TN 16 (10-01)
GN 00605.001 Overview of Annual Representative Payee Accounting
Social Security Act § 205(j)(3) and 1631(a)(2)(C);
Regulations 20 CFR § 404.2035, 404.2065, 416.635 and 416.665
Representative payee policy for reporting on the use of benefits is the same for title II and title XVI. However, there are some differences between processes and procedures in the two programs. Concurrent title II and title XVI cases are selected and processed as title XVI cases for accounting purposes (e.g., the case is selected based on the Supplemental Security Record, FOs must develop continued eligibility when conserved funds equal or exceed $2,000).
The term “beneficiary” is used generically in this subchapter to refer to both title II beneficiaries and title XVI recipients. Title II and title XVI (or SSI) designations are used where differences exist.
The instructions in this chapter apply to the entire audience unless otherwise specified. This means that if an instruction does not designate FO, PC, CR, etc., it applies to anyone who is involved in or is responsible for performing the work.
Social Security law and regulations require representative payees to use the benefits they receive for the current needs of the beneficiary and in their best interests. They are responsible for keeping records and reporting on the use of benefits. The payee must complete a paper Representative Payee Report, (SSA-623-OCR-SM, SSA-6230-OCR-SM, SSA-6234-OCR-SM) or an online report (using iRPA) annually. However, we may request a payee complete an accounting report anytime we receive information that raises a question about the payee’s use of monthly benefits or conserved funds.
The accounting report is used to monitor how the payee spent or saved the benefits on behalf of the beneficiary, identify situations where representative payment may no longer be appropriate, or determine if the payee is no longer suitable. We send an accounting report to all representative payees if any benefits were paid during the 12-month report period, except State mental institutions participating in the Onsite Review Program.
NOTE: Representative payees with dedicated accounts are excluded from the annual accounting selection criteria. Field offices (FOs) are responsible for monitoring how these payees used the title XVI benefits and dedicated account funds by sending them a Representative Payee Report of Benefits and Dedicated Account, SSA-6233-BK, to complete. (See GN 00605.200 for monitoring dedicated accounts.)
2. When to complete Representative Payee Evaluation Report, SSA-624-F5
FOs are required to conduct a face-to-face interview when the payee's responses on the accounting report indicate improper use of benefits or a change in custody, or the payee fails to complete the initial and second request SSA-623-OCR-SM, SSA-6230-OCR-SM, or SSA-6234-OCR-SM, or when the payee fails to complete an online report (iRPA) to SSA. In addition to the payee, the beneficiary and custodian (if other than payee) are also interviewed to confirm information provided by the payee and to ensure the beneficiary's current needs are being met. FOs complete a Representative Payee Evaluation Report, SSA-624-F5, to document the interviews, their evaluation and action taken as appropriate. (See GN 00605.085 for processing non-responder alerts and GN 00605.100 for the SSA-624-F5.)
3. When to consider a change of payee
If the payee does not respond after repeated attempts by the FO to obtain the required accounting report, FOs are required to consider a change of payee (see GN 00605.090). When the FO determines that the current payee is no longer suitable and a change of payee is necessary, it develops for a successor payee. If a new payee is not readily available, the beneficiary is either paid directly (unless direct payment is prohibited) while the FO continues payee development. If the FO determines that direct payment would cause substantial harm to the beneficiary, direct payment can be delayed for a maximum of 30 days (see GN 00504.105).
4. Increased monitoring of payee performance
In addition to monitoring payee performance through the annual accounting process, FOs are required to conduct site visits and random reviews of all fee-for-service and certain volume payees under the Expanded Monitoring Program. Other features of the program include a 6-month visit to newly appointed fee-for-service payees; annual certification that fee-for-service payees meet the requirements to charge a fee for their services; and “quick response checks” when the FO receives complaints from vendors over nonreceipt of payment, etc. These initiatives were put into place to protect beneficiaries from misuse of benefits by organizational and other volume payees and to ensure these payees are carrying out their duties and responsibilities in compliance with representative payment polices and procedures.
The following terms are associated with the processing of the accounting reports as described in this subchapter:
Actionable – SSA-623-OCR-SM and SSA-6230-OCR-SM accounting reports that require Processing Center (PC) or FO development because of unacceptable responses, relevant remarks, relationship and payee coding discrepancies, etc. The Wilkes-Barre Direct Operations Center (WBDOC) Screening Process (see GN 00605.040) refers to these cases as “exceptions.”
Approved – SSA-623-OCR-SM and SSA-6230-OCR-SM accounting reports processed to completion (e.g., system control was cleared, unacceptable response was resolved, conserved funds were input via the Representative Payee System (RPS)).
Prongfile – Undeliverable SSA-623-OCR-SM and SSA-6230-OCR-SM accounting reports and non-responder alerts which are “No Action Necessary” because the payment status code is T1/T01 (death) or S8/S08 (payee development).