TN 30 (09-11)

GN 02201.025 Title II Overpayment Reconsideration Request

Citations:

20 CFR 404.522a

A. Reconsideration policy

An overpaid person or his or her representative may request reconsideration when he or she disputes the fact or amount of an overpayment. The overpaid person may request this appeal by calling the National 800 Number or by calling, visiting, or writing the field office (FO); or by writing the processing center (PC) within 60 days of the date of the initial overpayment notice. For additional instructions about the reconsideration request, see GN 03102.200 and GN 03102.225.

The reconsideration request must be in writing. The written request (e.g. a letter, facsimile, or submission of additional evidence) must clearly imply the recipient’s disagreement with the initial determination.

If the overpaid person requests reconsideration more than 60 days after notification of the overpayment, the PC will need to make a good cause determination before processing the request. For good cause instructions, see GN 03101.020.

B. FO instructions

1. Reconsideration request

The request for reconsideration documents the reason that the overpaid person disagrees with the decision. If the reason is not clear, discuss whether the person disagrees with the fact that he or she was overpaid or the overpayment amount. Clearly document the reason on the SSA-561-U2 Request for Reconsideration (see GN 03102.225B.7). For example, the reason should state, “I did not work” or “I did not receive a pension,” rather than just the generic statement, “I do not agree with the determination.”

Do not use this form if the overpaid person is only requesting an explanation of the overpayment (see GN 02201.017).

Do not use this form if the overpaid person is only requesting a waiver of the overpayment (see GN 02250.230).

2. Stop recovery

  • Stop recovery using the Protest/Stop Recovery Request (FO) (DRPF) screen in the Debt Management System (DMS) (see MSOM DMS 006.019).

  • Use #4, Recon Fact/Amount, as the protest reason or #5, Waiver and Recon Fact/Amount, if appropriate.

  • On the remarks screen annotate “Reconsideration Request for (beneficiary identification code (BIC) e.g. HA) sent to PC (number) on MM/DD/YY.” (Include a remark about the good cause determination if applicable.)

  • Fax the SSA-561-U2 to the servicing PC, via Paperless fax, with the SSA-409 Post Adjudicative Routing cover sheet or equivalent.

NOTE: Fax a copy of the SSA-561-U2 and any evidence into the Non-Disability Repository for Evidentiary Documents (NDRed). If this is a misuse case, the FO will process the reconsideration request per GN 00604.064B. Do not send the request to the PC for misuse cases.

3. Non-receipt (DCN) allegation

Do not use the SSA-561-U2 for non-receipt double check negotiation (DCN) allegations. Instead, use the SSA-795 Statement of Claimant or Other Person and follow instructions in GN 02406.310 to process this allegation.

4. Waiver is also implied

If the overpaid person also implies he or she is unable to repay the overpayment or the overpayment is not his or her fault:

  • stop recovery using the DRPF screen in DMS. Use #5, Waiver and Recon Fact/Amount, if appropriate. On the remarks screen annotate “SSA-561-U2 for (BIC) sent to PC (number) on MM/DD/YY;” and

  • forward the SSA-561-U2 to the servicing PC (via Paperless fax) before making a waiver determination on the implied waiver request.

A formal determination on the reconsideration request is always necessary.

Once the PC has made the reconsideration determination and an overpayment balance remains, they will send the necessary materials to the FO to process the implied waiver request (see GN 02201.021).

NOTE: While the reconsideration determination is pending in the PC, the implied waiver request is not controlled in the FO nor is there an SSA-632-BK Request for Waiver of Overpayment Recovery or Change in Repayment Rate involved.

C. PC instructions

When the PC receives an SSA-561-U2, or equivalent documentation requesting a reconsideration (see GN 03102.100C.2) from either the FO or directly from the overpaid person, take the following actions:

  1. Ensure that the reasons for appealing the overpayment are clearly documented (see GN 03102.225B.7). For example, “I did not work” or “I did not receive a pension.”

  2. Stop recovery using the Protest/Stop Recovery Request (PC) (DRPR) screen in DMS (see MSOM DMS 006.003). Use #4, Recon Fact/Amount, as the protest reason. On the remarks screen annotate “Received SSA-561-U2 for (BIC) on MM/DD/YY.”

  3. If the issue is a DCN non-receipt allegation, follow instructions in GN 02406.310.

  4. If the SSA-561-U2 indicates that the overpaid person is unable to repay the overpayment and the overpayment is not his or her fault, continue to process this request as a reconsideration. The form specifically states, “I do not agree with the determination on the above claim and request reconsideration.” When you have completed the reconsideration, forward an MDW to the servicing FO. The FO will process the implied waiver request.

  5. If you receive something other than an SSA-561-U2 and the overpaid person indicates:

    • he or she is unable to repay the overpayment; or

    • the overpayment is not his or her fault; and

    • there is no indication the overpaid person is disputing the overpayment,

    treat as a waiver only and forward to the FO after making the necessary DMS inputs to stop recovery for a waiver request and annotate DMS remarks.

    See the chart below for specific instructions.

    NOTE: If the overpayment is $1,000 or less and it is clear the overpaid person is not at fault; do not forward to the FO to process the implied waiver request. The PC should process the implied waiver request under the $1,000 Administrative Waiver Tolerance after making the reconsideration determination (see GN 02250.350).

  6. Process the request as follows:

    If

    Then

    Reconsideration supports a reversal of the initial finding of overpayment (i.e., there is no overpayment) and waiver (or implied waiver) of recovery was not requested

    1. Annotate the reconsideration determination using an SSA-662 Reconsideration Determination (or the equivalent). (See GN 03102.450)

    2. Annotate the approval using the Fact/Amount Appeal Disposition (DRAD) screen in DMS. (See MSOM DMS 006.011)

    3. Annotate DMS remarks with the determination and that the overpaid person did not request a waiver.

    4. Send the overpaid person a notice explaining the reversal, and include the overpaid person's right to a hearing.

    5. Fax a copy of the SSA-561-U2 and SSA-662 to NDRed.
      (See GN 00301.310)

    Reconsideration does not completely reverse the overpayment determination and waiver (or implied waiver) of recovery was not requested

    1. Annotate the reconsideration determination using an SSA-662 Reconsideration Determination (or the equivalent).

    2. Send the overpaid person a reconsideration determination notice. Include the following in the notice:

      • right to an ALJ hearing;

      • recovery will begin (or resume) in 30 days even if a hearing is requested;

      • the right to request waiver;

      • recovery will not begin (or resume) if waiver is requested within 30 days and, if waiver is requested at any time, recovery will stop effective with the date of the waiver request (for sample notices see NL 00703.118 and NL 00703.119).

    3. Annotate the denial using the DRAD screen in DMS.

    4. Annotate DMS remarks with the determination and that the overpaid person did not request a waiver.

    5. Fax a copy of the SSA-561-U2 and SSA-662 to NDRed.
      (See GN 00301.310)

    Reconsideration supports a reversal of the initial finding of overpayment (i.e., there is no overpayment) and the person requested waiver (or implied waiver) of recovery

    1. Annotate the reconsideration determination using an SSA-662 Reconsideration Determination (or the equivalent). (See GN 03102.450)

    2. Annotate the approval using the Fact/Amount Appeal Disposition (DRAD) screen in DMS. (See MSOM DMS 006.011)

    3. Annotate DMS remarks with the determination and that the overpaid person requested a waiver.

    4. Send the overpaid person a notice explaining the reversal, and include the overpaid person's right to a hearing.

    5. State in the notice that the overpaid person does not need a waiver request on the determination since the overpayment no longer exists.

    6. Fax a copy of the SSA-561-U2 and SSA-662 to NDRed. (See GN 00301.310)

    Reconsideration does not completely reverse the initial overpayment determination; the person requested waiver (or implied waiver) and the overpayment amount is $1,000 or less and it is clear the person is without fault

    1. Annotate the reconsideration determination using an SSA-662 Reconsideration Determination (or the equivalent).

    2. Annotate the denial or partial approval using the DRAD screen in DMS.

    3. Annotate the waiver request using the DRPR screen in DMS.

    4. Process the waiver portion following instructions in GN 02250.350.

    5. Annotate DMS remarks with the determination and that the overpaid person requested a waiver.

    6. Send the overpaid person a notice with both the reconsideration and waiver determinations. Include the overpaid person’s right to request an ALJ hearing.

    7. Fax a copy of the SSA-561-U2 and SSA-662 to NDRed.

    Reconsideration does not completely reverse the overpayment determination; the person requested waiver (or implied waiver) and the overpayment amount is more than $1,000 or there is some evidence (or question) of at fault,

    1. Annotate the reconsideration determination using an SSA-662 Reconsideration Determination (or the equivalent).

    2. Annotate the denial or partial approval using the DRAD screen in DMS.

    3. Annotate the waiver request using the DRPR screen in DMS.

    4. Annotate DMS remarks with the reconsideration denial and that a waiver request is still pending.

    5. Send the overpaid person a notice that explains the reconsideration denial, includes an ALJ hearing paragraph, and that his or her waiver request is pending.

    6. Fax a copy of the SSA-561-U2, SSA-662, and any material relevant to the overpayment to NDRed.

    7. Send an MDW to the FO stating the following:

      • reconsideration was denied,

      • waiver is also being requested,

      • SSA-632-BK (full waiver development) is needed, and

      • relevant paperless material was scanned into NDRed.

D. 800 Number instructions

National 800 Number agents should follow the instructions in TC 26001.030 Request for Reconsideration.


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