TN 26 (07-07)

GN 00605.074 Reviewing the SSA-6234-OCR-SM (08/2007)

A. Introduction

This section contains instructions about how to evaluate payee responses on the SSA-6234-OCR-SM (Representative Payee Report). The instructions apply to the entire audience, unless otherwise specified.

Most payee report forms will be automatically scanned and reviewed in the Wilkes-Barre Direct Operations Center (WBDOC). The following instructions describe the reviewing guidelines used in the scanning process at WBDOC. They should also be used for those reports which cannot be processed automatically at WBDOC and must be processed manually. For general information on the representative payee report forms, see GN 00605.010.

B. Procedure

REMINDER: When using the chart below to review payee responses, use Direct Contact (DIRCON) (telephone or mail) whenever possible to resolve discrepant responses and confirm unacceptable responses.

1. Reviewing the Responses

Follow this chart which shows possible payee responses on the SSA-6234-OCR-SM, which indicates what, if any, action is required based on each response. REMEMBER: Check the REMARKS section of the form for explanations to questionable payee responses. (See GN 00605.065 for a discussion of the questions on the SSA-6234-OCR-SM.)

Question

Payee Response

Action Required

1

Yes

No Action.

 

No

Review the Representative Payee System (RPS) (and Supplemental Security Record (SSR) to see if the latest beneficiary address is on SSA records. If it is, prepare a SSA-5002 (Report of Contact) and document that a face-to-face interview is not necessary. (The need for a payee change was considered when the custody change was input to the SSR and RPS.) Also review the payee coding on the Master Beneficiary Record (MBR), SSR and RPS and correct as appropriate.

Only develop for an SSA-624-F5 (Representative Payee Evaluation Report) when the latest beneficiary address is not shown on the SSR and RPS or the payee submitted an unacceptable response which cannot be resolved.

Blank

DIRCON for a response.

2A

Yes

No action.

No

Field Office (FO) will conduct face-to-face interviews and complete an SSA-624-F5 if an appropriate explanation cannot be obtained via DIRCON.

Blank

DIRCON for a response.

2B

Yes

Verify that payee is authorized to collect a fee; review the data tags at the top of the SSA-6234 to verify that the amount collected is appropriate (GN 00605.061):

Fee For Services (FFS) indicates whether the payee is authorized to collect a payee fee. If this field does not contain a “Y” and the payee reports collecting a fee, the RPS ZIPL must be checked (see GN 00605.074B.2. If fee authorization cannot be verified by reviewing the RPS, the FO must resolve the fee issue.

Guardianship Status (GS) indicates whether a payee has been appointed legal guardian. A “Y” in this field indicates that the payee is the beneficiary’s legal guardian. A legal guardian may collect a fee as indicated by the court. (GN 00602.040; GN 00605.074B.4.b.)

Maximum Fee Amount (MFA) shows the maximum total fee which may be collected by the payee throughout the reporting period. If the payee reports a fee withholding which exceeds the MFA development per GN 00605.074B.3-5.

Drug Addiction/Alcoholism (DAA) indicates whether there is DAA involvement which may affect the amount of fee a payee may collect as explained in GN 00506.200.

If the payee reports withholding a fee for payee services and the data tags on the report form do not indicate that the payee is authorized to collect a fee, the reviewer should query the RPS (ZIPL screen; MSOM RPS 004.002) to determine if the payee has been authorized to collect a fee. Any inconsistencies must be resolved by the FO with a face-to-face interview with the payee.

NOTE: If it is discovered that a payee has collected an unauthorized fee for services, an investigation and determination must be made to document whether misuse had occurred.

No

No Action

Blank

DIRCON for a response.

2C

Any amount

Add the amounts in questions 2B, 2C, 2D and 2E. If the total is less than 90% of the Total Accountable Amount (TAA) and the payee cannot resolve the difference, the FO will conduct a face-to-face interview and complete an SSA-624-F5.

If the payee indicates “ALL” (or the TAA) as a response to more than one question and the payee cannot resolve the difference, the FO will conduct a face-to-face interview and complete an SSA-624-F5.

2D

Same as 2C above

Exception: If the beneficiary resides in an institution and the amount in 2D is $360 or more, or an amount equal to the TAA if smaller

Same as 2C above

No Action

Blank

DIRCON for a response.

EXCEPTION: If the beneficiary resides in an institution, and the amount in 2D is $360 or more, or an amount equal to the TAA if smaller

or

an amount less than $360 or the TAA if smaller

No action

If the payee cannot explain how he/she provides for the beneficiary's personal needs or how personal needs are met, the FO should review personal needs spending with the payee or consider a change of payee if appropriate.

2E

Same as 2C above.

Same as 2C above

EXCEPTION: An amount equal to or greater than 3 x Federal Benefit Rate (FBR)

Title II – No Action

Title XVI or Concurrent – FO will develop according to GN 00603.001 if the payee must be contacted for another reason. SI 01110.000

or

$2000 or more

An amount <20% of TAA and TAA is >$25,000

or

An amount <20% of Conserved Funds (CF) and CF is >$5,000

or

An amount >$10,000 for Title II only cases.

Title II – No action

Title XVI or Concurrent – FO will receive an alert from WBDOC when conserved funds equal $2000 or more and must develop continuing Supplemental Security Income (SSI) eligibility. The PSC receives the unacceptable forms because of other unacceptable or blank responses

FO should DIRCON for explanation of expenditures

FO should DIRCON for explanation of rapid CF spend down

FO should DIRCON for explanation of possible excessive CF; ensure needs are being met

Any amount and Conserved Fund (CF) data entry is $5000 or more

If the amount in 2E is less than 25% of the TAA and you contact the payee to resolve another issue, determine if the payee is spending funds appropriately.

  3

REMINDER: Apply these instructions only if the amount in question 2E exceeds $500.

 

  3A

Checking/Savings Account

Review title of account in item 3B.

GN 02402.055; GN 00603.010.

U. S. Savings Bonds

Review method of titling in item 3B. GN 00603.030

Certificates of Deposit

Review method of titling in item 3B. GN 00605.068H.; GN 00603.030

Collective Savings/Checking Account

Review the PF (Precedent File) data tag at the top of the SSA-6234 to determine if precedent file information for the payee is on record. A “Y” indicates information is on record and no action is needed.

If the PF tag is blank and the payee indicates more than $500 (in question 2E) held in a collective account, the collective account precedent file in RAC must be reviewed and the discrepancy must be resolved.

MSOM RAC 002.007

Other

Evaluate type of account in item 4A. Also, review title of account in item 3B or 4B. (GN 00605.068G and GN 00605.068)

Blank

DIRCON for a response.

3B

Any response except “Other”

No action, if 3A is acceptable.

Other

Evaluate title of account in item 4B. (GN 00605.068H)

Blank

DIRCON for a response.

 4A

Stocks or mutual funds

Follow instructions in GN 00603.040

Blank and 3A is “Other”

DIRCON for a response.

4B

Any response other than those specified in
GN 00603.010 and GN 00603.020

Develop according to GN 00605.068H.

Blank and item 3B is “Other”

DIRCON for a response.

5

Blank or signed by someone other than the payee

Develop per GN 00605.069 for a completed, signed payee report

2. FFS Discrepancies

When the payee provides a YES response to Question 2B and the data tag coding at the top of the SSA-6234 does not indicate that the payee is a FFS or not the beneficiary's legal guardian, query the RPS’ ZIPL screen (MSOM RPS 004.002) for FFS coding and/or the Organization/Institution Representative Payee Full Query Response (OIFS) (special text) screen, if it exists, for evidence that the payee is authorized to collect a fee. If the RPS shows the payee is authorized to collect a fee, accept the payee’s response to Question 2B and ensure the “F” indicator is coded to the ZIPL.

NOTE: Technicians who may not have query access to the ZIPL screen through RPS can obtain query access to the screen via MFQ 19=RPQY (Representative Payee).

3. When FO Development of FFS is Required

When the payee's response to Question 2B is YES and the FFS and GS data tags on the SSA-6234 do not indicate that a fee was authorized or that the payee is the beneficiary’s legal guardian, and a review of the RPS does not reveal evidence that the payee was ever authorized to charge a fee, the FO must contact the payee to resolve the fee issue and develop for misuse of benefits as appropriate (GN 00604.000).

4. Determining When a Fee Amount is Excessive

a. Payee is Fee for Service

A FFS payee can charge and collect a fee for payee services for any months in which the beneficiary receives title II and/or title XVI benefits. Fee amounts are subject to change in December of each year and the increased fee is effective with the January check. Refer to GN 00506.200C.2. to determine the maximum monthly fee allowed.

The amount shown in the MFA data tag shows the maximum allowable fee the payee may collect from the beneficiary. The MFA will show a maximum of 10% of the TAA in most cases. When the payee’s response to Question 2B exceeds the MFA, the FO must develop to resolve

b. Payee is Beneficiary’s Legal Guardian

The Court authorizes the amount of fees a legal guardian can collect for customary guardianship costs and court-ordered fees for services performed on behalf of the beneficiary. Part of the beneficiary's funds may be used to cover these costs provided the beneficiary's current needs are being met and other conditions exist. Refer to GN 00602.040 for the policy and procedure governing guardianship fees.

The amount shown in the MFA data tag shows the maximum allowable fee the payee may collect from the beneficiary. The MFA will show a maximum of 20% of the TAA when guardianship status exists. When the payee’s response to Question 2B exceeds the MFA, the FO must develop to resolve.

5. FO Development of Excessive Fee Amount

a. Payee is FFS – Fees Exceed Allowable Amount

When a payee is an authorized FFS payee and the reported fees exceed the allowable amount:

  • Query the Philadelphia Regional Office (RO) database at http://phapps.ph.ssa.gov/rpmonitor/rpstart.asp and the RPS to determine if a site review was conducted within the past 3 months, review the findings and follow-up. For example, did the review team find that the payee was improperly collecting a fee for payee services; has the payee reimbursed or is in the process of reimbursing the beneficiaries’ accounts; or has the review team/FO obtained proof or is awaiting proof that corrective action was taken?

  • Conduct a site review of the organization or follow-up on pending corrective action to reimburse beneficiaries accounts.

  • Develop for misuse of benefits as appropriate.

  • Contact your RO site review coordinator for guidance as appropriate.

b. Payee is Beneficiary’s Legal Guardian - Fees Appear Excessive

Determine if the guardianship fees appear to be in the beneficiary's best interests (see GN 00602.040, GN 00605.074B.4.) following these steps:

Step

Action

1

Contact the payee and determine if the Court authorized the collection of guardianship fees. If yes, go to step 2. If no, go to step 5.

2

Ask the payee if the guardianship fees are included as part of the State's support obligation to the beneficiary. If yes, go to step 5. If no, go to step 3.

3

Ask the payee what types of services the guardianship fees cover. Determine if the fees are for providing services to the person (i.e., for the care, treatment, education and welfare of the beneficiary) and/or the management and control of the beneficiary’s estate (e.g., Veteran’s (VA) benefits, cash, real and/or personal property, stocks, investments, etc.). Go to step 4.

4

Refer the case to the Regional Chief Counsel (through the ARC, MOS) for review when the Social Security/SSI benefits represent at least 50 percent of the estate and the costs associated with the guardianship fees and services appear excessive in light of the beneficiary’s income and resources.

5

Investigate why the payee is collecting a fee from the beneficiary and develop for misuse of benefits as appropriate.

6. Processing Concurrent Cases — Separate Payees Discovered

Decision Factor: Under the accounting selection program, if a beneficiary is concurrently entitled to title II and title XVI payments, a single SSA-6234-OCR-SM is generated, which enables the payee to account for all payments received on one form. In these cases the form is controlled under the title XVI system, and the SSA-6234-OCR-SM is sent to the payee on the SSR.

NOTE: You can identify a concurrent accounting report by the presence of computer printed data in both the Identification (ID) and Beneficiary Identification Code (BIC) fields in the top portion of the form (see GN 00605.061C.).

In rare cases separate payees may have been appointed for each claim. In accordance with POMS GN 00502.183B.4., one payee should be appointed for all benefits to which the beneficiary is entitled, unless there is some compelling reason to appoint separate payees.

Apply these instructions when you discover that the SSR and MBR show that different payees have been appointed:

  • Resolve the issue which causes the exception;

  • Obtain an SSA-6234-F6 from the title II payee for the accounting period in question; and

  • Develop for the appointment of the same payee for both claims unless there is a compelling reason to appoint separate payees.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200605074