BASIC (03-04)

GN 01085.030 Paper Retention Policy for the Paperless Program Service Center (PSC)

A. Background

The Paperless Processing Center System (PPC) is a document imaging and management system that SSA employs in the payment centers (PCs) to manage the work.

This section provides guidance for the retention and subsequent disposition of program-related documents once an action has been successfully imaged; i.e., it is clearly readable.

The following retention policy applies only to paper forms (and other paper documents) that are scanned into the paperless imaging equipment in the PSCs.

B. Policy

SSA will destroy original documents and forms that are scanned into the paperless imaging system once the PSC determines that the images are of high enough quality to meet processing standards; i.e., the images are clearly readable.

Exclusions from destruction are:

  • Documents/forms contained in the initial claims files;

  • Documents that must be returned to the beneficiary; e.g., marriage certificates;

  • Disability medical documents;

  • Certain Title XVI documents.

C. Procedure

  1. Set aside exclusions to the destruction process at the front-end of the process. Return forms and documents to the beneficiary as appropriate. Associate all other forms excluded from the destruction process with the paper claims file. Destroy the paper claims file in accordance with current retention schedules.

  2. Destroy paper documents and forms that the PSC processed without imaging (e.g. direct input work).

  3. Refer to the following chart for imaged documents. Retain documents contained in the initial claims file, and exclusions shown in GN 01085.030B.

  4. Use the following guidelines for Title II forms and documents that are not listed in GN 01085.030D:

    1. Computer Output – Destroy once the image is clearly readable.

    2. Responses/Inquiries - Destroy once the image is clearly readable.

    3. Statements - Destroy once the image is clearly readable, UNLESS it is part of the initial claims file. If the statement is part of the initial claims file, then follow the procedures in GN 01085.030C.1.

    4. Reporting Events - Destroy once the image is clearly readable.

D. Exhibit - retention periods for program-related forms

The following exhibit is a guide for discarding forms in PSC modules using the paperless process. Although we display many forms, this is not an all-inclusive list. Follow GN 01085.030C.4. for unlisted forms.

FORM NUMBER

TITLE

RETENTION DISPOSITION

SSA-1

Application for Retirement Insurance Benefits

UNTIL paper claims file is destroyed.

SSA-2

Application for Spouse Insurance Benefits

UNTIL paper claims file is destroyed.

SSA-3

Marriage Certification

UNTIL paper claims file is destroyed.

SSA-4

Application for Child Insurance Benefits

UNTIL paper claims file is destroyed.

SSA-5

Application for Mother or Father Insurance Benefits

UNTIL paper claims file is destroyed.

SSA-7

Application for Parent Insurance Benefits

UNTIL paper claims file is destroyed.

SSA-8

Application for Lump Sum Death Payment

PAPERLESS LSDP ONLY CLAIMS

Destroy 60 DAYS after verification of systems acceptance of LSDP action.

ALL OTHER LSDP/SURVIVOR CLAIMS

UNTIL paper claims file is destroyed.

SSA-10

Application for Widow(er) Insurance Benefits

UNTIL paper claims file is destroyed.

SSA-11

Request to be Selected as Payee

Destroy once the image is determined to be clearly readable.

SSA-16

Application for Disability Insurance Benefits

UNTIL paper claims file is destroyed.

SSA-19

Application for Special Age 72-or-Over Monthly Payments

UNTIL paper claims file is destroyed.

SSA-21

Supplement of Claim of Person Outside the U.S.

Destroy once the image is determined to be clearly readable.

VA-21-4182

Abbreviated Application for VA Benefits

Destroy once the image is determined to be clearly readable unless used for protective filing; then retain UNTIL paper claims file is destroyed.

VA-21-8046

VA Payment Notice (Stop-Suspend-Resume)

Destroy once the image is determined to be clearly readable.

SSA-24

Application for Survivor Benefits

UNTIL paper claims file is destroyed.

SSA-25

Certificate of Election for Reduced Spouse benefits

UNTIL paper claims file is destroyed.

HCFA-40B

Application for Supplementary Medical Insurance

Destroy once the image is determined to be clearly readable.

BRI-46-289

Inquiry from OPM

Destroy once the image is determined to be clearly readable.

VA-70-7210

Request for Index and Locator Information

Destroy once the image is determined to be clearly readable.

SSA-101

Determination of Award - -

Manual

Destroy once the image is determined to be clearly readable.

SSA-L106

School Certification of Birth Data

Destroy once the image is determined to be clearly readable.

SSA-122

Request for Additional Information

Destroy once the image is determined to be clearly readable.

SSA-149

Waiver of Benefit Payment

Destroy once the image is determined to be clearly readable.

SSA-150

Modified Benefit Formula Questionnaire for the Windfall Elimination Provision (WEP)

Destroy once the image is determined to be clearly readable.

SSA-174

Representative Payee Diary Card

Destroy once the image is determined to be clearly readable.

SF-180

Request Pertaining to Military Service Records

Destroy once the image is determined to be clearly readable.

SSA-208

Authorization for Garnishment

Destroy once the image is determined to be clearly readable.

SSA-209

Garnishment Information Update

Destroy once the image is determined to be clearly readable.

DD-214

Statement of Military Service

Destroy once the image is determined to be clearly readable.

SSA-L244

Letter Transmitting Reconsideration Determination

Destroy once the image is determined to be clearly readable.

SSA-250

Development Worksheet

Destroy once the image is determined to be clearly readable.

SSA-L250

Notice of Application for Withdrawal of Claim

Destroy once the image is determined to be clearly readable.

SSA-L293

RSDI Notice of Unscheduled CDR

Destroy once the image is determined to be clearly readable.

SSA-381-SP

Waiver of Option to Receive Spanish Language Notice

Destroy once the image is determined to be clearly readable.

SSA-385

OIO Case Folder Flag

Destroy once the image is determined to be clearly readable.

SSA-408

Route Slip

Destroy once the image is determined to be clearly readable.

SSA-409

Postadjudicative Routing

Destroy once the image is determined to be clearly readable.

SSA-450

Claims Input Data Form

Destroy once the image is determined to be clearly readable.

SSA-454

Report of Continuing Disability Interview

UNTIL paper claims file is destroyed.

SSA-455

Disability Update Report

UNTIL paper claims file is destroyed.

SSA-492

PC Case Folder Flag

Destroy once the image is determined to be clearly readable.

HA-520

Request for Review of Hearing Decision Order

Destroy once the image is determined to be clearly readable.

SSA-521

Request for Withdrawal of Application

Destroy once the image is determined to be clearly readable.

SSA-533

Translation Request

Destroy once the image is determined to be clearly readable.

HA-539

Notice Regarding Substitution of Party (Upon Death of Claimant)

Destroy once the image is determined to be clearly readable.

SSA-546

Workers' Compensation / Public Disability Benefits Information

UNTIL paper claims file is destroyed.

SSA-553

Special Determination

Destroy once the image is determined to be clearly readable.

SSA-559

Transmittal Sheet for Claims Folder / Material

Destroy once the image is determined to be clearly readable.

SSA-561

Request for Reconsideration

Destroy once the image is determined to be clearly readable.

SSA-562

Request for Assistance / Certification of Documents or Records

Destroy once the image is determined to be clearly readable.

SSA-L566

SSA Application Development

Destroy once the image is determined to be clearly readable.

SSA-573

Special Typing Instructions

Destroy once the image is determined to be clearly readable.

SSA-622

Representative Payee Questionnaire – Individual

Destroy once the image is determined to be clearly readable.

SSA-623

Representative Payee Report

Destroy once the image is determined to be clearly readable.

SSA-624

Representative Payee Evaluation Report

Destroy once the image is determined to be clearly readable.

SSA-625

Report by Former Representative Payee

Destroy once the image is determined to be clearly readable.

SSA-632

Request for Waiver of Overpayment Recovery or Change in Overpayment

Destroy once the image is determined to be clearly readable.

SSA-632

Recovery Interview Supplement

Destroy once the image is determined to be clearly readable.

SSA-635

Waiver Determination

Destroy once the image is determined to be clearly readable.

SSA-636

Transmittal Notice for a Hearing

Destroy once the image is determined to be clearly readable.

SSA-654

Request for Information From Uniformed Services

Destroy once the image is determined to be clearly readable.

SSA-655

Certification by Federal Agency

Destroy once the image is determined to be clearly readable.

SSA-656

Information as to Continuing Eligibility Under Title 38 USC, Section 412, Veterans' Benefits

Destroy once the image is determined to be clearly readable.

SSA-662

Reconsideration Determination

Destroy once the image is determined to be clearly readable.

SSA-702

Statement Regarding Date of Birth and Citizenship

UNTIL paper claims file is destroyed.

SSA-704

Certification of Contents of Document(s) or Record(s)

Destroy once the image is determined to be clearly readable unless contained in the initial claims file.

SSA-L706

Proof of Age Letter to Custodian

Destroy once the image is determined to be clearly readable.

SSA-721

Statement of Death by Funeral Director

Destroy once the image is determined to be clearly readable.

SSA-723

Statement Regarding Presumed Death Due to Unexplained Absence

UNTIL paper claims file is destroyed.

SSA-730

Request to Have SSI Overpayment Withheld from SSA benefits

UNTIL paper claims file is destroyed.

SSA-L732

Additional Information Needed From Claimant to Adjudicate Claim

Destroy once the image is determined to be clearly readable.

SSA-753

Statement Regarding Marriage

UNTIL paper claims file is destroyed.

SSA-754

Statement of Marital Relations

UNTIL paper claims file is destroyed.

SSA-760

Certificate of Support

UNTIL paper claims file is destroyed.

SSA-766

Statement of Self-Employment

Destroy once the image is determined to be clearly readable.

SSA-768

Certification of Evidence of Wages

Destroy once the image is determined to be clearly readable.

SSA-781

Certificate of Care and Responsibility for Welfare of Child Not in Applicant's Custody

UNTIL paper claims file is destroyed.

SSA-783

Statement Regarding Contributions

UNTIL paper claims file is destroyed.

SSA-787

Physician / Medical Officer Statement

Destroy once the image is determined to be clearly readable.

SSA-788

Statement of Care and Responsibility for Beneficiary

Destroy once the image is determined to be clearly readable.

SSA-790-RR

Request for Railroad Earnings

Destroy once the image is determined to be clearly readable.

SSA-795

Statement of Claimant or Other Person

Destroy once the image is determined to be clearly readable.

SSA-827

Authorization to Release Medical Information to SSA

Destroy once the image is determined to be clearly readable.

SSA-831

DIB Determination and Transmittal Sheet

Destroy once the image is determined to be clearly readable.

SSA-832

Cessation or Continuance of Disability / Blindness Determination and Transmittal - Title XVI

Destroy once the image is determined to be clearly readable.

SSA-833

Cessation or Continuance of Disability / Blindness Determination and Transmittal – Title II

Destroy once the image is determined to be clearly readable.

SSA-892

ESRD Medical Determination

Destroy once the image is determined to be clearly readable.

SSA-924

Folder Documentation

Destroy once the image is determined to be clearly readable.

SSA-1002

Statement of Agricultural Employer for Years Before 1988

Destroy once the image is determined to be clearly readable.

SSA-1003

Statement of Agricultural Employer for Years After 1987

Destroy once the image is determined to be clearly readable.

SSA-L1043

Letter Requesting Necessary Evidence

Destroy once the image is determined to be clearly readable.

SSA-L1044

(Follow-up) Letter Requesting Necessary Evidence

Destroy once the image is determined to be clearly readable.

SSA-L1045

(Closeout) Letter Requesting Necessary Evidence

Destroy once the image is determined to be clearly readable.

SSA-1099

SS Benefit Statement

Destroy once the image is determined to be clearly readable.

SSA-1129

Attorney Fee Case – Past Due Benefit Summary

Destroy once the image is determined to be clearly readable.

SSA-L1157

Notice of Disability

Destroy once the image is determined to be clearly readable.

SSA-1178

Evaluation of Fee Petition

Destroy once the image is determined to be clearly readable.

SSA-1203

Determination of Benefits Payable After Offset (WC/PDB)

Destroy once the image is determined to be clearly readable.

SSA-1208

Keep Flag on Top

Destroy once the image is determined to be clearly readable.

DD-1300

Report of Casualty

Destroy once the image is determined to be clearly readable.

SSA-1314

Annual Report Data

Destroy once the image is determined to be clearly readable.

SSA-1323

Report on Individual With Childhood Impairment

Destroy once the image is determined to be clearly readable.

SSA-1372

Student's Statement regarding School Attendance

Destroy once the image is determined to be clearly readable.

SSA-1383

Student Reporting Form – Changes

Destroy once the image is determined to be clearly readable.

SSA-1386

Student's Statement Regarding Resumption of School Attendance

Destroy once the image is determined to be clearly readable.

SSA-1388

Report of Student Beneficiary at End of School Year

Destroy once the image is determined to be clearly readable.

SSA-1390

Report of Student Beneficiary About to Attain Age 19

Destroy once the image is determined to be clearly readable.

SSA-1425

Reporting Changes that Affect SSA Payment

Destroy once the image is determined to be clearly readable.

SSA-1473

Request for Railroad Annuity Information

Destroy once the image is determined to be clearly readable.

SSA-1535

Application for Search of Census Records

Destroy once the image is determined to be clearly readable.

SSA-1588

Beneficiary Recontact Report

Destroy once the image is determined to be clearly readable.

SSA-1610

Public Assistance Agency Information Request

Destroy once the image is determined to be clearly readable.

SSA-1671

Transmittal of Critical Case

Destroy once the image is determined to be clearly readable.

SSA-1696

Appointment of Representative

Destroy once the image is determined to be clearly readable.

SSA-1709

Request for Workers' Compensation / Public Disability Benefits Information

Destroy once the image is determined to be clearly readable.

SSA-1719

RSI Postentitlement Direct Input

Destroy once the image is determined to be clearly readable.

SSA-1719-B

SSI Postentitlement Direct Input

Destroy once the image is determined to be clearly readable.

SSA-1719-C

SSI Postentitlement Direct Input

Destroy once the image is determined to be clearly readable.

SSA-1719-NC

SSI Non-Receipt Direct Input

Destroy once the image is determined to be clearly readable.

SSA-1720

Annual Report Direct Input

Destroy once the image is determined to be clearly readable.

SSA-1724

Claim for Amounts Due

Destroy once the image is determined to be clearly readable.

SSA-1826

Sample Itemized Statement of Earnings

Destroy once the image is determined to be clearly readable.

PHS-1867

Public Health Service DMW Credit Reporting Form

Destroy once the image is determined to be clearly readable.

SSA-2038

Date of Birth Determination

Destroy once the image is determined to be clearly readable.

SSA-2118

Request for Document Information

Destroy once the image is determined to be clearly readable.

SSA-2164

Work Notice Direct Input

Destroy once the image is determined to be clearly readable.

SSA-2417

Determination of Benefit Rights

Destroy once the image is determined to be clearly readable.

SSA-2454

Offset Worksheet (WC/PDB) – Triennial Redetermination Previously Applied

Destroy once the image is determined to be clearly readable.

SSA-2455

WC/PDB Offset Worksheet – Disability

Destroy once the image is determined to be clearly readable.

SSA-2506

Psychiatric Review Techniques

UNTIL paper claims file is destroyed.

SSA-2512

Pre-1957 Military Service – Federal Benefit Questionnaire

Destroy once the image is determined to be clearly readable.

SSA-2514

Claimant's Intent to File

Destroy once the image is determined to be clearly readable.

SSA-2519

Child Relationship Statement

UNTIL paper claims file is destroyed.

SSA-2521

Request for Priority Action

Destroy once the image is determined to be clearly readable.

SSA-2708

Request to Call or Visit the District Office

Destroy once the image is determined to be clearly readable.

SSA-2764

SALT Coding Sheet

Destroy once the image is determined to be clearly readable.

SSA-2795

Determination of Resumption of Award

Destroy once the image is determined to be clearly readable.

SSA-L3044

Social Security Notice to Employee

Destroy once the image is determined to be clearly readable.

SSA-3105

Important Information About Your Review Rights

Destroy once the image is determined to be clearly readable.

SSA-3368

Disability Report

UNTIL paper claims file is destroyed.

SSA-3369

Vocational Report

UNTIL paper claims file is destroyed.

SSA-L3400

Social Security Notice

Destroy once the image is determined to be clearly readable.

SSA-3428

Determination of Disallowance

Destroy once the image is determined to be clearly readable.

SSA-3440

Claims Collection Litigation Report

Destroy once the image is determined to be clearly readable.

SSA-3441

Reconsideration Disability Report

UNTIL paper claims file is destroyed.

SSA-3601

MCS or Non-CAPS Routing Form

Destroy once the image is determined to be clearly readable.

SSA-3621

MBR Account / Benefit Data Change Form

Destroy once the image is determined to be clearly readable.

SSA-3643

Offset Worksheet (WC/PDB) – Triennial Redetermination

Destroy once the image is determined to be clearly readable.

SSA-3820

Medical History and Disability Report

UNTIL paper claims file is destroyed.

SSA-3881

Questionnaire for Children Claiming SSI Benefits

UNTIL paper claims file is destroyed.

SSA-3885

Government Pension Questionnaire

Destroy once the image is determined to be clearly readable.

SSA-3926

Determination of Benefit Adjustment

Destroy once the image is determined to be clearly readable.

HCFA-4040

Application for Supplementary Medical Insurance

UNTIL paper claims file is destroyed.

SSA-4078

Request for Earnings After Death

Destroy once the image is determined to be clearly readable.

SSA-L4107

Change of Address – Additional Information Needed

Destroy once the image is determined to be clearly readable.

SSA-4111

Certificate of Election for Reduced Widow(er) Benefit

Destroy once the image is determined to be clearly readable.

SSA-L4112

Request for Employment Information

Destroy once the image is determined to be clearly readable.

SSA-L4157

Request for Earnings Information

Destroy once the image is determined to be clearly readable.

SSA-4162

Child-Care Dropout Questionnaire

Destroy once the image is determined to be clearly readable.

SSA-4164

Consent Form for a Representative Payee

Destroy once the image is determined to be clearly readable.

SSA-4184

Self-Employment / Corporate Officer

UNTIL paper claims file is destroyed.

SSA-4268

Explanation of Determination

Destroy once the image is determined to be clearly readable.

SSA-4345

SSI Offset Worksheet – Federal

Destroy once the image is determined to be clearly readable.

SSA-L4360

SS Benefit Information

Destroy once the image is determined to be clearly readable.

SSA-4385

Certification of Contents of Court Records

Destroy once the image is determined to be clearly readable.

SSA-4500

Federal determination of Error in State's Wage Reports

Destroy once the image is determined to be clearly readable.

SSA-4582

Wage Suspense / Reinstate Card

Destroy once the image is determined to be clearly readable.

SSA-4641

Authorization for SSA to Obtain Personal Information

Destroy once the image is determined to be clearly readable.

SSA-4734

Residual Physical Functional Capacity Assessment

Destroy once the image is determined to be clearly readable.

SSA-4734

Mental Residual Functional Capacity Assessment

Destroy once the image is determined to be clearly readable.

SSA-5002

Report of Contact

Destroy once the image is determined to be clearly readable.

SSA-L5004

Acknowledgment of Misdirected Tax

Destroy once the image is determined to be clearly readable.

SSA-5015

Diary and Listing Slip

Destroy once the image is determined to be clearly readable.

SSA-5016

Scouting Request – Pending Claim

Destroy once the image is determined to be clearly readable.

HA-5051

Transmittal of ALJ's Decision or Dismissal to ODAR

Destroy once the image is determined to be clearly readable.

SSA-5052

RSI Health Insurance Information Request

Destroy once the image is determined to be clearly readable.

SSA-L5114

Letter Notifying Self-Employed Claimant of Adjustment

Destroy once the image is determined to be clearly readable.

SSA-5526

Request for Assistance – Disability

Destroy once the image is determined to be clearly readable.

SSA-5527

Request for Assistance – Representative Payee

Destroy once the image is determined to be clearly readable.

SSA-6220

Representative Payee Questionnaire – Institutions

Destroy once the image is determined to be clearly readable.

SSA-6230

Representative Payee Report for Children

Destroy once the image is determined to be clearly readable.

SSA-7004

Request for Earnings and Benefit Estimate Statement

Destroy once the image is determined to be clearly readable unless used for protective filing; then retain UNTIL paper claims file is destroyed.

SSA-7005

Personal Earnings and Benefit Estimate Statement

Destroy once the image is determined to be clearly readable unless used for protective filing; then retain UNTIL paper claims file is destroyed.

SSA-7008

Request for Correction of Earnings

Destroy once the image is determined to be clearly readable.

SSA-7011

Statement of Employer Regarding Earnings

Destroy once the image is determined to be clearly readable.

SSA-L7013

Request to Employer for Wage Information

Destroy once the image is determined to be clearly readable.

SSA-L7014

Request for Earnings Information

Destroy once the image is determined to be clearly readable.

SSA-L7015

Follow Up to SSA-L7014 Request

Destroy once the image is determined to be clearly readable.

SSA-7052

DO Record of Earnings Discrepancy Development

Destroy once the image is determined to be clearly readable.

SSA-7057

Request for Tax Return Information

UNTIL paper claims file is destroyed.

SSA-7104

Partnership Questionnaire

Destroy once the image is determined to be clearly readable.

SSA-7160-F4

Employment Relationship Questionnaire

Destroy once the image is determined to be clearly readable.

SSA-7157

Farm Arrangement Questionnaire

Destroy once the image is determined to be clearly readable.

SSA-7160

Employment Relationship Questionnaire

UNTIL paper claims file is destroyed.

SSA-7161

Foreign Enforcement Questionnaire

Destroy once the image is determined to be clearly readable.

SSA-7162

Foreign Enforcement Questionnaire

Destroy once the image is determined to be clearly readable.

SSA-7163

Questionnaire about Employment or Self-Employment Outside USA

Destroy once the image is determined to be clearly readable.

SSA-8000

Application for SSI – Long Form

UNTIL paper claims file is destroyed.

SSA-8001

Application for SSI – Short Form

UNTIL paper claims file is destroyed.

SSA-8006

Statement of Living Arrangements, In-Kind Support and Maintenance

UNTIL paper claim or postentitlement file is destroyed.

SSA-8008

Living Arrangement and In-Kind Support and Maintenance Guide

UNTIL paper claim or postentitlement file is destroyed.

SSA-8010

Statement of Income and Resources

UNTIL paper claim or postentitlement file is destroyed.

SSA-8011

Statement of Household Expenses and Contributions

UNTIL paper claim or postentitlement file is destroyed.

SSA-8202

Statement for Determining Continuing Eligibility for SSI

Destroy 7 YEARS after completion of the redetermination action.

SSA-8203

Statement for Determining Continuing Eligibility for SSI Payment

UNTIL paper claim or postentitlement file is destroyed.

SSA-8299

Request for Special Age 72 Reinstatement

Destroy once the image is determined to be clearly readable.

SSA-8510

Authorization to SSA to Obtain Personal Information

Destroy once the image is determined to be clearly readable.

SSA-8740

Referral and Treatment Status of SSI Drug Addicts and Alcoholics

UNTIL paper claim or postentitlement file is destroyed.

SSA-9432

Notice Regarding Military Service Wage Credits

Destroy once the image is determined to be clearly readable.

SSA-9584

State Mental Institution Policy

Destroy once the image is determined to be clearly readable.

SSA-9584

Certification by State Mental Institution

Destroy once the image is determined to be clearly readable.

SSA-L9778

Work Report

Destroy once the image is determined to be clearly readable.

SSA-L9779

Work Report

Destroy once the image is determined to be clearly readable.

SSA-L9780

Work Report

Destroy once the image is determined to be clearly readable.

SSA-L9781

Work Report

Destroy once the image is determined to be clearly readable.

HA-13041

Statement of Service

Destroy once the image is determined to be clearly readable.

NA-13047

Reply to Request for Information

Destroy once the image is determined to be clearly readable.

NA-13075

Questionnaire about Military Service

Destroy once the image is determined to be clearly readable.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201085030
GN 01085.030 - Paper Retention Policy for the Paperless Program Service Center (PSC) - 01/02/2015
Batch run: 01/02/2015
Rev:01/02/2015<