TN 35 (06-18)

GN 02401.908 Description of Forms or Letters Used or Reviewed By the Department of the Treasury (Treasury) Questioned Documents Branch (QDB)

A. Form FMS-1133

Treasury generates Form FMS-1133 (Claim Against the United States for the Proceeds of a Government Check) when the Social Security Administration (SSA) inputs a nonreceipt or stop payment request for Title II or Title XVI checks. The form contains questions the beneficiary, recipient or representative payee must complete in order to assist Treasury in determining if the check in question is forged.

If the beneficiary, recipient, or representative payee loses or does not receive the form, the field office (FO), Teleservice center (TSC) or program service center (PSC) may do a one-time print of the FMS-1133 from the Treasury Check Information System (TCIS). If FO or TSC personnel need additional printed forms, contact the Regional Office through normal communication (vHelp); PSC personnel can contact their Operations Analysis Staff, or contact Treasury at 855-868-0151, if necessary. The form is available for print until Treasury receives the completed FMS-1133.

Treasury will not provide the form when SSA uses a non-permanent stop code to request a certified photocopy (L-stop).

NOTE: Do not input regular photocopy or status requests through the SSA system because this information is available on TCIS.

B. Form FMS-3858

Treasury generates the white routing Form FMS-3858 (Claims Document) when responding to a nonreceipt, stop payment, or certified photocopy input. The form contains essential information about:

  • the alleged missing Title II or Title XVI check (number, symbol, amount, and date);

  • the beneficiary, recipient, or representative payee’s name and address;

  • the stop code input by SSA, Treasury’s status code response; and

  • other pertinent check information.

Treasury generates an FMS-3858, along with a photocopy of the cashed check, when a technician inputs:

  • a nonreceipt or stop payment of the original check and the check was cashed;

  • nonreceipt of a replacement check and the check was cashed; or

  • certified photocopy (L-stop).

In addition, Treasury returns the form and photocopy of the check when:

  • the previously gave SSA a credit for a check that has since been cashed; or

  • they issued a replacement check and the original check is subsequently cashed (possible overpayment situation).

C. Check information and payee signature (CIPS) letter

SSA sends the CIPS letter to the beneficiary, recipient, or representative payee to obtain recent signatures to present to Treasury’s Questioned Documents Branch (QDB) for a handwriting analysis determination.

Treasury’s QDB uses the CIPS letter to compare the recent signatures submitted by SSA and returns a decision for additional processing.

NOTE: If the SSA technician uses any other form or document to obtain signatures, Treasury takes no action on the request and returns the unprocessed form to the sender.

D. Handwriting Analysis Letter (HAL) final report

The HAL is the final report from the Treasury QDB. The report must appear on Treasury letterhead. It describes the results of the handwriting analysis performed by the document examiner in the QDB. The letter normally has three headings:

  1. Questioned (details which checks were reviewed);

  2. Standard (details what was used for signature comparison); and

  3. Report (details the results of the handwriting analysis).

For an example of a completed HAL, see NL 03001.065.

E. References

  • GN 02406.160 When to Use Forms FMS-1133 and FMS-3858

  • SM 01315.210 When Treasury Will Send a FMS-3858

  • SM 01315.212 How to Read a FMS-3858

  • SM 01315.213 How to Process a FMS-3858/FMS-1133

  • NL 03001.055 Request for Check Information and Payee Signature Letter

  • NL 03001.060 Cover Letter for Limited Payability Cases Requesting Handwriting Analysis from the Department of the Treasury (Treasury)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202401908
GN 02401.908 - Description of Forms or Letters Used or Reviewed By the Department of the Treasury (Treasury) Questioned Documents Branch (QDB) - 06/15/2018
Batch run: 06/15/2018
Rev:06/15/2018