TN 28 (09-14)

GN 02607.770 Recipient Appeals Suspension of Title XVI Payments

A. Recipient appeals suspension

Suspension of Title XVI payments for residing in a public correctional institution is a determination subject to administrative and judicial review. The suspension is final and binding unless the claimant requests an appeal within 60 days after receipt of notice or SSA revises the initial determination. The level of appeal for which the recipient may file depends on whether we suspended current payments or payments for a closed period. For more information on the levels of appeal, see SI 04005.010.

1. Suspension of current payments

When we make a determination to suspend current payments, we are making an initial determination. If a recipient appeals an initial determination, the first level of appeal is a reconsideration. Process as follows:

  1. process a request for payment continuation per SI 02301.310C;

  2. do not update PUPS with a protest action;

  3. process the request for reconsideration per SI 04020.000; and

  4. evaluate the recipient's reason for appeal using the steps in GN 02607.770B in this section.

2. Closed period of suspension

When we make a determination to suspend payments for a closed period, we are making a revised initial determination. If a recipient appeals a revised initial determination, the first level of appeal is a hearing. Process as follows:

  1. do not update PUPS with a protest action;

  2. process the request for a hearing per SI 04030.000; and

  3. evaluate the recipient's reason for appeal using the steps in GN 02607.770B in this section.

B. Evaluating the reason for appeal

When the recipient disputes a report of confinement from a correctional institution, process the rebuttal of the suspension as follows:

1. Recipient alleges he or she was released from correctional institution

Determine the release date by requesting from the recipient:

  1. the official release documentation; or

  2. a copy of the release document that is certified by the custodian of the record. The document should state that the individual was released (date of release) and is no longer a prisoner or inmate of that correctional institution.

2. Recipient alleges that he or she was not a prisoner

  1. Investigate the allegation by:

    • preparing a report of contact or DROC screen that records the facts and types of evidence presented during the interview or case review;

    • contacting the appropriate official of the correctional institution that reported the information to SSA, court authorities, or prosecuting attorney's office to request assistance in verifying the identity of the individual and date of confinement;

    • determining if the individual is participating in a work-release or in a home monitoring program;

    • requesting statements from reliable sources that can attest to the whereabouts of the individual (e.g., employers, neighbors, community leaders, local law enforcement community, church group, doctors, hospitals, etc.);

    • asking the recipient if his or her SSN was ever lost or stolen; and

    • asking the recipient if he or she knows of anyone who may be using his or her SSN illegally.

  2. If you discover evidence during the investigation that indicates another individual is fraudulently using the SSN reported by the correctional facility, develop for fraud and similar fault following the instructions in SI 04070.020. Report potential programmatic fraud cases directly to the Office of Inspector General’s (OIG), Office of Investigations Field Division (OIFD) following instructions in GN 04111.005.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202607770
GN 02607.770 - Recipient Appeals Sus