TN 15 (12-98)

GN 00605.224 How to Evaluate Payee Responses About Use of Dedicated Account Funds

A. INTRODUCTION

This section explains how to review the payee's responses about the use of benefits from the dedicated account as an indicator that the items or services are questionable expenditures.

B. POLICY

1. Permitted Expenditures

A payee is allowed to use dedicated account funds for medical treatment, education or job skills training for the benefit of the child. Funds may also be used for the following, if they benefit the child and are related to the child's impairment: personal needs assistance; special equipment; housing modification; therapy or rehabilitation; and other items or services SSA determines appropriate. Attorney fees incurred in pursuit of the child's disability may be considered “impairment related” . SSA has determined that in emergency situations where the unavailability of dedicated account funds for basic living expenses may result in the child becoming homeless or malnourished, expenditures from the dedicated account may be used if they are otherwise appropriate. (See GN 00602.140.C.2.b. for examples of permitted expenditures and GN 00602.140.D. for case specific examples.)

2. Expenditures Not Permitted

Payment for items or services not described above are not permitted. Basic maintenance costs (food, housing, clothing, and personal items) not related to the child's impairment may not be paid with dedicated account funds.

3. Misapplication of Benefits

Misapplication of benefits occurs when a payee knowingly used dedicated account funds for expenditures not permitted.

C. DESCRIPTION OF SSA-6233-BK - Question 7 A-B

Question 7A — Did you take any money out of the dedicated account during the report period? [ ]YES[ ]NO If YES, please explain what items and/or services you purchased and the amount of each purchase:

Question 7B — Were these purchases for medical treatment, or education or job skills training? [ ]YES[ ]NO If NO, please explain how they benefited the beneficiary and are related to his/her impairment(s):

D. PROCEDURE

1. Evaluate Expenditures

DECISION FACTOR: Any items or services not listed in
GN 00602.140.B.3.a. - GN 00602.140B.3.c. are not permitted expenditures. Procedures for determining appropriate other items and services, and examples of some types of allowable expenditures are in GN 00602.140.C.2.

2. Evaluate How Item or Service Relates To Impairment

DECISION FACTOR: The burden is on the payee to explain why or how an item or service other than those specified in GN 00602.140.B.3.a. is related to the child's impairment(s). FO personnel should use their best judgement to decide, on a case-by-case basis, whether the expenditure relates to, results from, or would improve the child's condition.

3. Expenditure Is Questionable

  • Conduct a face-to-face interview with the payee whenever practical.

  • Determine if the payee requested SSA approval before making expenditure(s) in the “other” category and if the request(s) was approved or denied, (See GN 00602.140.C.6.).

  • If the payee did not obtain SSA approval before making expenditures in the “other” category, review the payee's financial records and receipts to determine if the expenditure is permitted according to GN 00602.140.B.3.a. - GN 00602.140.B.3.c. Ensure the payee has the opportunity to explain (or provide supporting evidence) why or how the expenditure (other than medical treatment, education or job skills training) relates to, results from, or improves the child's condition.

  • Follow the procedures for making a misapplication determination if your review of the dedicated account reveals that the payee knowingly misapplied funds for items or services not permitted. (See GN 00602.140.C.8.) If the payee misapplied all of the funds in the account, follow