payments. Follow the instructions in SI 00510.001B.6. and SI 00510.020. if the claimant has been notified of potential entitlement to Title II benefits and he or she chooses not to file. Also, if the claimant is a DWB, follow the instructions in HI 00801.154 and DI 11015.005 for counting months of SSI eligibility toward the 5-month waiting period, and the 24-month qualifying period for Medicare.
E. Procedure - restricting the scope
1. MCS applications
a. Claims filed but not signed
Delete the unsigned MCS claim per MSOM MCS 017.002 if the claimant later decides to restrict the scope of the application.
b. Claims filed but not adjudicated
Discuss the withdrawal procedures as appropriate per GN 00206.000 or
Follow Manual Clearance (MANC screen) procedures found in MSOM MCS 020.004. Use this procedure only if a claim was erroneously established before the restriction of the application.
c. Claims filed on the internet (iClaim) NOT adjudicated
When the technician establishes an iClaim RIB application on MCS before identifying the claimant’s intent to file for AUXSPO benefits only, the technician must MANCLR the erroneous propagated RIB claim and subsequently establish the AUXSPO claim on MCS. Refer to GN 00204.055H.3.b. for instructions on establishing a new claim and MANCLR the iClaim.
2. Claim(s) adjudicated
Process a withdrawal in accordance with GN 00206.000.
3. Excluding DIB
Follow the instructions in GN 00205.035 when an RSI claimant chooses to exclude DIB from the scope of the application.
4. Excluding RIB from widow(er) or surviving divorced spouse claims
a. Delayed Retirement Credits (DRCs)
See RS 00615.690 for an explanation of DRCs. A widow(er) or surviving divorced spouse may wish to exclude a reduced RIB from the scope of the application and defer filing for an unreduced RIB because of the increasingly greater amount payable after FRA because of DRCs.
b. Statement to restrict the scope
In the situation described in GN 00204.020E.4.a, obtain a statement as follows if the claimant has not attained FRA, excludes a reduced RIB from the scope of the application and wishes to defer filing for an unreduced RIB:
“I do not wish this application to be considered an application for reduced benefits on my own record.”
NOTE: If the application is taken in MCS, the statement to restrict the scope will automatically be generated on the application when the question on the ADDB screen is answered “no” (see MSOM MCS 005.012C.).
Include a paragraph on the award notice advising the claimant to recontact SSA upon attainment of FRA. At that time the question of unreduced RIB entitlement and DRCs will be reviewed and explained (see NL 00725.005B, FOB003).
F. Policy - deemed filing provision
A claimant who is entitled to reduced RIB and reduced spouse's benefits must file for both benefits if eligibility for both benefits exists in the first month of RIB or AUXSPO entitlement. This deemed filing rule also applies when totalization benefits are involved (GN 01701.000). The claimant who is entitled to reduced RIB and reduced spouse's benefits must file for totalization benefits if he or she wants to receive any social security benefits. (See DI 11015.001 for instructions on handling a surviving divorced spouse claim based on the DWB provisions in Section 5103 of P.L. 101-508.) The deemed filing rule applies to:
All reduced spouse's benefits, including independently entitled divorced spouse's benefits, on all SSNs;
An SSA-25 (Certificate of Election for Reduced Spouse's Benefits); and
A reduced spouse whose entitlement to DIB terminates before FRA.
NOTE: If a RIB applicant is eligible for reduced spouse's benefits on more than one record, he or she must file for benefits on all records.
a. Child in care
A claimant who is between the age of 62 and FRA, has in his or her care a child (under age 16 or a disabled adult child) of the NH who is entitled to child's benefits, and is filing for spouse's benefits is not deemed to have filed for reduced RIB. He or she may exclude RIB from the scope of the application for spouse's benefits by a clear declination.
If a NH becomes entitled to reduced spouse's benefits and in the first MOET to such benefit is entitled to DIB, the NH is not deemed to have filed for reduced RIB unless the DIB terminates before FRA. When DIB terminates before FRA, the NH is deemed to have filed for reduced RIB in the first month where there is no entitlement to DIB but there is entitlement to reduced spouse's benefits.
NOTE: A conversion from DIB to RIB is not a “deemed filing” situation, as the NH is FRA so the deemed filing provision does not apply.
3. Deemed filing rule invoked retroactively
It does not matter whether it was apparent that eligibility for both reduced RIB and reduced (divorced) spouse's benefits existed when the claimant filed, or that the claimant refuses to submit evidence to establish entitlement to the other benefit. The law does not define a time limit as to when the deemed filing provision may be invoked. Whenever SSA becomes aware of the claimant's eligibility for the other benefit, the deemed filing provision will be invoked retroactively. The subsequent application will be adjudicated retroactively to the first MOET of the benefit to which the individual is already entitled.
4. Failure to submit evidence
Under the law and regulations, the claimant must decide whether to file an application and submit essential evidence. The only sanction for failing to do either is non-entitlement to benefits. In deemed filing situations, failure to submit evidence is the basis for a disallowance. Since the initial determination of non-entitlement was correct based upon the evidence in file at the time the determination was made, that determination is not reopened. However, the effect of invoking deemed filing is the same as reopening the earlier denial.
For example, a claimant for reduced RIB is deemed to have filed for reduced spouse's benefits. However, he or she refuses to submit evidence of current marital status (e.g., complete the marital history questions on the SSA-2-F6). The “claim” for spouse's benefits is disallowed, but the claim for RIB is awarded. Should the claimant subsequently submit the required evidence with a claim at a later time, the deemed filing rule will be invoked retroactively to the first MOET of the RIB claim.
5. Conditional MOET
In conditional MOET cases, the question of the applicability of deemed filing cannot be resolved until after any required annual reports are processed and a formal determination of the correct MOET has been made. This should be part of the explanation of reduced benefits. Moreover, give the explanation even when only one of the eligible claimants files.
One problem area, which existed before the 1977 amendments, involves cases where one spouse files for RIB and subsequently the other spouse files for RIB creating a potential deemed filing situation. The system treats the two spouses' RIB records separately. To identify eligibility to spouse's benefits after the annual reports are processed, prepare a listing following the instructions in GN 00204.020H.
When a claimant is eligible for both reduced RIB and spouse's benefits (including divorced spouse) and attempts to restrict his or her application to one type of benefit, the adjudicator must consider whether the claimant is eligible for the benefit in the first MOET for which the application is filed due to the deemed filing provision.
It is possible for the NH on whose E/R spouse's benefits are payable to effectively restrict retroactivity by use of the option “C” election code. This may preclude the applicability of the deemed filing provisions to the spouse. Also, it should be noted that an annual report is no longer required; therefore, a result unintended by the claimants may ensue because their MOETs may not be reviewed. Since an initial determination of the MOET would have been made at the time the claim was adjudicated, it is the claimant's responsibility to pursue the matter. Any adjustment of the MOET will be subject to the rules of administrative finality.
G. Examples - deemed filing
1. EXAMPLE 1: reduced RIB/reduced spouse
Helen filed 12/21/98 and is awarded reduced RIB effective 01/99. Later, based on a 06/10/99 filing, her husband becomes entitled to RIB effective 01/99. One-half of his Primary Insurance Amount (PIA) is greater than Helen's PIA. Therefore, she is deemed to have filed retroactively for reduced spouse's benefits effective 01/99. Same example, but if Helen's husband's MOET was 06/99 or any month after 01/99, the deemed filing rule for Helen would not be invoked retroactively because she was not eligible for both benefits in the first month of AUXSPO entitlement.
2. EXAMPLE 2: reduced RIB/reduced spouse—Government Pension Offset (GPO)
Margaret filed on 11/10/99 and is entitled to a reduced RIB effective 01/2000. Based on non-covered government employment, her WEP PIA is $694.00. Margaret's husband decides to retire and files for RIB on 12/20/99 and becomes entitled to RIB effective 01/2000. One half of his PIA is greater than Margaret's PIA, so she is “deemed” to have filed for reduced spouse's benefits effective 01/2000 even though her spouse's benefit is subject to full GPO. Deemed filing is still applicable because Margaret is entitled to a reduced RIB and a reduced spouse's benefit in the first month of entitlement.
3. EXAMPLE 3: DIB terminations/reduced spouse/reduced RIB
John Jones, age 62, filed an application in 10/97 for reduced husband's benefits beginning 1/98 and is entitled to DIB as of 1/98. In this case, he is not deemed to have filed for reduced RIB. Mr. Jones' disability later ceases and his DIB is last payable for 2/99. Mr. Jones is deemed to have filed for reduced RIB in the first month there is no entitlement to DIB (3/99) and there is entitlement to reduced spouse's benefits.
Where the NH becomes entitled to reduced spouse's benefits and in the first MOET to such benefit is also entitled to DIB, the NH is not deemed to have filed for reduced RIB, unless the DIB terminates before FRA. In the case of DIB terminations before FRA, the NH is deemed to have filed for reduced RIB effective with the month after the month the DIB terminates.
H. Procedure - deemed filing listing codes
If a NH files for RIB in the same year as, but not simultaneously with, his or her spouse, and at least one of the MOET's is conditional, prepare a listing as follows:
In September of each year, the PSC will call up the prior year's listing and determine whether deemed filing must be invoked.