TN 17 (05-13)
GN 02607.860 Processing Title II Benefit Reinstatements
A. Post-entitlement Operating System (POS) processing of reinstatements
These instructions supplement the input instructions in MSOM COMMON 005.027 and MSOM PRISON 003.006. The field office (FO) will take the following actions when reinstating benefits to beneficiaries in prisoner suspension.
Reinstate benefits using POS, the Prisoner Suspensions and Reinstatement (PRSN) screen, by selecting Option 5 of the Post Entitlement Selection List (PESL), and then selecting PRISONER SUSPENSIONS AND REINSTATEMENTS (LAF-S7) on the POS Suspensions/Terminations and Reinstatements (PEST) screen. If your review of the beneficiary’s record identifies an overpayment with a future due process recovery date, do not use POS if your input also involves an underpayment. Refer these reinstatements to the PC for processing.
NOTE: Only input a reinstatement month that equals the current operating month (COM) or earlier. If the reinstatement effective month is later than COM, hold the POS input until the reinstatement COM to avoid a Daily Update Master Accounting System (DUMAS) exception that could delay benefits.
NOTE: If there is no PUPS record, such as when the original suspension action occurred prior to 1995, you will get an alert message of “PUPS NIF”. Do not attempt to create a PUPS record. Continue processing through POS even though it will generate a processing exception that will require PC intervention.
Press ENTER on the PU02 screen and the Prisoner Remarks Screen (PRMK) displays next. Annotate the PRMK screen with information on the beneficiary’s official release document(s) that supports reinstatement, the results of your review of the document(s), and the date you faxed the release document(s) into NDRED. At the end of your remark, add your first initial and last name, your unit designation, and the current date. For more information on reinstating benefits using PUPS, see MSOM PRISON 003.006.
NOTE: Effective May 18, 2013, you must enter the release information on the PRMK screen if you are entering a RELEASE DATE entry on the PU02 screen. You cannot continue with your reinstatement action if you do not add the beneficiary’s release information on the PUPS PRMK screen.
For additional processing information on cases with existing Bene Over/Under Payment Data (BOUD) or Partial Recovery Field on the MBR, see MSOM COMMON 005.027. DO NOT use POS to reinstate benefits retroactively if there is an overpayment with a BOUD field and a future due process recovery date (DPRD) if your input also involves an underpayment. See MSOM COMMON 005.027 for additional information when you have an existing BOUD or Partial Recovery Field on the MBR for the beneficiary.
Press ENTER to trigger the reinstatement action. Query the Transaction History Query Response (THISR), Option 4 on the Master File Query (MFQ), to see if an exception exists, using instructions on the THISR in SM 00514.001.
NOTE: FO technicians must initiate the reinstatement using the POS/PUPS input even if the case is a processing exclusion that will require action by the PC.
Check the MBR after two days to verify that the action reinstated benefits. If the action did not process, prepare a tickle via the Modernized Development Worksheet (MDW) to check the case again in 30 days. For processing instructions if the reinstatement has not occurred after 30 days, see GN 02607.860B in this section.
1. PUPS processing of the reinstatement action
For further information on the POS/PUPS automated systems reinstatement functions, see MSOM COMMON 005.027.
2. Exclusions to POS automated reinstatement processing
For the list of simple and complex exclusions to POS automated reinstatement processing, see MSOM T2PE 003.001J.
3. POS exclusion processing
a. FO input of POS/PUPS reinstatement
When the system cannot process the FO reinstatement input in POS/PUPS, POS will create an online message, “T2 REINSTATEMENT EXCLUSION ACTION SENT TO PC FOR PROCESSING.” Check the THISR to see if a POS exclusion exists for your action. POS will generate a Processing Center Action Control System (PCACS) issue to notify the PC of the reject. The PC will process the reinstatement using Manual Adjustment, Credit and Award Processes (MADCAP). The PC receives the generated output to correct all PRSN reinstatement data necessary to complete a MADCAP action.
b. PC input of POS/PUPS reinstatement action
When the PC uses POS/PUPS to process a prisoner reinstatement and a processing exclusion occurs, the PC technician will see the message, “UNABLE TO PROCESS - MACADE/MADCAP ACTION NECESSARY.”
For processing instructions on a POS reinstatement exclusion, see GN 02607.860B in this section.
4. Action when the FO or PC denies the request for reinstatement
a. FO denies reinstatement request
If you determine that you cannot reinstate the beneficiary's benefits, and all development is complete, prepare a special determination. Include the reasons for denying reinstatement; e.g., the identity of beneficiary is questionable, the beneficiary submitted fraudulent release papers, or the beneficiary’s release is not official. Sign the determination using your first initial and last name and add your unit designation and the current date. Fax your signed and dated determination under the cover of a Form SSA-2790 (Prisoner Fax Request) to the Paperless Processing Center (PPC) number for the PPC with jurisdiction. On the form, notify the PPC that you attached a special determination denying the beneficiary’s prisoner reinstatement and request PPC review of the special determination. Indicate on the Fax Form if you faxed any documents into NDRED. The PPC is responsible for reviewing FO special determinations. For general instructions on preparing a special determination, see GN 01010.365.
b. PC actions when FO denies the reinstatement request
Use the Processing Center Action control System (PCACS) to control the special determination and take the following actions:
Review the information the FO provided and the PUPS record (including the remarks). This allows you to familiarize yourself with the facts of the reinstatement denial and any other case characteristics that may affect the content of the denial notice.
If you concur with the FO determination, prepare a notice to the beneficiary explaining why we denied his or her reinstatement request, and include reconsideration and appeal language in the notice. Send a copy of the denial notice to the Online Retrieval System (ORS). For instructions on reviewing a FO special determination, see GN 01010.375.
Fax the special determination into the Non-Disability Repository for Evidentiary Document (NDRED), using the “Other” document type. This action verifies that you agree with the FO’s decision and provides documentation that is accessible to FO employees for future review.
Add remarks to the PUPS PRMK screen to explain the reinstatement denial decision. After the remark add the initial date of the FO denial determination, also include your first initial and last name, your SSA unit designation code, and the current date.
NOTE: If you do not agree with the FO’s decision to deny reinstatement of benefits, explain your decision on the PRMK screen in PUPS. Email the FO the reasons you disagree with the special determination’s justification for not reinstating benefits. The FO must then take action to obtain additional information or process the reinstatement.
B. FO Instructions if reinstatement does not process
1. Reinstatement is not processed after 30 days (tickle matures)
If after 30 days the PUPS record shows REINSTATEMENT but the MBR does not have a SUSPENSE STOP date or a RESUME INPUT date on the Prisoner Suspension (PRSNDATA) line, the benefit reinstatement did not process (i.e., ledger account file (LAF) S7).
The FO must contact the PC to request action.
The FO prepares a Form SSA-2790 (Prisoner Fax Request), located in GN 02607.995. Fax the request form to the appropriate PC requesting manual reinstatement. For instructions on preparing the Form SSA-2790 (Prisoner Fax Request) and PC Prisoner Fax numbers, see GN 02607.995.
Annotate the PUPS PU02 screen with the beneficiary’s release date information for documentation purposes only. Add remarks to the PRMK screen indicating the reason for the reinstatement (i.e., you reviewed and verified the beneficiary’s official release document), add the date you faxed the release document into NDRED. End the remark with your first initial and last name, your SSA unit designation code, and the current date. Close the PUPS record after updating the release information and remarks.
NOTE: If further contact with the PC is necessary after this follow-up action, process the subsequent recontact using the instructions in GN 01070.228.
2. PC receives PCACS issue based on POS/PUPS processing exception or the FO faxed a Prisoner Processing Exclusion Request Form
The PC is responsible for MADCAP/MACADE actions. If Title II Redesign (T2R) cannot process a POS/PUPS reinstatement action, the PC receives an issue via PCACS. T2R generates an issue to the PC via PCACS, with a TOEL 2 of PRIRNT (Prisoner Reinstatement) or PRIRESU (Prisoner Resumption). The servicing PC will use MADCAP/MACADE to reinstate benefits if the POS/PUPS action rejects.
The PC Prisoner Unit will reinstate benefits using the steps in the following chart:
Verify that the beneficiary continues to meet all disability and non-disability eligibility factors before reinstating the benefits. Determine if a prior overpayment exists before issuing an underpayment.
Review the PUPS record to confirm that there is a PRMK screen that contains the beneficiary’s release document and that the PUPS record is complete, correct, and closed.
Reinstate benefits via MADCAP/MACADE.
Send the beneficiary a notice. Explain to the beneficiary that he or she is no longer under prisoner suspension. Provide reconsideration and appeal rights in the notice. Send a copy of the notice to ORS.