BASIC (09-87)

GN 00302.370 Developing Evidence of Age of Eligible Worker When Uninsured Spouse Applies for HI

A. Background

An uninsured spouse or former spouse of an eligible worker may obtain HI coverage at age 65 or later based on the worker's record even if the worker has not yet applied for benefits (see HI 00801.022 - HI 00801.027). In this case, the claimant needs to prove that the worker statisfies all requirements for entitlement (including the age requirement) except for having filed an application.

B. Rule

It is often necessary to prove only that the worker is age 62 or older. Thus, unless the worker's DB affects the first month of HI coverage for the applicant or affects insures status, the specific DB need not be determined as long as it is clear that the worker is at least age 62.

C. When to Use This Procedure

If, by all indications in file, the worker attains age 62 before the HI claimant attains age 65, and insured status is not affected, determine the worker's age using the procedure below.

NOTE: If there is an indication that SSA has already established the worker's DB, no further development of the worker's age is needed. Such casers should be unusual.

D. Example

The claimant attained age 65 in 1/84. He applied for HI benefits on the E/R of his wife, whose DB is shown on various documents as 7/6/19, 6/7/20, and 6/7/21. Since all DB's indicate the worker is age 62 before the claimant is age 65, the special procedure may be used.

E. Caution

If any evidence presented at any time indicates that the worker will be age 62 after the claimant becomes age 65 (or after the claimant's month of entitlement, if later), or insured status is affected, follow normal proof-of-age procedures.

F. Example

The claimant attains age 65 in 6/83. She applied for HI benefits on the E/R of her husband, whose DB is shown as 8/10/21 in SSA's record and 8/10/20 on other documents. If the SSA record is correct, her HI entitlement can not begin until 8/83 (when the worker attains age 62). However, if 8/10/20 is the worker's correct DB, the claimant's entitlement can begin in 6/83. In this case, normal proof-of-age development must be undertaken to establish the worker's DB.

G. Procedure: Worker and uninsured spouse live in same household

If the worker and uninsured spouse live in the same household, develop evidence of age under normal proof-of-age procedures. You can generally expect cooperation from the worker where both spouses live together.

H. Procedure: Worker and uninsured spouse do not live in same household

If the worker and uninsured spouse do not live in the same household, use the following procedure.

StepAction

1

Is preferred evidence of the worker's age in the claimant's possession or obtainable within 10 days?

  • If yes, obtain perferred evidence and stop.

  • If no,, go to step 2.

2

  • Document the file with an explanation (on an RC or SSA-795) of the unavailability of preferred evidence, and

  • Request automatically convincing evidence (GN 00302.110ff.)

3

Is automatically convincing evidence in the claimant's posession or obtainable within 10 days?

  • If yes, obtain automatically convincing evidence and stop.

  • If no, go to step 4.

4

  • Document the file with an explanation (on an RC or SSA-795) of the unavailability of automatically convincing evidence, and

  • Obtain at least 3 documents (one of which may be an SSA record) recorded at least 5 years prior to the current filing date that show the worker's DB or age.

5

Do all documents obtained in step 4 show the worker to be at least age 62?

  • If yes, go to step 6.

  • If no, develop evidence of age under normal proof-of-age procedures (GN 00302.010-GN 00302.240) and stop.

6

Does the evidence presented satisfy all requirements of step 4 (i.e., at least 3 documents recorded at least 5 years prior to filing)?

  • If yes, go to step 7.

  • If no go to step 8.

7

  • Use the DB shown on the oldest record available as the worker's DB and stop.

8

  • Develop more extensively to get additional evidence, regardless of delay.

9

Does the evidence obtained after more extensive development satisfy all the requirements of step 4.

  • If yes, go to step 7.

  • If no, go to step 10.

10

  • Use the DB shown on the oldest record available and stop, provided:

    • All efforts to obtain additional evidence have been exhausted,

    • At least one record (in addition to an SSA record) is presented, and

    • Each record shows the worker to be age 62.

NOTE: If the minimal evidence requirerd in this step is not obtainable, disallow the claim due to failure to establish the worker's eligibility for benefits. However, see the procedure in subsection I. below.

I. Extreme difficulty in obtaining evidence

Sometimes it may be very difficult to obtain evidence of the worker's age from the claimant due to a lack of communication or cooperation between the worker and the claimant. This is most likely to occur when the worker and spouse do not live together, but may also happen when they do.

Follow the procedure below if evidence (e.g., a civil birth record) is clearly unobtainable due to reasons beyond either SSA's or the claimant's control (e.g., the worker refuses to cooperate).

J. Procedure for developing age or DB when worker doesn't cooperate

 

StepProcedure
1Document the file (with an RC or SSA-795) as to why the evidence sought is unobtainable.
2Treat the evidence at issue as if it were nonexistent, and try to obtain other evidence (if necessary, from lower order of priority).
 

NOTE: Records that may be useful and available in such circumstances include:

  • SSA record

  • Marriage license

  • Financial record

  • Children's records which show parent's age or DB, such as:

    • Birth record

    • School record

    • Medical record.

3Provide assistance to the claimant, if necessary, per GN 00301.230 -
GN 00301.235.
 

EXAMPLE: If the adjudicator believes it would be helpful, the FO may, with the claimant's permission, contact the worker to explain what evidence is needed and the purpose for which it is required.

4Disallow the claim for failure to establish the worker's eligibility for benefits in those rare cases where the claimant may still be unable to present sufficient evidence to establish that the worker is at least age 62.
 

NOTE: Use the time periods shown in GN 01010.410 to determine when such a claim may be disallowed.

K. Forwarding claims materials postadjudicatively for study

Whether the claim was awarded or disallowed, the adjudicator or authorizer who finally adjudicates the claim will, in all claims using this procedure, forward to OISP copies of the following:

  • Forms SSA-2038-F3 (when prepared), or

  • Forms SSA-553 (when prepared), or

  • The claims folder, or

  • A copy of the application and all evidence reflecting the worker's age or DB, whichever is needed to provide OISP with a picture of the proof-of-age development in that particular claim.

Mail the material to:

Social Security Administration
6401 Security Boulevard
Attention: Office of Income Security Program
Office of Application and Electronic Services Support Policy
Relationships and Claims Evidence Team
Baltimore, Maryland 21235-6401

OISP will study the claims in order to determine whether further policy revisions are needed.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200302370
GN 00302.370 - Developing Evidence of Age of Eligible Worker When Uninsured Spouse Applies for HI - 06/13/2016
Batch run: 06/13/2016
Rev:06/13/2016