TN 16 (09-04)

GN 02406.310 Request for Reconsideration of DCN Overpayment or Forgery Determination

A. Introduction

When an individual protests a DCN overpayment by asserting that he/she did not receive or did not cash both checks, it is appropriate to have that individual file a request for reconsideration (see GN 03102.100, SI 04020.000). A claimant must request reconsideration within 60 days of the date of the notice of initial determination. If the claimant requests reconsideration within the first 30 days from the date of the overpayment notice, recovery will not begin. If the claimant requests reconsideration anytime from the 31st day until the 60th day, overpayment recovery may have begun but will be suspended until a forgery determination is received from DT. Any monies collected will NOT be returned at this point. Adjudication of a request for reconsideration filed after the 60 days must be supported by good cause and overpayment recovery will be suspended while awaiting a forgery determination from DT. See GN 03101.020. If claimant wishes to appeal the DCN overpayment but does not do so within the 60-day reconsideration period, nor is good cause established, SSA will send the FMS-1133(s) to DT for a forgery determination BUT WILL NOT CEASE OVERPAYMENT RECOVERY. It is to SSA’s advantage to have DT determine whether forgery is a factor or not so the money can be reclaimed if appropriate; however, because the protest was neither timely nor met good cause, overpayment recovery is not ceased.

B. Process

1. Forms Needed to Request Reconsideration

A “request for reconsideration” is handled differently in title II and title XVI DCN overpayment situations:

a. Title II

A signed SSA-795 should be obtained from the beneficiary stating that he/she requests reconsideration on the DCN overpayment. This takes the place of the SSA-561-U2 that is not used in this situation because it produces a workload in the PC for the Reconsideration Reviewer that cannot be resolved until the forgery determination is made by DT.

b. Title XVI

A signed SSA-561-U2 should be obtained from the recipient before processing a request for reconsideration on a DCN overpayment. In addition, if overpayment recovery has already begun, it will not be suspended unless and until the signed form is received.

2. Reconsideration Requested Within 30 Days of Overpayment Notification

If a request for reconsideration is filed with SSA within 30 calendar days of the date on the overpayment notice, overpayment proceedings will not begin if:

  1. The claimant asserts that he/she did not cash both checks, or

  2. The claimant maintains he/she never received the either or both check(s).

3. Reconsideration Requested Anytime During the 60-Day Period

  1. When a claimant receives an initial overpayment notice for a DCN and protests that overpayment, new policy dictates that a signed SSA-795 to this effect is required for title II and can be signed in the FO or sent to the claimant for signature with a return envelope addressed to the PC or FO. For title XVI, a signed SSA-561-U2 is required and must be received before overpayment recovery ceases.

    If available, the claims package can be sent out with the appropriate form to be completed and returned to either the PC or FO, as appropriate.

    IMPORTANT: If claims package/reconsideration forms are mailed to the claimant, ask him/her to contact SSA if the package is not received within 5 days.

  2. Claimant must complete and return an FMS-1133 for each check in question to SSA (1) within 30 days of receiving the package, or (2) after notification that the package is available (e.g., FO/TSC notifies claimant by telephone that package is in the FO and claimant states that he/she wishes to come into the FO to complete the form) or SSA will reinstate the overpayment collection.

  3. Establish a 30-day diary for the return of the completed claim form to SSA. If the FMS-1133 is returned within 30 days, overpayment recovery will not begin. If the completed claims package is received between the 31st day and the 60th day, overpayment recovery will be suspended but any monies already collected will not be returned.

  4. Inform the claimant that DT will not take any action on the allegation without a completed claim form FMS-1133 for each check in question.

  5. The PC/FO makes copies of the FMS-1133 and retains it for 1 year. Copies will be available to the claimant upon request.

  6. The completed claims package is forwarded to DT for a forgery determination.

4. Claimant Requested Reconsideration After 60 Days from the Overpayment Notification

  1. Reconsideration must meet the good cause criteria found at GN 03101.020.

  2. If good cause criteria are met, process as in GN 02406.310B.3.

5. Claimant Requested Reconsideration After 60 days from Overpayment Notification and GOOD CAUSE NOT ESTABLISHED

Since the request for reconsideration was not filed within the 60-day period and did not meet the good cause criteria, reconsideration is not appropriate. However, SSA will accept the completed FMS-1133 form(s) and send them to DT for a forgery determination. In addition,

  • DO NOT CEASE OVERPAYMENT RECOVERY.

  • If DT determines that forgery was involved, DT will reclaim the money and return it to SSA. SSA will refund any monies withheld from the claimant during the recovery period.

  • If DT determines that no forgery was involved, overpayment recovery is either already underway or has been completed.

C. Procedure - FO/PC/TSC Action When The Beneficiary Or Recipient Protests The Overpayment (Within 60 Days Of Overpayment Letter) Caused By The Negotiation Of The Original And Courtesy Disbursement Or Replacement Check

1. FO/800# Answering site Initial Action

a. Title II

  • Input protest/stop recovery (TC23 3 Alleged Non-Receipt of Check to ROAR) to prevent recovery of the overpayment (see MSOM DMS 006.019 and MSOM DMS 006.020). This will set up a 90-day diary.

  • Notify the servicing PC via priority MDW that the claimant has filed a protest of the overpayment. (PC now has jurisdiction.)

b. Title XVI

The TSC will:

  • Notify the servicing FO via priority MDW that recipient is protesting the DCN overpayment.

  • Mail the SSA-561-U2 to the recipient for signature with a return envelope addressed to the FO of jurisdiction.

  • Do not suspend recovery based on the telephone request.

The FO will:

  • After receipt of the completed SSA-561-U2, input an L-TAC (see GN 02406.001–Glossary of Nonreceipt Terms) in the CO field to suspend recovery. Set up a manual diary for 90 days. Keep SSA-561 with copy of the claims package(s).

2. PC Initial Action

  • Obtain a signed SSA-795 stating that the beneficiary requests reconsideration of the DCN overpayment.

  • Keep the SSA-795 with copy of the claims package.

  • If title II collection efforts have not been suspended, input protest/stop recovery (TC 23R to ROAR).

3. FO/PC Action to Process the Reconsideration/Obtain a Forgery Determination

  1. Have claimant come into the FO and sign an SSA-795 (title II)/SSA-561-U2 (title XVI) or mail the appropriate form to the claimant with a return envelope addressed to the FO/PC which states he/she wishes to protest the DCN overpayment (can be sent with the FMS-1133 package). Have claimant call if claims package is not received within 5 days.

  2. If claims package is not available at the time the SSA-795 or SSA 561-U2 are sent out, have the claimant come into the FO or mail the blank FMS-1133 and check photocopy to the claimant with a return envelope addressed to the FO/PC. Instruct the claimant that the FMS-1133 must be returned in 30 days or recovery will recommence. Have claimant call the FO if the claims package is not received within 5 days.

  3. Diary for 30 days plus 5 mailing days for return of the FMS-1133 package.

  4. If the claimant wishes to come into the FO to complete the FMS-1133, the FO should diary for 30 days from the moment of notification to the claimant that the FMS-1133 is available.

  5. If a completed FMS-1133 is not received in SSA within 30 days plus 5 mailing days, begin/recommence overpayment recovery.

  6. Review the responses on the FMS-1133 (see GN 02406.160) before sending the package to DT.

  7. Copy the completed claims package and retain it for one year. Copies will be available to the claimant upon request.

  8. Diary for 90 days for the return of the CDN from DT. Check CP&R or call DT’s general number at 855-868-0151 see if forgery determination is complete.

  9. If the Questioned Documents Branch cannot make a determination on the claim and forwards the case to the USSS, establish a 180-day diary for the response. This information is also available from CP&R or by calling DT at 1-855-868-0151. The technicians should call this number for all check claims, payment and post-payment inquiries.

4. DT Determines That Forgery Is NOT Involved (Claimant Endorsed the Check[s]):

  1. DT will send a CDN to SSA. This should be received within 90 days of DT receiving the FMS-1133.

  2. DT will send a denial letter to the claimant specifying the basis of the denial. The letter will contain the opinion of the handwriting expert and will provide DT’s return address and instructions in case the claimant wants to provide additional evidence and appeal the forgery determination within 60 days.

  3. Diary for 90 days for possible appeal of DT’s forgery decision (DT will send a CDN if appeal is filed).

  4. Do not resume recovery until either the 60-day appeal period has elapsed or DT makes a final determination on an appeal that forgery is not involved.

  5. After the appeal period has expired, FOs should ask their Regional Office (RO) and PCs should call their Operations Analyst to query DT CP&R system to see if claimant appealed forgery determination. Information can also be obtained by calling DT at 1-855-868-0151. The technicians should call this number for all check claims, payment and post-payment inquiries. Also check remarks on MBR/SSR, OR

  6. If the 60-day appeal period plus 30 additional days have elapsed and no appeal has been filed (i.e., no CDN received), resume overpayment recovery.

5. If Appeal Is Not Filed, Resume Recovery of Overpayment

a. Title II

  • Send the reconsideration notice. Use the sample notice in NL 00703.119 minus the SSA-662 with a paragraph stating that the DT determined that forgery was not involved.

  • Input a transaction code of 27 to ROAR (reconsideration denial).

b. Title XVI

  • Use a dictated notice stating that DT determined that forgery was not involved.

  • Transmit a 1719B to remove the L-TAC.

6. PC/FO Action When DT Determines Forgery Is Involved

There is no overpayment. Credit will be returned to SSA via OPAC (Online Payment and Collection system). Also:

  1. PC/FO: Send a reconsideration determination to the beneficiary/recipient. Do not include waiver language.

  2. PC: Title II - Input a transaction code of 25 to ROAR (reconsideration approval).

  3. FO: Title XVI - Credit will post to the SSR causing an excess decision. Delete the L-TAC entered earlier to suspend collection.

D. Procedure - FO/PC/TSC Action When Reconsideration Requested After 60-day Period - Good Cause Not Met

The request for reconsideration cannot be taken/processed because it was not made within the allowable 60-day reconsideration period and the criteria for good cause were not met. However, it is to SSA’s advantage to have DT perform the forgery determination. If forgery is involved, DT will reclaim the money and return it to SSA. Therefore, the FMS-1133 should be completed by the claimant and sent to DT for a forgery determination. Unlike an “official” reconsideration situation, overpayment recovery is NOT ceased nor is there a requirement for the SSA-795 or SSA-561 (because this is not an official “reconsideration period”).

IMPORTANT: In order for DT to reclaim if forgery is involved, DT MUST receive the completed claims package absolutely no later than 16 months after the issue date. DT must process the forgery claim and, if forgery is found, request reclamation from the bank before 18 months have passed since the issue date. It is important to get the claims package to DT as soon as possible to allow time for DT to resolve any obstacles, such as an illegible bank stamp on the back of the check (if this prevents reclamation, the check copy has to be sent to the FRB for resolution).

1. FO/TSC Initial Action

a. Title II

Notify the servicing PC via priority MDW that the claimant wishes to complete/submit the FMS-1133 claim form for the check(s) involved.

b. Title XVI

Notify the servicing FO via priority MDW that the claimant wishes to complete/submit the FMS-1133 claim form for the check(s) involved.

2. FO/PC Action to Process the FMS-1133 Package(s)

  1. Review the responses on the FM-1133 (see GN 02406.160) before sending the package to DT.

  2. Once claimant has completed the package, copy the completed claims package and retain it for one year.

  3. Send the original to DT for a forgery determination.

  4. Diary for 90 days for the return of the CDN.

  5. If FMS cannot make a determination on the claim and forwards the case to the USSS, establish a 180-day diary for the response. This information is also available from CP&R or by calling DT at 1-855-868-0151. The technicians should call this number for all check claims, payment and post-payment inquiries.

3. FO/PC Action if DT Determines That Forgery Is NOT Involved

  1. Claimant cannot appeal DT’s forgery determination since the requirements for a request for reconsideration were not met.

  2. Since overpayment recovery was not stopped while claim was at DT, recovery will continue until full recovery is made.

4. FO/PC Action if DT Determines That Forgery Is Involved

  1. Stop overpayment recovery.

  2. Refund any monies collected while case was being processed at DT.

E. Process - Department Of Treasury Action

Once DT receives a completed FMS-1133 from the claimant, it conducts a forgery investigation to determine if the claimant signed the check, cashed the check, gave someone else permission to cash the check, or benefited from or participated in all or part of the proceeds of the original check. DT will consider all information in the file. In addition:

1. Secret Service Involvement

If DT’s Questioned Documents Branch cannot make a determination of whether forgery is involved, the case may be referred to the Secret Service for investigation.

2. Notification of Forgery Determination

DT notifies the claimant of the forgery determination by letter and sends SSA the claims disposition (CDN).

3. Forgery Is Involved

If the determination is in favor of the payee (forgery involved), DT initiates reclamation of the money from the presenting bank. Once the money is reclaimed, DT credits this amount back to SSA.

IMPORTANT: All CDNs should contain a final disposition advising SSA as to whether the check(s) was forged. FOs should contact the RO and PCs should contact their Operations Analyst for any CDN containing a vague disposition (e.g., “Settlement at Agency’s Discretion”).

F. Procedure -- FO/PC Action When Beneficiary Or Recipient Protests DT’s Forgery Determination

1. Title II

Input a transaction code of 23 to ROAR (protest to recovery action) if not already on the record.

2. Title XVI

Input an L-TAC if not already on the record, pending DT’s forgery determination.

3. Protest of Forgery Decision

The claimant should contact DT directly to protest DT’s original forgery determination. The notice of the forgery determination will provide instructions for the payee to appeal the decision to DT. However, if the claimant contacts SSA for assistance:

  1. Photocopy the letter at Exhibit L for claimant to complete.

  2. Assist the claimant by providing check identification information (number, symbol, program, etc.).

  3. Include as attachments any proof provided by the claimant to assist DT in its redetermination. DO NOT use the FMS-3864, Agency Recertification Followup, as a transmittal.

  4. Mark the envelope “FORMAL PROTEST” and mail to:

    Department of the Treasury
    Bureau of the Fiscal Service
    Check Claims Branch
    Exception Inquiries Section-Appeal
    P.O. Box 51318
    Philadelphia, PA. 19115–6318

    Materials can also be faxed to DT at 202-874-8447.

4. Diary

Prepare a 180-day diary to control for CCB response.

G. Process - DT Action On Appeal Of Forgery Determination

1. Appeals - Second Review

Appeals will be handled by a DT claims analyst who did not participate in the initial investigation. Any handwriting comparison conducted on appeal will be made by a handwriting expert other than the person who provided the original opinion.

2. Second Determination Made

Once DT makes a second determination, they send a CDN to SSA and a letter to the claimant either affirming or reversing their original forgery determination.

3. Appeal Denied

If denied at this appeal level (DT maintains there was no forgery), the denial letter will inform the claimant that he/she may have the right to file a lawsuit in federal court with respect to the denial.

4. Judicial Review

The denial of an appeal, with respect to DT’s forgery determination, is a final DT action. Judicial review of a determination is not permitted prior to denial of a timely appeal from a forgery claim.

5. ALJ Review

Since the existence of the overpayment is based on DT’s determination that the check(s) was not forged, a Social Security ALJ is not likely to reverse DT’s determination; however, claimants may still pursue further appeals with SSA based on the reconsideration denial.

H. Local Agent Of Secret Service Or Representative Of Treasury Department Requests Assistance

If a Secret Service Agent has been unable to contact the payee directly, assistance may be requested from the servicing FO. After the individual has properly identified him or herself as an agent of the Secret Service investigating a complaint about a missing check, the FO should release any available information pertinent to the investigation (e.g., signature specimens from around the time the check was cashed, whereabouts of the payee, etc). Because the time for investigation is limited, the FO should make every effort possible to assist the agent in contacting the payee in the time allotted. Disclosure of information in these cases is permissible under Regulation No. 1.

I. Procedure - PC/FO Action When “Second Appeal” Determination Is Returned

1. DT Determines Check Was Not Forged

  1. Send a notice of reconsideration to the claimant based on DT’s decision that check(s) was not forged. Explain that DT’s forgery determination is final and binding.

  2. Reinstate overpayment recovery. For title II, annotate PHUS via SSA-1257-U2 action code (AC-2) with the amount of the check. For title XVI, transmit a 1719B to remove the L-TAC.

  3. Recovery should begin COM+1.

2. DT Determines Check Was Forged

  1. Send a reconsideration determination to the beneficiary/recipient.

  2. For title II, prepare an SSA-1257-U2, AC-1 to null the event code 010 previously annotated to the PHUS record. Then input a transaction code of 25 to ROAR (reconsideration approval).

  3. For title XVI, delete any manual diary set but leave the L-TAC in place as recovery is inappropriate.

J. Procedure - Recording Reconsideration/Appeal Due Process Events

1. Background

Although the MBR and SSR indicate if a DCN has occurred in the preceding 2 years, neither title II nor title XVI has a dedicated query/field to indicate that a forgery determination has been requested, decided, appealed, denied, etc. The presence of this information is important to determining misuse/a pattern of reporting nonreceipt as well as providing a diary of due process events.

2. PC/FO:  In Order to Supplement Data Carried on the MBR/SSR, Enter the Following Information in Remarks or the Special Message Field

Remember that a title II protest can be recorded and overpayment recovery ceased (if appropriate) as soon as the objection to the DCN overpayment is made. The title XVI protest should not be recorded nor overpayment recovery ceased until the signed SSA-561 is received.

  • Claimant protests the overpayment resulting from the DCN and the date of the check(s) involved (Example: “MM/DD/YYYY Protest O/P of 11/03/97 CK”);

  • Date the FMS-1133 is sent to DT for a forgery determination (if known) (Example: “1133 to DT MM/DD/YYYY”);

  • DT’s decision on the forgery claim obtained from the claims disposition notice (Example: “MM/DD/YYYY No Forgery on 11/03/97 CK”);

  • Forgery claim denied and claimant protests the denial (Example: “MM/DD/YYYY protest DT denial”).

  • Beneficiary/recipient is true DCN abuser.  Add the phrase, “DCN Abuse - Input as C-stop until mm/yy” in the “RMKS” field on the SSR and/or “SPMSG” field on the MBR.  If additional DCN abuse occurs, the date should be changed to reflect the most recent occurrence of the abuse.

K. Process - Waivers

IMPORTANT: Double check negotiations should NOT be waived as they indicate an intention to commit fraud by falsely stating that the check was not received. Similarly, he $1000 waiver tolerance does not apply because the beneficiary or claimant is not “without fault.”

L. Exhibit

FORMAL PROTEST

 

DATE:               

TO:

FROM:

Department of the Treasury

Social Security Administration

FMS - CCB

(Local address)

Exception Inquiries Section

 

Appeals

 

P.O. Box 51318

 

Philadelphia, PA. 19115–6318

 

Fax: 202-874-8447

 

The following claimant is filing a formal protest on the forgery determination made by your office.

CLAIMANT’S NAME   ­______________________________                                              

 

CLAIMANT’S CURRENT ADDRESS ____________________________                                         

 

 

SSN  _____________________________                                      

 

PROGRAM (check one): ____   SSI (Title XVI) or  _____  SSA (Title II) _____

 

CHECK NUMBER __________ CHECK SYMBOL  ____________                       

 

CHECK DATE__________ CHECK AMOUNT ____________

 

ADDITIONAL INFORMATION   __________________________                                    

 

 

CLAIMANT’S SIGNATURE ________________________________                                              

Please contact the person named below if you have any questions.

 

___________________
 

(Employee’s Name)

 

___________________
 

(Position)

 

 
 

(Tele