SSA - POMS: GN 00504.110 - When We May Suspend Benefits

A. Policy for suspending benefits

We must pay benefits directly to the beneficiary, unless we determine that substantial harm would result. For examples of substantial harm determinations see GN 00504.105C.

We suspend benefits only if

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a representative payee problem surfaces,
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a new representative payee is not available, and
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direct payment is prohibited.

If you decide to suspend benefits for a reason other than a payee's death or refusal to continue as payee, you must obtain approval at a second tier level (e.g., technical assistant or member of management). The field office (FO) or processing center (PC) making the decision is responsible to suspend benefits.

B. When to suspend benefits

You may suspend benefits when we cannot find a suitable payee in the following situations:

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a beneficiary in direct pay is adjudged legally incompetent;
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a representative payee dies, is unwilling to continue serving, or is no longer qualified and there is a reason that prohibits direct payment, or substantial harm would result from direct payment. Document this decision and record the reason for suspense. For more information on required suspension, see GN 00504.105A.2.b.

NOTE: The policy on suspensions described in GN 00504.105 applies to all situations. For example, failure to return an accounting form is not a valid reason to suspend benefits automatically. Make direct payments pending development for a new payee if there would be no substantial harm.

C. How to suspend benefits

If you determine that we cannot pay the beneficiary directly while resolving the representative payee issue use the following guidelines to suspend benefits.

1. Suspending an initial award

Process the initial “no payment” award suspending all benefits, and promptly continue representative payee development.

a. Suspending title II claims

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Establish the Master Beneficiary Record (MBR)
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Input the payee issue using the Special Message Field on the (CIPM) screen (MSOM RSDHI 001.001)

NOTE: Modernized Claims System (MCS) can process these claims and build a notice based on the suspension action.

b. Suspending title XVI claims

Prepare a manual award notice, using language in NL 00801.010B.2. Input the payee issue in the Remarks field.

2. Suspending benefits after adjudicating the claim

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Input the suspense code action (S8/S08). The system generates the appropriate notice language.
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Expedite payee development.
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Suspend payment for reason “whereabouts unknown” rather than for representative payee development if you are unable to make direct payment because you cannot locate the beneficiary.
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Input suspense code S9 for title II and enter “WHEREU” in the RFST field
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Input suspense code S06 for title XVI.

For more information on reasons for suspension or termination (RFST) see SM 00510.175C.11.

For guidance on lack of representative payee or address unknown, see SM 01305.590.

REMEMBER: If the reason for suspension is NOT suitable for the payee, you may contact the payee of record to act on the beneficiary's behalf in SSA related matters.

3. Suspending concurrent claims

Before suspending the claim

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Determine if the beneficiary has concurrent claims.
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Take appropriate action on both records.
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Verify status on each by querying the MBR and Supplemental Security Record (SSR).
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Query the Representative Payee System (eRPS) to determine if a payee application is pending.

4. Documenting your reasons for suspending benefits

Input the reason for suspense on the MBR/SSR, and indicate why direct payment is not possible.

Input direct payment as an interim measure on the Report of Contact Details screen of eRPS (MS INTRANETERPS 016.002).

Input information for title II cases using the Special Message field of the MBR on the CIPM screen. Use the Remarks field to record this information on the SSR.

Use language such as “pye died-direct payment prohibited - unable to locate payee - development in process” or “misuse by pye - substantial harm - new payee not available.”

D. Initiate direct payment for S8/S08 cases

1.
The Payment Center (PC) may receive suspense output when the field office (FO) input or a Returned Check Action Program (REACT) transaction that caused the case to be in S8 (e.g., check returned due to death of payee).
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  The Office of Systems identifies S8/S08 cases and posts them to the Management Information Services Facility (MISF).
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  The FO should initiate direct payment to the beneficiary unless there is a reason that prevents direct payment.
2.
The SSR produces an A P1/PD diary 30 days after suspension input if the S08 payment status is still on the SSR.
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  The FO should initiate direct payment to the recipient unless there is a reason that prevents direct payment.
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  Do not delete the diary until you resolve the payee issue.

E. References

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MSOM MCS 009.016 Title II - Suspensions
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GN 00504.160 Required Contacts Before Issuing Payments Following a Period of Suspension or Nonpayment
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GN 00504.105 Direct Payment to Incapable Beneficiaries When Further Payee Development is Needed
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SI 02301.201 Description of SSI Posteligibility (PE) Events
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SI 02301.215 Summary of Posteligibility (PE) Suspension, Stop Payment and Termination Events by Payment Status Code (PSC)
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SM 01305.020 Nonpayment
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SM 01311.355 Withholding an Underpayment (UTAC)
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SM 01601.910 Remarks on Data - RMKS
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SM 00848.425 Determining RFD (Reason for Deduction), WIC (Work Identification Code) and RFST (Reason for Suspension or Termination)
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MSOM RSDHI 001.001 Special Message entry on CIPM screen

Social Security

Program Operations Manual System (POMS)

GN 00504.110 When We May Suspend Benefits