SSA - POMS: GN 02604.435 - Imposing the Administrative Sanction

A. Person does not request reconsideration

If the person does not request reconsideration, the period of nonpayment or ineligibility for benefits begins on the first day of the second month following the last day of the period for requesting the reconsideration and ends on the last day of the final month of the sanction period. For example, if the period for requesting reconsideration ends on 01/10, a 6-month period of nonpayment or ineligibility begins on 03/01 and ends on 08/31.

When the Regional Sanction Coordinator concurs on the sanctions determination and notice(s), FO technicians should impose the administrative sanction and release the notice(s) within 14 days. Untimely processing of an administrative sanction will create an overpayment on the record.

NOTE: If the person is not currently entitled or eligible for either Title II or Title XVI benefits when we impose the sanction, we will defer the sanction period until they are entitled or eligible to some payment under either Title II or Title XVI.

For more instructions on deferred sanctions, see instructions in GN 02604.435C in this section.

B. Person requests reconsideration

If the person requests reconsideration, the FO will process the reconsideration following the normal reconsideration process. Document the reconsideration determination on Form SSA-662 (Reconsideration Determination) or RPOC for Title II and Form SSA-8450 (District Office Record of SSI Reconsideration) or DROC for Title XVI. For concurrent cases, document the decision on both forms. (See GN 03102.450, GN 01010.360 and SI 04020.060C.) Notices for reconsideration determinations are now available on DPS under the PE menu. In addition, the “Reconsideration filed” date will appear in the Administrative Sanctions Tool (AS Tool).

NOTE: FO technicians do not refer reconsideration determinations to the RSC for review.

For more information on Title II reconsideration, see GN 03102.000.

For more information on Title XVI reconsideration, see SI 04020.000.

1. Reconsideration affirms administrative sanction

If the reconsideration decision affirms the original decision, the period of nonpayment or ineligibility begins on the first day of the second month following the month we notify the person of our reconsideration determination and ends on the last day of the final month of the sanction. However, the sanction period cannot begin before the start date in the original notice. For example, if we issue a notice of our reconsideration decision on 08/31, a 6-month period of nonpayment or ineligibility begins on 10/01 and ends on 03/31 of the following year. The “Decision Affirmed” date is shown in the AS Tool.

NOTE: If the person is not currently entitled or eligible for either Title II or Title XVI benefits when we impose sanctions, we defer the sanction period until they are entitled or eligible to some payment under either Title II or Title XVI.

For more instructions on deferring sanctions, see instructions in GN 02604.435C in this section.

REMINDER: A new sanction period cannot begin before an existing period ends.

After reconsideration, the sanction period begins regardless of whether the person appeals the reconsideration decision.

Note:

When preparing the explanation of the decision within the reconsideration notice, include the dates of the new sanction period using the UTI labeled “PEN035” (Admin. Sanctions Recon Det-bene/rcpt on SSA rolls). For a deferred sanction period, use the UTI labeled “PEN034” (Admin. Sanctions Recon Det - deferred sanction). Update the Administrative Sanctions Tool with the determination.

2. Reconsideration reverses administrative sanction

If the reconsideration reverses the original decision, send a favorable reconsideration notice to the person. Update the Administrative Sanctions Tool with the determination.

3. Reconsideration request is not timely but you find good cause

If the FO finds good cause for late filing of the reconsideration request, take necessary actions to reinstate benefits from the original suspension date and make the reconsideration decision.

If the reconsideration affirms the sanction, follow instructions in GN 02604.435B.1 of this section.

If the reconsideration reverses the decision, follow instructions in GN 02604.435B.2 of this section.

C. Deferred administrative sanctions

When the FO makes a decision to impose an administrative sanction, and the person is not currently entitled/eligible for either Title II or Title XVI benefits, we must defer the sanction period. The sanction period cannot begin until the person is entitled or eligible to some payment under either Title II or Title XVI. There is no limit on how long we wait to impose the sanction. The sanction period begins with the first month that we schedule a payment under either Title II or Title XVI. Entitlement or eligibility for a payment of even a partial or intermittent benefit will cause the sanction period to start (see GN 02604.447J.9). The administrative sanction is all inclusive of any type of payment made under either title.

If we decide to defer a sanction because we denied the claim or no payment is due for any reason, enter the following as a Special Message on the MBR for Title II or a Remark on the SSID for Title XVI:

“Admin Sanc apply when entitled/eligible under Title II or Title XVI Refer to Administrative Sanctions Tool”.

In addition, enter the sanction information Administrative Sanctions (SPAS) screen in the Client database (see GN 02604.440).

When entitlement or eligibility under either title begins, follow the procedure in GN 02604.440.

Note:

If a potential sanction applies to a person who filed a false claim using another person’s SSN, establish an MBR (or SSID) on the SSN belonging to the person we sanction. Process a denial using the same denial code used on the first record. Do not send a notice on the second denial. Enter the above remark on the MBR or SSID to ensure we impose the sanction in the future.

Social Security

Program Operations Manual System (POMS)

GN 02604.435 Imposing the Administrative Sanction