SSA - POMS: 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 Coonsolidated Claims Experience (CCE);
•

Paper evidence to support your capability determination that you scanned into Non-Disability Repository for Evidentiary Documents (NDRed) using the Evidence Portal (EP), or into 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 their living expenses were and who paid their bills.

I spoke in-person to Mr. Jones' spouse (caretaker/custodian), Mrs. Susan Jones, on 4/12/16. Mrs. Jones stated that Mr. Jones is unable to manage their benefits or direct the management of their benefits and they have managed all their 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 their social worker, Ms. Judith Porter, who stated they observeMr. 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 their finances to meet their 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 they last examined Mr. Jones on 3/15/16. Dr. Smith noted that Mr. Jones is incapable of managing their benefits or directing the management of their benefits. I scanned the SSA-787 into NDRed using the Evidence Portal (EP).

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 their benefits to meet their 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:

a

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

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

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

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 family member does not want to apply to be the payee. Based on the family member questioning capability, you develop the beneficiary’s capability and determine the beneficiary is still capable, so there is no new representative payee application in eRPS.

Add your capability determination by following these steps:

a

Go to the “Beneficiary Details” screen per MS INTRANETERPS 007.002;
b

On the “Beneficiary Details” screen, choose the “Add Note” link, per MS INTRANETERPS 015.002;
c

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

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

Hit the Save Note button.

IMPORTANT: Make sure you are on the Beneficiary Details screen before adding your capability determination so your capability determination is always associated with the beneficiary’s eRPS record.

View completed capability determinations in “Beneficiary Details” notes, per MS INTRANETERPS 015.003.

3. Case not established in eRPS

Follow these procedures for all beneficiary cases not established in eRPS.

EXAMPLE:

•

SSA approves a beneficiary for disability benefits and the state Disability Determination Services (DDS) provided an opinion that the beneficiary may need a representative payee; however, you develop for capability and determine the beneficiary is capable; therefore, there is no representative payee application or any previously established eRPS case for the beneficiary; or
•

For cases where the representative payee does not have an SSN and the beneficiary has no prior eRPS case established.

a. For TII or concurrent cases

•

Complete the “Report of Contact” (RPOC) in MCS.
•

Write in the “Report” section, “CAPABILITY DETERMINATION” before adding the details of your determination, see MS MCS 008.007.

b. For TXVI only cases

•

Complete the “Report of Contact page” in the Consolidated Claims Experience (CCE).
•

Write in the “Report ” section “CAPABILITY DETERMINATION” before adding the details of your determination, see MS 07416.002.

c. Cannot establish a RPOC in MCS or Report of Contact in CCE

Use the paper Form SSA-5002 (Report of Contact) and scan it into NDRed using the Evidence Portal (EP) or scan into eView.

Social Security

Program Operations Manual System (POMS)

GN 00502.065 Documenting a Capability Determination