TN 5 (07-07)

GN 02613.830 Requests Received at SSA Offices for Relief Under the Fowlkes Acquiescence Ruling (AR)

A. Procedure – Inquiries Received by SSA Offices Regarding the Applicability of Relief Under the Fowlkes AR

1. Criteria for Evaluating if Fowlkes Relief Can be Granted

a. Criteria for Granting Fowlkes AR Relief

See GN 02613.810B. for the criteria for determining if relief (i.e., fully favorable or partially favorable relief) under the Fowlkes AR can be granted.

b. Denying Fowlkes AR Relief

SSA will not provide relief under the Fowlkes AR under the following circumstances:

  • SSA has evidence that a beneficiary has an outstanding warrant for probation or parole violation, or

  • SSA did not issue an initial or appeal administrative review fugitive felon payment suspension notice or good cause determination on or after December 6, 2005, or

  • the beneficiary did not reside in the Second Circuit (i.e., Connecticut (CT), New York (NY), or Vermont (VT)) when SSA made the determination in the preceding bullet, or

  • SSA previously granted a requested for Fowlkes AR relief to the beneficiary.

SSA will limit Fowlkes relief (i.e., grant partially favorable relief) if the beneficiary no longer resides with the Second Circuit at the time the beneficiary requests Fowlkes relief and while SSA makes a decision regarding the request for Fowlkes relief.

NOTE: If the outstanding felony warrant was issued by a law enforcement agency in the States of VT, or NY, or CT, but the beneficiary did not reside in CT, NY or VT when SSA issued the beneficiary the initial or appeal administrative review fugitive felon payment suspension notice or good cause determination on or after December 6, 2005, the beneficiary cannot be granted Fowlkes AR relief.

2. Levels of Administrative Review and Application of the Fowlkes AR

Under the Social Security Act and regulations, a person who disagrees with an initial determination or decision may request further review. This is called an appeal. The appeal consists of several levels of administrative review that must be requested within certain time periods and at the proper level. The levels of administrative review are reconsideration, Administrative Law Judge (ALJ) hearing, and Appeals Council (AC) review. The AC review ends the administrative review process. If an individual is still dissatisfied, he/she may request judicial review which is done by filing an action in Federal court.

If the individual does not request review within the appropriate time period, the individual may lose the right of further review unless he/she can show good cause for failure to make a timely request for review. See GN 03101.001 for further information on the levels of administrative review.

The Fowlkes Court AR requires SSA to continue payment to beneficiaries who have outstanding felony arrest warrants and who reside in the Second Circuit, (CT, NY or VT) unless SSA has additional evidence that the individual knows that there is an outstanding felony arrest warrant, and the outstanding arrest warrant was issued on the basis that the individual has fled from justice. Therefore, any initial determinations or administrative review decisions that are made on or after December 6, 2005, and based on the beneficiaries reside(d) in CT, NY, or VT should be reviewed and revised by SSA, if appropriate, based on the Fowlkes AR and these instructions.

Requests for relief or resumption of monthly Title II benefits by the beneficiary where SSA has made an initial or administrative review decision regarding a felony warrant suspension issue should be evaluated as indicated in GN 02613.830A.2. and GN 02613.830A.3.

3. Residence of Beneficiary

a. SSA Records to Examine for Residency

SSA will examine several SSA records in order to determine the residence of the beneficiary on or after December 6, 2005, in order to make a decision regarding granting relief under the Fowlkes AR and the type of relief (either fully favorable or partially favorable). (See GN 02613.810B. for the criteria for granting relief under the Fowlkes AR.)

The SSA records that must be examined to try and determine residence include:

  • The beneficiary’s current address on the Master Beneficiary Record (MBR) and

  • The beneficiary address on the SSA notice of initial determination or the SSA notice of administrative review n or after December 6, 2005. (These notices will be on the Online Retrieval System (ORS).) and ,

  • Any other SSA notes or information on the beneficiary’s record that provide information regarding the beneficiary’s residence after December 6, 2005 (e.g., Special Message Field on the MBR, representative payee coding that reflects the beneficiary does not live with the payee, etc.)

Check the address on the Master Beneficiary Record (MBR). The Change of Address Date (CAD) field on PAYMENT line on the MBR should reflect the date the beneficiary address was last changed for the beneficiary. Use the MBR payment address (including the CAD date) information and compare it to the address and date on the SSA notice of initial determination of fugitive felon suspension or the SSA notice of determination on an administrative appeal that you have accessed and viewed on the ORS. The address data on both SSA records should be consistent with one another in order to establish the residence of the beneficiary for part of the Fowlkes AR relief criteria without requiring further development or investigation of the beneficiary residence. (See GN 02613.810A.5. for the residence requirements necessary to qualify for Fowlkes relief.) If the address data on the MBR and the SSA notice are not the same, investigate the discrepancy per GN 02613.830B.1., Step 3. If the beneficiary is residing in one Second Circuit State and then moves to another Second Circuit State to reside on or after December 6, 2005, residency does not have to be developed in order for the beneficiary to qualify for Fowlkes AR relief.

INFORMATION: The SSA technician will use the Online Retrieval System (ORS) to view the copy of the initial fugitive felon suspension letter or the copy of the administrative appeal letter that SSA sent to the beneficiary regarding the fugitive felon suspension determination. You have to access ORS Version 7 effective June 11, 2007 via Internet Explorer. For information on using the ORS notice system, see MSOM ORS 003.001.

b. Date on Documents to Establish Residency

The beneficiary address on the MBR in the PAYMENT line should reflect a mailing address in the State of CT, NY or VT on or after December 6, 2005, for SSA to grant Fowlkes AR relief. The SSA letter sent to the beneficiary regarding the fugitive felon suspension decision (i.e., initial fugitive felon suspension/overpayment determination or administrative appeal decision or good cause determinations) must be dated December 6, 2005, or later for Fowlkes AR to be considered.

c. Residency to Establish Type of Relief to Grant Under Fowlkes

If the beneficiary meets the residency requirements in the Second Circuit per GN 02613.810A.5. and GN 02613.830A.3.a., then a comparison of residence must be done between the SSA-795 Request for Fowlkes AR Relief Statement from the beneficiary and the MBR address to see if Fowlkes relief must be limited. (See GN 02613.810B. for the criteria for granting relief under the Fowlkes AR.)

SSA will not limit Fowlkes AR relief if the beneficiary is residing in the Second Circuit (i.e., residing in CT, NY or VT) at the time the request for relief (SSA-795 Request for Fowlkes AR Relief) is made at an SSA office and he/she will remain in the Second Circuit throughout the relief evaluation process until after SSA makes its determination regarding the request for relief. If the beneficiary is not residing in the Second Circuit when he/she requests relief under the Fowlkes AR, only limited (i.e., partially favorable) relief for the period of time the beneficiary was in fugitive felon suspension and he/she resided in the Second Circuit is possible.

SSA will use the address information obtained on the SSA-795 Request for Fowlkes AR Relief Statement from the beneficiary (see GN 02613.830B.1., Step 1) to establish the beneficiary’s residence address at the time the beneficiary files a request for relief under the Fowlkes AR. The statement of residence provided on the SSA-795 request for Fowlkes relief will provide the residence information necessary to determine if the beneficiary can qualify for fully favorable Fowlkes AR relief or partially favorable Fowlkes AR relief. Compare the SSA-795 statement requesting Fowlkes AR relief, signed by the beneficiary, to the MBR beneficiary mailing address. If there are no inconsistencies between the two addresses, residence in the Second Circuit can be established if both addresses indicate the beneficiary is living in CT, NY or VT. If there are inconsistencies in the two addresses, develop for the residence address discrepancies and determine the actual residence of the beneficiary in order to make a decision of the request for Fowlkes AR relief. See GN 02613.830B.1., Step 4, for instructions on resolving the residency discrepancy.

NOTE: If a beneficiary resided in one Second Circuit Sate and then moves to another Second Circuit State on or after December 6, 2005, no consistency of addresses is needed to qualify for Fowlkes relief.

4. Date to Consider in Evaluating if Relief Could Apply Under for Fowlkes AR

If SSA sent the beneficiary a notice to explain SSA’s initial determination of fugitive felon suspension/overpayment or a notice to explain SSA’s determination/decision on any beneficiary appeal of the suspension (including good cause determinations), the date of the SSA notice(s) will be used when determining if the Fowlkes AR can be applied and what Fowlkes AR relief can be granted, if applicable. The notice date must be December 6, 2005, or later to be eligible for consideration of relief under the Fowlkes AR.

5. FO Receipt of Fowlkes AR Inquiries Requesting Relief

a. Fowlkes Inquiries on Title II Cases

When the SSA FO receives an inquiry from a beneficiary regarding the Fowlkes AR, process as indicated in the following chart:

If the inquirer

then the SSA FO technician will

wants a copy of the Fowlkes AR or information about the contents of the Fowlkes AR

comply with the request per GN 02613.810, and GN 02613.840 and GN 03501.020.

NOTE: The Fowlkes AR can be found on POLICYNET. Go to the MORE LINKS section of the POLICYNET Main Page, select Rulings and ARs, on the Social Security Rulings and Acquiescence Rulings page, select the TABLE OF CONTENTS, on the TABLE OF CONTENTS page, select ACQUIESENCE RULINGS on the ACQUIESENCE TABLE OF CONTENTS PAGE, select SECOND CIRCUIT, on the SECOND CIRCUIT ACQUIESENCE RULINGS TABLE OF CONTENTS, select AR 06-1(2) Fowlkes v. Adamec, 432 F.3d 90 (2d Cir.2005).

requests relief or resumption of Title II benefit payment under the Fowlkes AR and

Beneficiary did not receive a special Fowlkes Title II AR readjudication notice from SSA.

Beneficiary received fugitive felon suspension information via:

fugitive felon Title II advance notice of proposed suspension, or

Title II fugitive felon initial determination of suspension/overpayment notice or

other Title II fugitive felon administrative review (appeal) notice; or,

information received from advocates or other sources

See GN 02613.830B. for processing instructions where the beneficiary requests relief under Fowlkes and he/she did not receive a Special Title II Readjudication Fowlkes AR notice prompting the beneficiary to contact SSA to request Fowlkes AR relief.

requests relief or resumption of Title II benefit payment under the Fowlkes AR and

Beneficiary did receive from SSA a

Special Title II Readjudication Fowlkes AR notice from SSA

See GN 02613.830C. for processing instructions where the beneficiary requests relief under Fowlkes and he/she received a Special Title II Readjudication Fowlkes AR notice from SSA regarding the Fowlkes AR decision.

b. Fowlkes Inquiries on Title XVI Cases

See SI 00530.800D.4. for instructions on handling Fowlkes AR inquiries for SSI cases.

c. Fowlkes Inquiries on Concurrent Cases (Entitlement/Eligibility to Both Title II and Title XVI)

Fowlkes AR inquiries on concurrent cases (i.e., entitlement and eligibility on Title II and Title XVI, respectively) should be treated independently under each title. Title II Fowlkes AR inquiries are handled in accordance with GN 02613.830A.5.a. Title XVI Fowlkes AR inquires are handled in accordance with SI 00530.800D.4.

B. Process – Beneficiary Requests Relief Under Fowlkes AR

1. FO Receipt of Request for Relief Under Fowlkes AR

If the beneficiary contacts SSA to request relief under the Fowlkes AR, process as indicated in the following chart:

Steps

Actions by SSA Office

1

Obtain information from the beneficiary, as appropriate, about how application of the Fowlkes AR could change SSA’s decision on his or her fugitive felon suspension.

Have the beneficiary prepare a statement (SSA-795, Statement of Claimant or Other Person—Request for Fowlkes AR Relief Statement) that will include the following information. See GN 02613.830F. for an example of the information that should be included in the SSA-795 Request for Fowlkes AR Relief Statement.:

--a statement from the beneficiary requesting relief from the fugitive felon suspension provisions based on the Fowlkes AR and why this ruling applies to his/her case. See GN 02613.800B. for information on the rulings or determinations made in the Fowlkes AR;

--the beneficiary’s current residence address and how long the beneficiary has lived at this residence (the beneficiary must have a permanent residence in NY, CT or VT effective December 2005 or later for the Fowlkes AR to apply to their claim for reinstatement of benefits). (See GN 02613.830A.3. for information on residence of the beneficiary.);

--information about his/her felony warrant (e.g., date it was issued, where it was issued, what are the criminal charges on the warrant; why the beneficiary did not satisfy the warrant, etc.), and;

--the date of the notification or decision of SSA’s initial determination of fugitive felon suspension or other dated SSA decisions at other levels of the administrative review process and the address where the decision notice was sent, if applicable.

Have the beneficiary sign and date the statement.

The SSA-795 Request for Fowlkes AR Relief Statement will be sent to the Payment Centers Paperless System for receipt and imaging. The SSA-795 Request for Fowlkes AR Relief statement must be kept with the folder. Forward the SSA-795 to the appropriate jurisdictional PC via SSA-409 after it has been completed by the beneficiary and no further development action is necessary on any unresolved items on the SSA-795. See GN 02613.830B.1., Step 5, for more information regarding faxing the SSA-795 to the jurisdictional PC using the Paperless Processing Center system.

Go to Step 2.

2

Evaluate the answers on the statement. Compare and verify the information as reported by the beneficiary against SSA records. All information and evidence provided by the beneficiary on the statement must be resolved before the request can be evaluated by SSA to determine if the request for relief under the Fowlkes AR can be considered.

Examine the following SSA records in comparison to the beneficiary’s SSA-795 Request for Fowlkes AR Relief Statement:

Review Process:

Obtain an MBR to determine the:

  • address of the beneficiary to determine if he/she is residing in NY, CT or VT effective December 6, 2005 and later (including current residency in NY, CT, or VT); and

  • current payment status of the beneficiary; and

  • warrant information available off of the MBR.

ACTION: Gather information from the MBR for comparison purposes then continue the review process. If beneficiary is not currently residing in CT, NY or VT, go to Step 4.

Obtain a copy of the initial fugitive felon suspension/overpayment notice or the administrative review notice sent to beneficiary from the Online Retrieval System (ORS).

From the SSA initial suspension/overpayment notice or the administrative appeal notice:

  • Review and verify that SSA made an outstanding felony warrant suspension determination (effective 12/6/05 or later) at the initial or administrative appeal level and determine the level of initial or administrative appeal the beneficiary has achieved at this point in time.

ACTION: If the reason for the initial suspension determination or the administrative review suspension decision is not related to fugitive felon suspension, go to Step 6 to deny the request for Fowlkes AR relief. If the reason SSA is suspending on the notice is patterned after the following language: “We cannot pay benefits to you beginning January 2005 because you have an outstanding arrest warrant for a felony crime,” continue the review process.

  • Obtain the date that SSA made the initial and any administrative review determination or decision on the SSA issued notice.

ACTION: If the latest SSA notice determining whether payments should be suspended based on fugitive felon status is dated December 5, 2005 or earlier, go to step 6 to deny the request for Fowlkes AR relief. If the SSA notice determination date is December 6, 2005 or later, continue the review process.

  • Obtain the beneficiary’s mailing address from the appropriate SSA issued notice.

 

ACTION: If beneficiary’s MBR mailing address is different than the address on the initial suspension notice or the address on the administrative review notice is not in NY, CT, or VT, then go to Step 3 to resolve the residency discrepancy. If there is no address issue to resolve, then continue with the review process. Obtain warrant queries from the Fugitive Felon System Control File (FFSCF) database to determine if SSA has received warrant information for the beneficiary and then to review the FFSCF warrant information, if applicable, to make sure the warrant is for a felony offense rather than for a probation or parole violation.

See GN 02613.820A.3. for instructions on identifying a felony warrant from the (FFWQ) query.

NOTE: If the beneficiary moves from one Second Circuit State to another Second Circuit State, on or after December 6, 2005, do not develop for a discrepancy in residence addresses.

ACTION: If the warrant is for a probation or parole violation and not for a felony offense, then go to Step 6 to deny the request for Fowlkes AR relief. If the warrant is for a felony offense, then continue to the Completion of the Review Process.

Completion of Review Process

If:

  • there is no address issue outside of NY, CT, or VT to resolve; and

  • the latest of either the SSA initial fugitive felon suspension or the appeals review determination notice is dated 12/6/05 or later, and

  • the warrant is for a crime that is categorized as a “felony,” as opposed to probation or parole violation, and

  • SSA has not already provided Fowlkes AR relief, then go to Step 5.

If:

  • there is no address issue outside of NY, CT, or VT to resolve, and

  • the latest of either the SSA initial fugitive felon suspension or the appeals review determination notice is dated 12/6/05 or later, and

  • the warrant is for a crime that is categorized as a “felony,” as opposed to probation or parole violation, and

  • SSA has not already provided Fowlkes AR relief but the beneficiary’s current MBR mailing address does not reflect that the beneficiary is currently residing in CT, NY or VT, go to Step 4.

3

Residence address on the SSA initial determination or appeal notice is different than the MBR

Beneficiary must reside in the Second Circuit (CT, NY or VT) beginning 12/05 for at least 1 full calendar month and continuing to establish the Second Circuit residency requirements for consideration of fully favorable or partially favorable relief under the Fowlkes AR. (See GN 02613.810A.2. for criteria requirement for granting relief under the Fowlkes AR.) The beneficiary must reside in CT, NY or VT when SSA made its initial or administrative appeal decision about the fugitive felon suspension.

A “full calendar month” means all of the first day of the calendar month through all of the last day of such month (e.g., from 12:00 a.m. of the first day of the month until 11:59 p.m. of the last day of the calendar month). The full calendar month criteria are met after 12:00 a.m. on the first day of the new calendar month.

EXAMPLE: Beneficiary moves to NY 11/12/05. The calendar month does not begin until the next full month, i.e., 12/1/05, since 11/05 is a partial calendar month. The beneficiary must live in his NY residence from midnight on 12/1/05 until after the end of 12/31/05 and not move from his NY residence to another residence outside of the Second Circuit during this entire calendar month.

ACTION: Accept any evidence the beneficiary wishes to submit regarding his/her residency in NY, CT, or VT for over 1 full calendar month (e.g., proof of residence, should include: copies of rent receipts, mortgage payment receipts, water bills, electric bills or other energy bills, mail addressed to the beneficiary at his current NY, VT or CT address that is over 1 month old, agreements showing rental liability; banking records; magazine subscription addresses; driver's license; or other information which supports where the residence actually is that shows consistent physical residency in NY, CT or VT for more than 1 month).

If the reason for the discrepancy in the MBR address involves a temporary absence (e.g., the beneficiary resides in CT, NY or VT, but temporarily visited another State to stay with relatives for a short period of time) and the address on the SSA notice and the beneficiary did (does) reside in CT, NY or VT for one calendar month effective 12/2005 or later when SSA made its initial suspension determination or administrative review determination, document the reason for the address discrepancy. Document the reason for the address discrepancy and the evidence provided by the beneficiary to establish residency in CT, NY, or VT effective 12/2005 and later on the DWO1 worksheet, then go to Step 2 to continue the Review Process. If the beneficiary changed his or her residence to a State outside of the Second Circuit, he or she may be eligible for partially favorable relief under the Fowlkes AR, i.e, for a closed period of fugitive felon suspension for the months that the beneficiary resided in CT, NY or VT.

If a discrepancy exists in the beneficiary’s residence address on the MBR (i.e., MBR shows beneficiary resides in a State other than CT, NY or VT or in another country) and the address on the SSA initial determination or appeal notice reflects the beneficiary did not reside in CT, NY or VT effective 12/6/05 or later or the beneficiary cannot provide proof of residency in CT, NY or VT, go then go to step 6 to deny the request for Fowlkes AR relief.

4

Residence address on the MBR reflects beneficiary is not currently residing in CT, NY or VT.

OR

Beneficiary resided in CT, NY or VT effective 12/6/05 or later when SSA made the initial fugitive felon suspension determination or administrative appeal determination but does not live in CT, NY or VT when requesting relief under the Fowlkes AR.

ACTION: If the beneficiary does not currently reside in CT, NY or VT or will not continue to reside in CT, NY or VT while SSA evaluates his/her request for relief and will not continue to reside in CT, NY or VT when SSA makes its determination regarding the request for Fowlkes AR relief; SSA can only grant partially favorable relief under the Fowlkes AR, go to Step 5.

NOTE: For a fully favorable relief under the Fowlkes AR, the beneficiary must continue to reside in CT, NY, or VT when SSA evaluates the beneficiary’s request for relief under the Fowlkes AR and when SSA makes its final determination regarding the request for relief under the Fowlkes AR.

5

After evaluating the beneficiary’s SSA-795 Request for Fowlkes AR Relief statement regarding the request for relief and SSA’s records as indicated in Steps 2-4 and making sure that all information and evidence is accurate and complete in order to grant or deny a beneficiary’s request for relief, determine at what level of the administrative process the fugitive felon suspension determination or appeal decision was last made (if no current claim or appeal is pending).

IMPORTANT: The FO will be responsible for granting or denying all requests for relief under the Fowlkes AR based on the automated fugitive felon suspensions done by the Fugitive Felon Suspension and Reinstatements (FFEL) screen. A description of the automated suspensions created through the Fugitive Felon Computer Matching Operation and the FFEL screen are found in GN 02613.100. See GN 02613.100B. for a description of the automated fugitive felon suspension process.

If the FO was not the SSA office that made the initial determination (this does not include automated suspension determinations) of fugitive felon suspension or the SSA office that made the administrative review determination, process the case per GN 03501.001C.

The request for Fowlkes AR relief will be reviewed and processed by the same level of SSA office that made the initial determination or the administrative review determination. Route the transmittal flag (see the exhibit of the Fowlkes Transmittal Flag found in SI 00530.800G.), the SSA-795 statement and any other accompanying SSA records or documents to the SSA component that made the initial fugitive felon suspension determination or the administrative review determination based on the instructions in GN 03501.001C. On the Fowlkes AR transmittal flag, notify the SSA component receiving the request for Fowlkes AR Relief to process it per GN 02613.830B.1, Step 6.

CAUTION: The beneficiary may no longer be in the same service area where his initial suspension determination or administrative review determination was made. The same level of SSA office that made the initial suspension determination or the administrative review determination should now review the Fowlkes AR relief evidence and documents and make a Fowlkes AR relief decision. Do not transfer the Fowlkes AR relief statement and evidence to the actual SSA office that made the original initial suspension determination or the administrative review determination if the SSA office that received the request for Fowlkes relief is of the same level as the SSA office that made the suspension initial or administrative appeal decision on which Fowlkes AR relief is now being requested.

If the FO is the SSA component that must grant or deny the Fowlkes AR relief request, go to Step 6.

6

Decide whether to grant the beneficiary’s request for relief per the information supplied in the beneficiary’s statement in GN 02613.830B.1., Step 1 and the examination of SSA’s records in Step 2 through Step 4.

If the request for fully favorable or partially favorable relief under the Fowlkes AR should be granted, see GN 02613.840.

If the request for relief under the Fowlkes AR is denied, see GN 02613.830D. for instructions on denying a request for Fowlkes AR relief.

IMPORTANT: After all SSA reviews are done and any subsequent SSA actions have been taken on the SSA-795 Request for Fowlkes AR Relief Statement, the SSA-795 form should be sent to the PC via the Paperless Fax process. Forward the non-claims material (i.e., SSA-795 Request for Fowlkes AR Relief Statement) to the appropriate PC to be receipted into the Paperless Processing Center System and processed by the Payment Center’s (PC’s) Paperless system. If the faxed material should be forwarded to a component other than a jurisdictional module, clearly specify the location on the first page of the SSA-409 fax form. The SSA-795 Request for Fowlkes AR Relief Statement must be kept with the claims folder to document the request for Fowlkes AR relief.

NOTE: For concurrent cases, (i.e., the individual receives both Title II and Title XVI benefits) the request for Fowlkes AR relief will have to be evaluated separately for each Title based on the criteria found in GN 02613.810A.2. for Title II cases and the criteria found in SI 00530.800B. for the Title XVI entitlement and eligibility. See GN 02613.830E.2. for additional information on processing concurrent entitlement Fowlkes AR inquiries.

2. National 800 Number Receipt of Fowlkes AR Inquiries Requesting Relief

Process as indicated in the following chart if the request for Fowlkes AR information is received the Teleservice Center:

If the inquirer

Then the SSA technician will

wants a copy of the Fowlkes AR or information about the contents of the Fowlkes AR

Comply with the request per GN 02613.810B. and GN 03501.020.

requests relief or reinstatement of benefit payment under the Fowlkes AR

  • schedule a post-entitlement (PE) appointment if one is available, otherwise, send a manual development worksheet.

  • include in REMARKS the title and/or number of the AR (e.g., AR06-1(2) Fowlkes v. Adamec) and the reason he/she believes that applying the Fowlkes AR could change the decision in his or her case. The beneficiary may provide a statement that cites the Fowlkes AR or the holding or portion of the circuit court decision which could change the decision in his or her case.

  • provide the caller with the address for the servicing FO based on the beneficiary’s address on the MBR if he/she indicates that he/she would like to submit evidence.

3. PSC Receives Inquiries Requesting Relief Under the Fowlkes AR

If the case was last adjudicated at the PSC level and action is necessary on the inquiry from the beneficiary:

  • Process the inquiry per GN 02613.830A. if sufficient information is available on the inquiry from the beneficiary.

  • If additional information to grant relief under Fowlkes is required before a final determination can be made, request the FO servicing the beneficiary’s address on the MBR to obtain the additional information per GN 02613.830B.1. The FO will send the completed development back to the payment service center (PSC) for final evaluation and a decision on the request for relief under the Fowlkes AR.

C. Process – Beneficiary/ Claimant Requests Relief Under Fowlkes Based on SSA Special Readjudication Notice

After it receives a precedential circuit court decision and determines that an Acquiescence Ruling (AR) may be required, SSA codes cases into the Civil Action Tracking System (CATS) that might be subject to readjudication if an AR is issued. (See GN 03501.001C.1.a. for a description of the AR readjudication process.) After SSA issues the AR, it sends a readjudication notice was sent to the beneficiaries identified via the CATS coding process. The notice informs them the beneficiaries that potential relief may be granted under the AR. An example of the readjudication notice can be found in GN 02613.856C.6.

The one-time Fowlkes readjudication notice contained the following information:

  • the circuit court case name and the publication date of the Fowlkes AR,

  • the Second Circuit Court’s decision and the States to which it applies; and

  • instructions that explain how to request relief under the Fowlkes AR.

SSA issued the one-time Fowlkes readjudication emergency message, EM 07046 SEN dated MM/DD/YYYY, to advise SSA offices that the Fowlkes AR readjudication notices were sent and where to locate the one-time Fowlkes readjudication case processing instructions. Additional instructions for handling readjudication requests for relief can be found in GN 02613.830C.1.

NOTE: All requests for readjudication should be processed at SSA field offices. If any readjudication requests are inadvertently received by the PSC or sent to the PSC, the readjudication request and any accompanying material should be redirected to the beneficiary’s resident field office for action per GN 02613.830C.1.

1. Beneficiary Contacts SSA to Request Readjudication

If the beneficiary contacts the FO about having the Fowlkes AR applied to his or her claim, then the FO will process the request as discussed in the following table:

Tasks

FO Actions on Readjudication Request

1

Obtain a statement from the beneficiary that mentions the Fowlkes AR or the circuit court decision and explains how either could change the prior fugitive felon determination or decision. The information from the beneficiary should be in the form of a statement per the instructions found in GN02613.830B.1.

Annotate the CATS database per GN 02613.830C.4.a. as a responder to the readjudication notice. See also MSOM CATS 003.001 – CATS 003 for additional systems information about CATS.

2

Process the request for readjudication as described in GN 02613.830B.1. and make the determination whether the beneficiary can be granted relief under the Fowlkes AR. (See GN 02613.810 for residence requirements for determining if Fowlkes AR relief may apply.)

3

Annotate the Fowlkes readjudication decision to the CATS system per the CATS coding instructions found in GN 02613.830C.4.d.

NOTE: Readjudication may be requested at any time and it applies to beneficiaries currently entitled as well as those with pending claims (i.e., cases awaiting adjudication on administrative review or adjudicated cases in which the time to request administrative review has not expired). It also applies to beneficiaries with lapsed claims because a timely appeal was not pursued. The time limits for reopening do not apply to a request for readjudication under an AR. See GN 03501.015B.1.

2. Readjudication Letter is Returned to SSA as Undeliverable

The one-time Fowlkes readjudication notice will have the servicing SSA FO address as the return address on the envelope. If the readjudication notice is returned to the SSA FO as undeliverable, process the returned readjudication notice as indicated in the following chart:

a. Searching for a Current Address to Re-mail the Readjudication Notice

The following sources may provide a new address for the beneficiary when the Fowlkes readjudication notice is returned to SSA as undeliverable.

Checking Sources for New Address Information

FO Actions to Locate New Address and Re-mail the Notice

MBR—Address field

Query the MBR for a new address. If a more current address is found on the MBR, re-mail the readjudication notice to the new address on the MBR, changing any date appropriately by using the Document Processing System (DPS).

Annotate CATS with the new address information. See GN 02613.830C.4.c. for CATS coding instructions.

SSR—Address field

If a more current address is not found on the MBR, then check for a SID line on the MBR.

When a SID line is present on the MBR, then you should query the SSR for a more current address.

Check the change of address date on the SSR. Compare the change of address date on the SSR to the change of address date on the MBR. If an older address date appears on the SSR do not use the SSR address. Use the query (i.e., SSR or MBR) which contains the most current change of address date.

Re-mail the readjudication notice to the new address, changing any date appropriately by using the Document Processing System (DPS).

Annotate CATS with the new address information. See GN 02613.830C.4.c. for CATS coding instructions.

Direct Deposit field on MBR

Query the MBR to determine whether the beneficiary receives direct deposit or check. Contact the individual's financial institution (FI) for a current address using the letter E3759 (Request to Financial Institution For Correct Beneficiary Address) in NL 00703.759 or DPS Locate Letter under “General” category (Beneficiary's Bank), or prepare a letter similar to the E3759. Also, when the claim number is not that of the person on the record, please verify according to the name of the person on the account or the account number. Fax or mail the E3759 or substitute letter to the FI. Under the Right to Financial Privacy Act, 12 U.S.C. 3413 (k), banks are permitted to disclose the information to SSA.

Tickle/diary for 30 days.

Input any new address furnished by the FI through POS (see MSOM T2PE 003.002).

CAUTION: Develop in-care-of addresses per GN 02605.005.

Re-mail the readjudication notice to the new address, changing any date appropriately by using theDocument Processing System (DPS).

Annotate CATS with the new address information. See GN 02613.830C.4.c. for CATS coding instructions.

United States Postal Service (USPS)

Contact the United States Postal Service (USPS):

  • Send an SSA-L2001 to the USPS servicing the address of record.

  • Tickle/diary for 30 days.

  • Verify any addresses furnished by the USPS with the beneficiary.

  • Input COA through POS (see MSOM T2PE 003.002.) If direct deposit data is on the record, verify that the beneficiary wants payments to continue to be sent there.

Re-mail the readjudication notice to the new address, changing any date appropriately by using the Document Processing System (DPS).

Annotate CATS with the new address information. See GN 02613.830C.4.c. for CATS coding instructions.

Railroad Board Certified Cases (LAF E Cases)

Contact the Railroad Board (RRB) for LAF E cases to see if RRB has updated address information.

Input any new address furnished by the Railroad Board through POS (see MSOM T2PE 003.002).

Re-mail the readjudication notice to the new address, changing any date appropriately by using the Document Processing System (DPS).

Annotate CATS with the new address information. See GN 02613.830C.4.c. for CATS coding instructions.

Directory Assistance, or Searching the Internet

For all other cases, call directory assistance or check internet white pages in the city of the address of record. If a number is available:

Make one attempt to contact the beneficiary.

Input any new address furnished by the beneficiary through POS (see MSOM T2PE 003.002). CAUTION: If the beneficiary states that the address of record is correct, input it with a slight variation (i.e., change “St.” to “Street” or “Box” to “BX”).

Re-mail the readjudication notice to the new address, changing any date appropriately by using the Document Processing System (DPS).

Annotate CATS with the new address information. See GN 02613.830C.4.c. for CATS coding

b. Unable to Locate New Address—Beneficiary is in Current Pay or LAF S6-Develop Address Suspension

If there is no new address information available after all the sources in GN 02613.830C.2.a. are exhausted, and the beneficiary is in current payment status or the beneficiary is already suspended LAF S6—Develop Address Suspension, then:

  • Send the due process notice in NL 00703.760 to the address of record. Tickle/diary for 15 days.

    NOTE: Skip this step if the beneficiary is already in LAF S6.

  • Suspend benefits (S6—Develop Address Suspension) when the due process period expires and no response is received. (See MSOM T2PE003.013. for additional information on this process.)

    NOTE: Skip this step if the beneficiary is already in LAF S6.

  • Annotate the Special Message field with the following information. “Fowlkes Readjudication Notice sent to BIC XX--Notice Returned Undeliverable”.

  • Annotate CATS that the readjudication notice was returned as “undeliverable.” Add the last date that the readjudication notice was returned to SSA to the CATS system. See GN 02613.830C.4.b. for CATS coding instructions.

If the beneficiary responds to due process notice, then

  • Reinstate benefits from LAF S6 (Develop for Address Suspension) and input any new address furnished by the beneficiary through POS (see MSOM T2PE 003.002).

    CAUTION: If the beneficiary states that the address of record is correct, input it with a slight variation (i.e., change “St.” to “Street” or “Box” to “BX”).

  • Re-mail the readjudication notice to the new address, changing any date appropriately by using the Document Processing System (DPS).

  • Annotate CATS with the new address information. See GN 02613.830C.4.c. for CATS coding.

  • Delete the special message “Fowlkes Readjudication Notice sent to BIC XX--Notice Returned Undeliverable” from the Special Message Field on the MBR. See MSOM T2PE007.008 for information on deleting special message fields.

c. Unable to Locate New Address—Beneficiary is in Non-Payment Status (Other than LAF S6—Develop for Address Suspension)

If the beneficiary is not receiving monthly payments (LAF status is other than S6—Develop for Address Suspension), do not process the returned undeliverable readjudication notice further.

  • Annotate the Special Message field with the following information. “Fowlkes Readjudication Notice sent to BIC XX--Notice Returned Undeliverable”.

  • Annotate CATS that the readjudication notice was returned as “undeliverable.” Add the last date that the readjudication notice was returned to SSA to the CATS system. See GN 02613.830C.4.b. for CATS coding instructions.

  • Fax the undelivered readjudication notice to the PSC paperless system via an SSA-409. Annotate the SSA-409 with the following remark. "Fugitive Felon--Fowlkes Readjudication Notice Undeliverable--No New Address Available—No further action necessary." Fax the SSA-409 and the letter to the jurisdictional PSC.

3. Beneficiary Does Not Respond to the Readjudication Letter

Once SSA issues the one-time Fowlkes readjudication notice to the beneficiary, the beneficiary must respond and request readjudication if he/she thinks the Fowlkes AR may apply to his/her fugitive felon suspension period.

If the beneficiary does not contact SSA to request readjudication under the Fowlkes AR, then SSA will not follow-up or recontact the beneficiary regarding the relief allowed under the Fowlkes AR.

4. Civil Action Tracking System (CATS) Coding Instructions for Annotating Readjudication Information

Do not code any newly discovered beneficiaries requesting relief under the Fowlkes AR to the CATS system.

Annotate additional information to CATS for the readjudication period when the following situations exist:

  • the beneficiary requests (i.e., responds) readjudication based on receipt of the Fowlkes readjudication notice, or

  • the one-time readjudication notice is returned to SSA as undeliverable; or,

  • SSA locates a new address for the beneficiary and re-mails the readjudication notice to the new address, or

  • SSA makes a decision (i.e., affirmation that readjudication should apply or technical denial that readjudication does not apply) regarding the beneficiary’s request for readjudication.

Logging onto CATS

At the:

  • SSA’s Main Menu screen, enter “1” MANAGMENT INFORMATION SERVICES FACILITY/PROD REGION MENU

  • Support Menu screen, enter “M1” ADMIN/MI CICS

  • Log on Screen, enter you PIN and PASSWORD

  • MISF CICS MENU enter “01”

You are now at the Civil Action Tracking System Main Menu

Obtaining a CATS Query:

At the:

  • Civil Action Tracking System Main Menu screen, enter “1”

  • Query Menu screen, enter “1” SSN/Claim Number/Name

  • SSN/Claim Number/Name Selection screen, annotate the Court Case identifier “FW” and annotate the “9-digit social security number” and hit “enter.”

    NOTE: The "9-digit social security number" can be either the BOAN or the number for the earnings record where benefits are being received.

  • SSN/Name Query List screen, annotate “P” under Select for a Personal Detail Query Screen or “C” for a Claim Detail Query Screen.

a. Coding CATS for Beneficiaries Responding to the Readjudication Notice

When the beneficiary contacts SSA and he/she requests readjudication based on the Fowlkes AR readjudication notice, annotate this action to CATS as follows.

At the:

  • Civil Action Tracking System Main Menu screen, enter “2” Request for Review/Address Responder Update

  • Request for Review/Address Responder Update screen, annotate the Court Case identifier “FW” and annotate the “9-digit social security number” and press “enter.”

    NOTE: The "9-digit social security number" can be either the BOAN or the number for the earnings record where benefits are being received.

  • Claimant Update Selection screen, annotate “S” under the Select field and press “enter.”

  • Address/Responder Update screen, annotate “Y” along side of the Response Code and the date (MMDDYYYY) the beneficiary contacted SSA to request readjudication along side of the Date field. Press the PF6 key. The following message will appear: “Zip Code Validation Complete, Press PF6 to Update Record.” Press the PF6 key to complete the transaction.

b. Coding CATS for Undeliverable Readjudication Notice Mail

If the readjudication notice is returned to the SSA FO as “undeliverable,” add this information to CATS as follows:

At the:

  • Civil Action Tracking System Main Menu screen, enter “2” Request for Review/Address Responder Update

  • Request for Review/Address Responder Update screen, annotate the Court Case identifier “FW” and annotate the “9-digit social security number” and press “enter.”

    NOTE: The "9-digit social security number" can be either the BOAN or the number for the earnings record where benefits are being received.

  • Claimant Update Selection screen, annotate “S” under the Select field and press “enter.”

  • Address/Responder Update screen, annotate “U” along side of the Response Code and the date (MMDDYYYY) the undelivered readjudication notice was returned to the SSA FO along side of the Date field. Press the PF6 key. The following message will appear: “Zip Code Validation Complete, Press PF6 to Update Record.” Press the PF6 key to complete the transaction.

c. Coding for CATS When SSA Locates New Address for the Beneficiary and Re-mails the Readjudication Notice to the New Address

If the readjudication notice is returned to the SSA FO as “undeliverable,” and through development, SSA locates a new address for the beneficiary, add this information to CATS as follows:

At the:

  • Civil Action Tracking System Main Menu screen, enter “2” Request for Review/Address Responder Update

  • Request for Review/Address Responder Update screen, annotate the Court Case identifier “FW” and annotate the “9-digit social security number” and add a “Y” at the prompt, “Was a Successful Contact Made to Obtain a New Address?:” and press “enter.”

    NOTE: The "9-digit social security number" can be either the BOAN or the number for the earnings record where benefits are being received.

  • Claimant Update Selection screen, annotate “S” under the Select field and press “enter.”

  • Address/Responder Update screen, over-type the existing address information on the screen with the new address information. Annotate “U” along side of the Response Code and the date (MMDDYYYY) the undelivered readjudication notice was returned to the SSA FO along side of the Date field. Press the PF6 key. The following message will appear: “Zip Code Validation Complete, Press PF6 to Update Record.” Press the PF6 key to complete the transaction.

d. Coding CATS for the Fowlkes Readjudication Decision

After the SSA technician evaluates the beneficiary’s statement requesting readjudication under the Fowlkes AR per instructions in GN 02613.830B.1., the technician then makes a relief determination. The Fowlkes AR relief determination must be coded to CATS.

At the:

  • Civil Action Tracking System Main Menu screen, enter “3” Request for Review/Address Responder Update.

  • Request for Review/Address Responder Update screen, annotate the Court Case identifier “FW” and annotate the “9-digit social security number”. Press “enter.”

    NOTE: The "9-digit social security number" can be either the BOAN or the number for the earnings record where benefits are being received.

  • Claimant Update Selection screen, annotate “S” under the Select field and press “enter.”

  • Transaction Selection Screen, enter “DE” at the Enter Code(s): prompt and press “enter.”

  • Transaction Update Screen, enter the Decision Date (date SSA made the Fowlkes AR relief determination). Enter Type of Decision: “A” Affirmation (use this code when relief will be granted) or “T” Technical Denial (use this code if the request for relief under the Fowlkes AR is denied). Enter “1” (1 – Initial) at the Level of Adjudication prompt. Hit the PF6 key to record the Fowlkes AR relief decision to CATS and to complete the transaction. The following message will appear: “Transaction(s) Accepted: DE” after the transaction is completed.

D. Process – Beneficiary Is Denied Relief Under Fowlkes

1. FO Action on the Denial of the Beneficiary Statement Requesting Fowlkes Relief

Beneficiary is denied relief under Fowlkes AR:

  • Send the beneficiary a notice advising him/her that the request for Fowlkes AR relief is being denied. See notice language to send the beneficiary in GN 02613.856A.2.

  • Do not post a protest denial indicator to the FFSCF for the outstanding felony warrant request for relief under the Fowlkes AR. Close-out any outstanding development or other FO controls on the request for relief issue, if still pending. Do not provide appeal rights if you deny the request for readjudication (because the individual does not meet the criteria shown in GN 03501.001C. to allow a request for readjudication to be granted) for a person whose time to appeal the prior determination lapsed prior to the time of his or her request for readjudication under the AR. The denial of a request for readjudication to have an AR applied is not an initial determination subject to appeal.

2. PSC or Other SSA Component Denial Action on Beneficiary Request for Relief

Beneficiary is denied relief under Fowlkes AR:

  • Send the beneficiary a notice advising him/her that the request for Fowlkes AR relief is being denied. See notice language to send the beneficiary in GN 02613.856D.

  • Do not post a protest denial indicator to the FFSCF for the outstanding felony warrant request for relief under the Fowlkes AR. Close-out any outstanding development or other FO controls on the request for relief issue, if still pending. Do not provide appeal rights if you deny the request for readjudication (because the individual does not meet the criteria shown in GN 03501.001C. to allow a request for readjudication to be granted) for a person whose time to appeal the prior determination lapsed prior to the time of his or her request for readjudication under the AR. The denial of a request for readjudication to have an AR applied is not an initial determination subject to appeal

E. Policy – Miscellaneous Fowlkes AR Relief Issues

1. Multiple Warrants for the Same Beneficiary

If the beneficiary has multiple outstanding warrants, then process the case as indicated in the following:

If

Then

The beneficiary has more than one outstanding warrant and SSA has made an initial suspension or administrative review determination on the warrant.

Review and process each outstanding warrant suspension determination independent of one another based on the date of the SSA initial or administrative review decision made on each warrant issue.

In order to determine if Fowlkes AR relief can be granted to a beneficiary with multiple warrants and multiple SSA initial or administrative review determinations, you will need to examine each SSA warrant suspension determination independent of one another. You will need to determine the following information for each individual warrant suspension determination that SSA made for the beneficiary:

Date of SSA’s initial or administrative review decision;

Where the beneficiary was residing at the time SSA made its initial or administrative review determination;

Type of outstanding warrant, i.e., felony or probation or violation.

Each incident where SSA has notified the beneficiary/ claimant that SSA has made a decision to suspend benefits because the beneficiary has an outstanding warrant will have to be evaluated per GN 02613.830.A.1.

Each warrant that meets the criteria for Fowlkes AR relief should be evaluated and reviewed independent of one another and each warrant updated, as appropriate, to show the correct Fowlkes AR relief decision per GN 02613.840.

If the relief factors in GN 02613.810B.are not met for each individual warrant suspension determination, then suspension applies and the beneficiary cannot be granted relief.

2. Concurrent Title II and Title XVI Entitlement

If the beneficiary is concurrently entitlement to Title II and Title XVI benefits, then process as indicated in the following:

If the Beneficiary

AND he/she

Then

has entitlement and/or eligibility under Title XVI and under Title II for Social Security benefits

has an outstanding felony warrant that SSA has made a Title II fugitive felon suspension initial or administrative determination or a Title XVI fugitive felon suspension initial or administrative determination,

And

Beneficiary requests relief under the Fowlkes AR

Each SSA initial or administrative fugitive felon determination for each Title (i.e., either Title II or Title XVI) will have to be evaluated separately.

You will need to examine each SSA warrant suspension determination for each Title independent of one another. Determine the following information for each individual warrant suspension determination under each Title that SSA made for the beneficiary/recipient:

Date of SSA’s initial or administrative review decision under Title II or Title XVI;

Where the beneficiary was residing at the time SSA made its initial or administrative review determination for each Title II determination or Title XVI determination;

Type of outstanding warrant, i.e., felony or probation or violation.

Each warrant incident where SSA has notified the beneficiary that SSA has made a decision to suspend benefits because the beneficiary has an outstanding warrant will have to be evaluated per GN 02613.830.A.1. Each warrant will have to be updated to reflect the correct Fowlkes AR relief determination, if appropriate.

See SI 00530.800 for Fowlkes AR processing for Title XVI cases.

If the relief factors as mentioned in GN 02613.810B. are not met for each individual warrant suspension determination under each respective Title, then the beneficiary/recipient cannot be granted relief. See SI 00530.800 for Fowlkes AR processing for Title XVI cases.

3. Multiple Entitlement on Two Different SSNs

If the beneficiary is dually entitled on two separate SSNs, then process as indicated in the following:

If the Beneficiary

AND he/she

Then

is entitled to Title II benefits on two separate SSNs per GN 00205.005

has an outstanding felony warrant that SSA has made a Title II fugitive felon suspension initial or administrative determination,

And

Beneficiary requests relief under the Fowlkes AR and he/she currently resides in CT, NY, or VT effective 12/6/05 and ongoing

Each SSA initial or administrative fugitive felon suspension determination for each entitled SSN will have to be evaluated separately.

You will need to examine each SSA warrant suspension determination for each SSN independent of one another.

Evaluate the request for relief per each SSN and that respective initial or administrative appeal fugitive felon suspension determination per GN 02613.830A.1.

Each warrant on the FFSCF for each type of entitlement will have to be updated to reflect the correct Fowlkes AR relief determination, if appropriate per GN 02613.840.

is entitled to T2 benefits on one SSN and he/she files a separate application for T2 benefits on another SSN per GN 00205.005 effective 12/6/05 or later while residing in CT, NY or VT

has an outstanding felony warrant that SSA has made a Title II fugitive felon suspension initial or administrative determination,

And

Beneficiary requests relief under the Fowlkes AR and he/she currently resides in CT, NY, or VT effective 12/6/05 and ongoing

The SSA initial or administrative fugitive felon suspension determination for the already entitled SSN will have to be evaluated separately from the new application for T2 benefits.

You will need to examine the already entitled SSN benefit warrant suspension initial or administrative review determination and the request for relief under the Fowlkes AR independently of the newly entitled benefit on the other SSN.

The new benefit entitlement on the other SSN will not have the benefits suspended for an outstanding felony warrant when the beneficiary resided in CT, NY or VT after 12/6/05 and filed his/her new claim for benefits. See GN 02613.815B. The newly entitled benefit will be paid to the beneficiary even if the other benefit is suspended based on the criteria in GN 02613.810B.

Each warrant on the FFSCF for each type of entitlement will have to be updated to reflect the correct Fowlkes AR relief determination, if appropriate per GN 02613.840.

4. Entitlement Conversions on the Same SSN

If the beneficiary is entitled to two different types of benefits on the same SSN (e.g., child to student benefits, child to disabled adult child benefits DIB to RIB, RIB to DIB , B to D, etc.), then process as indicated in the following chart:

If the Beneficiary

AND he/she

Then

was already entitled to one type of Title II benefits on an SSN. Title II benefit entitlement changes because of an intervening event (death of the wage earner or beneficiary attained retirement age, etc) on the SSN (e.g., B to D Conversion, B2 to B conversion, etc.).

is entitled to another type of Title II benefit on the same SSN with a different date of entitlement based on the new type of Title II benefit effective 12/6/2005 or later and beneficiary resides in CT, NY or VT. The beneficiary has an outstanding felony warrant.

And

Beneficiary requests relief under the Fowlkes AR and he/she currently resides in CT, NY, or VT effective 12/6/05 and ongoing.

You will need to examine the first type of Title II benefit entitlement based on the criteria found in GN 02613.810B. to determine if Fowlkes AR relief can apply to this period of Title II benefit entitlement before the new Title II benefit entitlement begins.

If the new Title II benefit entitlement begins effective 12/2005 or later, benefits on the new Title II benefit entitlement can be paid to the beneficiary effective with the new date of current entitlement (e.g., 12/2005 or later) as long as the beneficiary resides in CT, NY or VT effective the same month as his/her current month of entitlement.

Each warrant on the FFSCF for each type of benefit entitlement will have to be updated to reflect the correct Fowlkes AR relief determination, if appropriate per GN 02613.840.

F. Exhibit – SSA-795 Request for Fowlkes AR Relief Statement

The following information should be provided by the beneficiary when the beneficiary contacts SSA to request relief based on the Fowlkes AR. See GN 02613.830B.1. for instructions on obtaining a request for Fowlkes AR relief statement from the beneficiary. Suggested language for the beneficiary to use in the Fowlkes AR relief request is as follows:

The following sample is provided as a guide for obtaining information from the beneficiary to determine if Fowlkes AR relief can be granted:

Sample of an SSA-795 Requesting Relief Under the Fowlkes AR

Please review the prior decision to [stop/deny] [my/Name of Beneficiary’s] [Social Security/SSI] payments because of an outstanding warrant for [my/Name of Beneficiary’s] arrest and make a new decision to resume [my/Name of Beneficiary’s] payments using the Fowlkes v. Adamec AR.

[I/Name of Beneficiary] understand that beginning December 6, 2005, based on the Fowlkes v. Adamec AR, SSA will not stop paying Social Security benefits to persons unless the person knows there is an outstanding felony warrant for his or her arrest, he or she does not resolve the warrant, and the warrant was issued because he or she is fleeing from justice. [I/Name of Beneficiary] fit this criterion and want [my/name of beneficiary’s] benefits resumed.

[My/Name of Beneficiary’s] current residence address is:

[I/name of beneficiary] [have/has] lived at this address since: (MM/DD/CCYY)

[My/Name of beneficiary’s] current mailing address is:

[My/Name of beneficiary’] felony warrant information is as follows:

Warrant Number:

Date warrant issued:

State of issuance:

Criminal Charges on the warrant:


Reason [I/Name of beneficiary] did not satisfy the warrant:

Date of initial suspension or administrative review notice from SSA notifying me of SSA’s decision to suspend my benefits because of this warrant: [MM/DD/CCYY]

Address where the SSA notice (initial or administrative review notice) was sent:

Signature of Beneficiary: Date Statement Signed:

IMPORTANT: After SSA makes a determination regarding the beneficiary’s request for relief based on the Fowlkes AR, the FO will fax the SSA-795 to the appropriate PSC for imaging into the electronic claims folder for the beneficiary. The imaged SSA-795 statement will be retained with the electronic folder indefinitely.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202613830
GN 02613.830 - Requests Received at SSA Offices for Relief Under the Fowlkes Acquiescence Ruling (AR) - 06/14/2013
Batch run: 06/14/2013
Rev:06/14/2013