TN 22 (04-12)

GN 02610.010 How to Identify Potential Windfall Offset Cases

A. Determine when you need windfall offset development

The claims representative (CR) will consider offset when there is any indication the beneficiary is concurrently entitled to both title II and title XVI benefits.

For example:

  • the beneficiary is filing for both title XVI and title II benefits;

  • the title II claims folder for a title II reinstatement shows title XVI involvement; or

  • the Master Beneficiary Record (MBR) shows title XVI data. Review the Supplemental Security Income data line (SID) on the MBR. For information about Supplemental Security Income (SSI) data on the MBR, see SM 00510.510.

B. Field office indicates windfall offset is involved

To prevent overpayments, the field office (FO) should annotate cases that require windfall offset development for initial claims and amended awards by:

  • coding windfall involvement on the benefit continuity factors (BECF) screen in modernized claims system (MCS).

  • inputting a windfall (WF) factor (FAC) code on the beneficiary data BEN2 screen on an A101 (Determination of Award). For processing claims using the A101 process, see GN 01010.200 and GN 01010.220.

  • send an electronic record of manual title II offset computation (e4345) to notify the processing center (PC) of a manually computed windfall offset case. When providing manually computed offset information to each other, the PC and the FO must communicate using an e4345.

NOTE: Use the electronic form (EF) 101 if you cannot process an award action on the A101. For processing claims using the EF101 process, see GN 01010.200.

C. Situations when the FO will initiate the e4345

The e4345 is a web-based application used to electronically communicate windfall offset information between the PC and FO. Normally, the PC will initiate the e4345. However, there are situations when the FO must initiate the e4345. The following situations are when the FO should initiate an e4345.

  • The windfall offset data cannot be posted to the Supplemental Security Record (SSR).

  • The completed offset computation is on the SSR, but the MBR has a windfall offset data (WOD) line with a windfall indicator (WIN) code other than A,L, or M.

  • The claims representative (CR) needs to follow up with the PC to post pending offset or authorized representative date to the MBR.

  • The CR needs to follow-up with the PC to process the offset or correct data on the MBR.

  • The offset results have been posted to the SSR but an MBR/SSR interface will not occur, e.g., terminated SSR.

NOTE: You do not need an e4345 action in every case. Do not enter windfall offset data into this application if all title II and title XVI actions can be automated and completed by the system. For instructions on when to use and how to complete the e4345, see Field Office User's Guide and Program Center User's Guide.

D. Processing center indicates windfall offset is involved

1. Initial claims

Claim Authorizers (CA) put a windfall (WF) factor (FAC) code on all A101s. For MCS and A101 coding instructions when processing Administrative Law Judge (ALJ) decisions with windfall offset involved, see GN 02610.055F and GN 02610.055G.

For instructions for completing the A101, see MSOM MCS 014.001 through MSOM MCS 014.025.

2. Reinstatements

Every disability reinstatement is a potential windfall offset case. Identify offset cases as follows.

Who

Action

Disability Examiner

Annotates SSA-831 “Concurrent SSI Claim”

CA/Benefit Authorizer (BA)

Recognizes title XVI offset data on MBR before reinstating title II (GN 02610.010A)

BA