TN 48 (06-17)

GN 00502.065 Documenting a Capability Determination

A. Policy for documenting a capability determination

A capability determination for a competent adult requires lay evidence, medical evidence (if available), and proper documentation. You must document your capability determination and the details of your reasoning following the instructions in this section.

B. How do I document a capability determination?

When documenting a capability determination you must record all facts including:

  • Lay evidence and medical evidence;

  • Reports of contacts you completed in the electronic Representative Payee System (eRPS), Modernized Claims System (MCS), or Modernized Supplemental Security Income Claims System (MSSICS);

  • Paper evidence to support your capability determination that you scanned into Non-Disability Repository for Evidentiary Documents (NDRed) or eView (Retention of Paper Material, see GN 00301.322); and

  • A concluding statement that you determine the beneficiary is capable or incapable, the basis of your determination (what evidence you considered), and how those factors support your capability determination.

EXAMPLE: Complete capability determination

I conducted an in-person interview with Mr. Ryan Jones on 4/12/16. Mr. Jones was unable to answer most of my questions, including what his living expenses were and who paid his bills.

I spoke in-person to his spouse (caretaker/custodian), Mrs. Susan Jones, on 4/12/16. Mrs. Jones stated that Mr. Jones is unable to manage his benefits or direct the management of his benefits and she has managed all his living expenses for the last two years. More details are in a report of contact in eRPS, dated 4/12/16.

I spoke on the phone to his social worker, Ms. Judith Porter, who stated she observes Mr. Jones’s daily living activities two times a week. Ms. Porter stated Mr. Jones does not understand the concept of money and is unable to manage his finances to meet his daily needs. More details are in a report of contact in eRPS, dated 4/12/16.

I received a SSA-787, dated 4/14/16, from Dr. John Smith that indicates he last examined Mr. Jones on 3/15/16. Dr. Smith noted that Mr. Jones is incapable of managing his benefits or directing the management of his benefits. I scanned the SSA-787 into NDRed.

After evaluating the lay and medical evidence, I have determined Mr.

Ryan Jones does not understand the concept of money, how to manage finances, or direct the management of his benefits to meet his daily needs. Therefore, I have determined Mr. Ryan Jones is incapable.

The example clearly supports the FO technician’s capability development and determination as follows:

  • Obtained lay evidence from Mr. Ryan Jones, Mrs. Susan Jones, and Ms. Judith Porter;

  • Obtained Medical Evidence from Dr. John Smith;

  • Evaluated both the lay and medical evidence;

  • Provided the location of the detailed report of contact with Mrs. Susan Jones and Ms. Judith Porter;

  • Provided the location of the scanned SSA-787 from Dr. John Smith; and

  • Included a concluding statement.

C. Where do I document a capability determination?

You must document your capability determination in the following locations.

1. Case established in eRPS – Completing a representative payee application in eRPS

Follow these procedures when you are completing a representative payee application in eRPS, whether you select or not select the applicant to serve as the representative payee.

While in the eRPS application:

  1. Choose the “Add Note” link, per MS INTRANETERPS 015.002;

  2. From the “Note Type” drop down choose “Bene Capability Determination”;

  3. Document the details of your capability determination in the “New Note” box; and

  4. Hit the “Save Note” button.

eRPS automatically saves your capability determination in the notes of the Summary section of the application and propagates your capability determination to the Beneficiary Details notes, so the determination is always associated with the beneficiary’s eRPS record.

For these cases, you view completed capability determinations:

  • In the “Summary” section of the application, per MS INTRANETERPS 009.022; and

  • In “Beneficiary Details” notes, per MS INTRANETERPS 015.002.

2. Case established in eRPS - No new representative payee application being completed in eRPS

Follow these procedures when there is an established beneficiary’s case in eRPS, but there is no new representative payee application in eRPS. This means in the past a representative payee application was completed in eRPS, so the beneficiary’s case is established in eRPS, whether the beneficiary still has a representative payee or not.

EXAMPLE: You may need to use this process when a beneficiary, who had a prior payee, is now in direct pay and a family member notifies SSA the beneficiary may need a payee again; however, the