TN 3 (01-13)

GN 02615.130 Title II Clark Court Order Administrative Appeal Processing

A. Appeals case processing

Beneficiaries who were suspended for probation or parole violation (PPV) outstanding warrants (i.e., 5011, 5012, 8101 or 8102) prior to 10/24/2006, but who had a pending appeal or an administrative appeal determination related to the PPV suspension issue (or PPV suspension-related overpayment issue) on or after 10/24/2006, are included in the Clark Court Order. For more information on the terms of the Clark Court order regarding administrative appeals, see GN 02615.100.

1. Identifying Class Members

We sent the Clark administrative appeal cases along with all the other Clark manual cases directly to the processing centers (PCs) for processing. You will find these Class Members on the Civil Action Tracking System (CATS) with a CCID of C2 Clark Court Order Manual cases. For information on Clark Court Order manual case processing, see GN 02615.120A.

2. Queries on PPV suspension or overpayment appeal issues

a. Review the MBR data

For information on the MBR data items, see GN 02615.120A.3.

b. Review the Recovery Overpayment Accounting Record (ROAR) data

Locate the beneficiary’s ROAR record on the bottom of the MBR. Review the beneficiary’s appeal history and determine the PPV suspension or overpayment appeal date from the chart.

ROAR

Review Action

BENEFIT line

Find the current balance due for all overpayments for the beneficiary in BBAL-$$$$$ field.

EVENT line

Find the Event Identifier (EI) for the PPV overpayment (e.g., 01, 02) for the PPV warrant in the administrative appeal fields.

Find the Type of Event (TOE) for the PPV overpayment on the EVENT data line, (e.g., T2 FF SUS/VIO, T2 FF SUS/FEL, OTHER, OR CONSOLIDATED LDO).

Find the STATUS of the current recovery effort for the PPV overpayment (e.g., BEN ADJ, DUE PROCESS).

HISTORY line

Determine when ROAR received the PPV overpayment amount and the administrative appeal in these fields. Check:

RUN DATE = FO established administrative appeal date (FO). TRANS = 23 AMOUNT = PPV overpayment amount SRC = 3—DO DOCXXX WRI-W--WAIVER REQUEST, or WRI - R – RECON REQUEST, or WRI – H –HEARING REQUEST

Example of a waiver request on ROAR:

RUN DATE FO established administrative appeal date (waiver request on the PPV overpayment). TRANS = 23 AMOUNT =PPV overpayment amount SRC 3—DO DOCXXX WRI- WAIVER REQUEST

Then, followed by the personal conference date: (ROAR data same as the above example, except for the following items.) WRI-P- PERSONAL CONF SOURCE-XXX WHLD-100.00 COM – 11/06 09/23/10 55 $3047.70 1-PSC SOURCE-001 CAT -- 67 --SPECIAL PAYMENTS DCAT-D1

NOTE: When evaluating Clark relief for an unfavorable PPV suspension or overpayment appeal determination (e.g., waiver denial, reconsideration denial, etc.) the HISTORY RUN DATE entry shows 10/19/2006 (HISTORY RUN DATE =10/19/06 plus five mailing days for the initial determination notice = 10/24/2006) or later date to qualify for Clark relief. For a pending administrative appeal, the HISTORY RUN DATE entries must show that there is no final appeal determination 10/19/2006 (HISTORY RUN DATE =10/19/06 plus five mailing days for the initial determination notice = 10/24/2006) or later for the relief qualifying T2 FF SUS/VIO overpayment.

NOTE: A ROAR entry of INFORMAL WAIVER or PART W/H REQUEST means the person inquired about waiver, but did not request a waiver, or the person requested overpayment recovery through partial withholding. Neither ROAR entry qualifies as an administrative appeal.

If the WRI- WAIVER REQUEST is the last TC 23 pending ROAR appeal entry, give the beneficiary Clark relief. For processing instructions, see GN 02615.130B in this section.

Examples of ROAR History:

Example 1

RUN DATE TRAN AMOUNT SRC

12/23/05 12 $6705.40

08/11/06 23 $6705.40 3--DO DOC-C51

WRI-N--INFORMAL WAIVER 09/14/06 43 $0.00 SOURCE-C51

WHLD-775.00 COM-10/06 SSC-2

10/19/06 23 $6705.40 3--DO DOC-C51

04/08/11 23 $20691.00 3--DO DOC-C80 WRI-

W--WAIVER REQUEST

06/22/11 43 $20691.00 SOURCE-C80 WHLD-1881.40 COM-06/11

09/23/11 23 $20691.00 1-PSC DOC-000 WRI-E—

EXPLANATION REQUEST

10/21/11 43 $0.00 WHLD-1948.90 COM-12/11 SSC-2

11/12/11 23 $20691.00 1-PSC DOC-000 RI-R--RECON REQUEST

The beneficiary is eligible for Clark relief because the last pending administrative appeal request (i.e., reconsideration) on this case was 11/12/11.

Example 2

RUN DATE TRAN AMOUNT SRC

04/17/08 12 $36828.00

10/21/08 41 $0.00 WHLD-50.00 COM-10/08 SSC-T

10/30/08 84 $36828.00 1-PSC OLD1--PCMOD NEW2--PCDCU DOC-000

DY-PSC ALERT 12/03/08

11/04/08 23 $36828.00 3--DO DOC-600 WRI-P--PERSONAL CONF

11/21/08 84 $36828.00 1-PSC OLD2--PCDCU NEW1--PCMOD DOC-000

DY-PSC ALERT 02/02/09

02/12/09 42 $3173.20 WHLD-3173.20 COM-02/09

LST WH-02/09 SSC-B

05/04/09 22 $0.05 SSC-B

05/04/09 42 $1569.70 WHLD-1569.70 COM-05/09

LST WH-05/09 SSC-B

05/13/09 55 $36828.00 1-PSC SOURCE-600

CAT-97--OTHER DCAT-D1

06/25/09 43 $5800.00 WHLD-1450.00 COM-07/09

LST WH-10/09 SSC-2

11/12/09 23 $26285.05 3--DO DOC-600

WRI-R--RECON REQUEST

12/08/09 27 $26285.05 1-PSC

01/25/10 23 $26285.05 3--DO DOC-600

WRI-H--HEARING REQUEST

01/27/10 43 $4350.00 WHLD-1450.00 COM-02/10

09/27/10 43 $14682.55 WHLD-1450.00 COM-10/10

LST WH-08/11 SSC-T

The beneficiary is eligible for Clark relief because the last pending administrative appeal request (i.e., hearing) on this case was 01/25/10.

Example 3

RUN DATE TRAN AMOUNT SRC

10/15/06 12 $9515.00

11/29/06 23 $9515.00 3--DO DOC-927

WRI-N--INFORMAL WAIVER

01/29/07 41 $250.00 SOURCE-927 WHLD-250.00 COM-03/07

LST WH-03/07 SSC-2

04/09/07 23 $9265.00 3--DO DOC-927

WRI-A--PART W/H REQUEST

04/10/07 41 $1350.00 SOURCE-927 WHLD-30.00 COM-05/07

LST WH-01/11 SSC-2

07/01/09 22 $584.00 SSC-T

The beneficiary did not administratively appeal. He or she inquired about waiver or had subsequent partial overpayment withholding. We made the final T2 FF SUS/VIO determination on the initial PPV overpayment on 10/15/06. This beneficiary is not eligible for Clark relief because the beneficiary did not file an administrative appeal before 10/24/2006 and there was no appeal pending on or after 10/24/2006.

Review the ROAR HISTORY line for all administrative appeal periods. Determine the beneficiary’s last level of PPV administrative appeal (i.e., waiver, reconsideration, Administrative Law Judge (ALJ) hearing or Appeals Council (AC) review).

Next, determine the last administrative appeal request date.

Status of Administrative Appeal Decision

Determination for Appeal Date

closed (PC, ALJ or AC action on appeal) or

closed (FO determination on waiver) (no higher administrative appeal requested)

Appeal date equals the determination date for the last highest level of PPV suspension or overpayment appeal.

pending (no PC, ALJ or AC action) or

pending (no final waiver decision) (no higher administrative appeal requested)

Appeal date equals the date that the beneficiary filed his or her latest administrative review request, but there is no final administrative review action.

Process the beneficiary’s last administrative appeal request per the instructions in this section for that particular appeal level:

  • Denied Waiver or PC Reconsideration appeal cases

    For instructions on processing denied waiver or reconsideration appeal cases, see GN 02615.130B in this section.

    NOTE: If the last administrative appeal is the ALJ level, obtain a current administrative appeal query to learn the beneficiary’s appeals status. For information on reviewing the administrative appeals query system, see GN 02615.130A.2.c. in this section.

  • ALJ hearings

    For instructions on processing ALJ cases, see GN 02615.130C in this section

  • AC cases

    For instructions on processing AC appeal cases, see GN 02615.130D in this section.

c. Review the Case Processing and Management System (CPMS) or Appeals Review Processing System (ARPS) Query

Obtain a CPMS query or an ARPS query via the Intranet. Review the beneficiary’s CPMS or ARPS query to determine if the beneficiary requested an administrative appeal of a PPV suspension or overpayment. If the administrative appeal information on the query does not relate to the PPV suspension or overpayment, do not use this information. Evaluate the next lower level of appeal associated with the PPV suspension or overpayment issue.

If the ALJ or AC administrative appeal request is associated with a Clark PPV suspension or overpayment issue, determine if the appeal is closed or pending using the chart below:

Status of Appeals Decision

Action on Appeals Decision

closed (unfavorable ALJ or AC decision, or AC denial of request for review, PPV suspension is still on record)

If there are no other pending administrative appeals on the case, provide Clark relief without vacating the ALJ or AC decision, or the AC denial of review. For processing an ALJ level case, see GN 02615.130C.1 in this section For processing an AC level case, see GN 02615.130D.1 in this section.

pending (no action taken on appeal request)

Notify the ALJ or AC that the beneficiary is eligible for Clark relief. Inform the specified ALJ or AC contact of the Clark relief. For processing an ALJ level case, see GN 02615.130C.1 in this section. For processing an AC level case, see GN 02615.130D.1 in this section.

B. Overpayment Waiver Recovery and PC reconsideration appeal processing

1. Pending and closed PC appeals—PPV issue only

If the record’s last appeal level resulted in a waiver (i.e., waiver of the PPV overpayment recovery) or PC reconsideration, use the chart to determine your processing action.

Status of Appeal

Status of Clark relief

PC Processing Action

closed (PC RECON determination) or

closed (FO denied waiver)

None for the warrant

Process the Clark relief. For processing instructions, see GN 02615.120A.3.

closed (PC RECON determination) or

closed (FO denied waiver)

Relief given

Take no action.

pending (no final PC RECON determination) or

pending (no final FO waiver determination)

None for the warrant

Process the Clark relief. For processing instructions see, GN 02615.120. .

pending (no final PC RECON determination) or

pending (no final FO waiver determination)

Relief given

Take no action.

2. Pending PC reconsideration appeals with multiple issues

If the pending appeal request includes issues in addition to those related to a PPV suspension or overpayment, resolve all reconsideration issues at the same time.

C. Office of Disability Adjudication and Review (ODAR) appeal

If there is an administrative appeal pending in Office of Disability Adjudication and Review (ODAR), notify the appropriate administrative appeal organization of the Clark relief. For cases pending at the hearing level, notify the hearing office. When a case is pending before the Appeals Council, notify the Office of Appellate Operations (OAO). For ALJ appeals case processing instructions, see GN 02615.130C.1 in this section. For OAO appeals case processing instructions, see GN 02615.130D.1.

1. Pending and closed ALJ appeals—PPV issue only

Use the chart to process ALJ appeals as follows.

Status of Appeal

Status of Clark Relief

PC Processing Action

closed (ALJ decision)

None for this warrant

Process the Clark relief. For instructions on relief processing, see GN 02615.120A.

closed (ALJ decision)

Relief given

Take no action.

pending (no final ALJ decision)

None for this warrant

Calculate the beneficiary’s benefits payable for the PPV suspension period that we are removing. Take no action to process the Clark relief at this time.

Contact the Hearing Office (HO)

Obtain the HO code (3-position code) from the beneficiary’s CPMS query.

Use the Mainframe’s Detailed Office/Organization Resource System (DOORS) to locate the HO’s email address.

Use the Outlook email’s OPTIONS tab to add voting buttons to the message and request “Request a Read Receipt.” This ensures the hearing office (HO) received your Clark email message.

Email the HO the following information:

Subject: Clark Court Order Case Message to HO for the ALJ SSN Beneficiary’s Name/BIC

ALJ’s Name Assigned to Hearing from the CMPS Query

Explain that the beneficiary appears to be eligible for Clark relief. Provide the facts found on the MBR, ROAR, CPMS or ARPS or on ORS and indicate the period for which we will resume the monthly benefits. If other higher priority suspension or payment issues occur and non-payment continues once we close the PPV suspension event, explain this.

Send the HO the completed email message. The HO will add the Clark v. Astrue (CACL) Class Action Case Characteristic to CPMS (if it is not already present) and then refer the Clark Court Order email to the appropriate ALJ for consideration.

Do not provide the beneficiary Clark relief unless the HO forwards the case to the PC for subsequent action on the PPV suspension or overpayment. This will occur only if the HO issues a favorable title II decision. The HO will place a message in the Alert and Message section in eView to notify the PC technician of Clark Court Order involvement. For paper cases, OAO will add a paper flag to the folder when it returns the folder for processing after all levels of appeals are completed.

If the ALJ makes a favorable decision, the HO forwards the case to the PC, process the Clark relief. For instructions on processing Clark relief, see GN 02615.120A.

If the ALJ issues an unfavorable decision, HO will mail the case to OAO.

pending (no final ALJ decision)

Relief given

Contact the HO

Obtain the HO code (3-position code) from the beneficiary’s CPMS query.

Use the Mainframe’s Detailed Office/Organization Resource System (DOORS) to locate the HO’s email address.

Email the HO the following information:

Subject: Clark Court Order Case

Message to the HO for the ALJ SSN Beneficiary’s Name/BIC ALJ’s Name Assigned to Hearing from the CMPS Query

Notify the ALJ that we already gave the beneficiary Clark relief. Provide the ALJ with the date we gave the relief (MM/DD/CCYY). Give the dates for the Clark relief period.

Send the HO the completed email message. The HO will add the Clark v. Astrue (CACL) Class Action Case Characteristic to CPMS (if it is not already present) and then refer the Clark Court Order email to the appropriate ALJ for consideration.

After the ALJ makes a favorable title II decision, the HO will forward the case to the PC. The HO will place a message in the Alert and Message section in eView to notify the PC technician of Clark Court Order involvement.

If the ALJ makes an unfavorable title II decision, the HO will forward the case to OAO.

No further PC action is necessary on the Clark relief.

2. Pending ALJ appeals with multiple issues

If the ALJ pending appeal request includes issues other than those related to the PPV suspension or overpayment decision, the case will remain with the HO, even if the beneficiary is due Clark relief.

Provide the HO with information on the beneficiary’s eligible Clark relief. For information on how to notify the ALJ about the beneficiary’s Clark relief and how to process the relief, see GN 02615.130C.1. in this section.

D. Appeals Council (AC) appeal processing

1. Pending and closed AC Appeals—PPV issue only

The chart provides instructions for processing AC appeal cases involving only the PPV suspension or overpayment.

Status of Appeal

Status of Clark Relief

PC Processing Action

closed (AC unfavorable decision or denial of request for review)

None for this warrant

Process the beneficiary’s Clark relief. For relief processing instructions, see GN 02615.120.

closed (AC unfavorable decision or denial of request for review)

Relief given

Take no action.

pending (no final AC action)

None for this warrant

Calculate the beneficiary’s benefits due for the PPV suspension or overpayment that we are removing. Take no action to process the Clark relief at this time.

Contact OAO via email. Email: |||ODAR OAO and provide the following information.

Subject: Clark Court Order Case

Message for the AC

SSN

Beneficiary’s Name/BIC

Adjudicator assigned to the appeal, if available, from the ARPS Query

Explain that the beneficiary appears to be eligible for Clark relief. Provide the facts found in the MBR, ROAR, CPMS or ARPS, or on ORS and indicate the period for which we will resume the beneficiary’s benefits. If non-payment continues because of other higher priority suspension or payment issues that will occur once we close the fugitive felon suspension event, explain this fact.

OAO will refer your email request to the appropriate person for consideration.

Do not provide Clark relief. OAO will send the case back to the PC after the AC acts on all appeal issues. OAO will return the case to the PC via form HA-505, “Transmittal by Office of Disability Adjudication and Review,” identified as “Clark Court Order.” OAO also adds a red “Special” label to form HA-505 prior to remanding the case to the jurisdictional PC. For an exhibit of the HA-505 from the OAO, see GN 02615.130D.3. in this section.

After receiving the HA-505, process the beneficiary’s Clark relief. For relief processing instructions, see GN 02615.120A.

pending (no final AC decision)

Relief given

Contact OAO via email. Email: |||ODAR OAO and provide the following information:

Subject: Clark Court Order Case

Message

SSN

Beneficiary’s Name/BIC

Adjudicator assigned to the appeal, if available from the ARPS query.

Notify the AC that we already gave the beneficiary Clark relief. Provide the AC with the date we gave relief (MM/DD/CCYY). Give the dates for the Clark relief period.

OAO will refer your email request to the appropriate person for consideration.

OAO will send the case back to the PC after the AC takes an action on the appeal issue. OAO returns the case to the PC via form HA-505 “Transmittal by Office of Disability Adjudication and Review” identified as “Clark Court Order.” OAO also adds a red “Special” flag to form HA-505 prior to remanding the case to the jurisdictional PC. For an exhibit of the OAO HA-505 form, see GN 02615.130D.3 in this section.

No further PC Clark relief action is necessary.

2. Pending OAO AC appeal case, multiple appeal issues

If the pending request for review before the AC includes issues other than those related to a PPV suspension or overpayment, the case remains with the AC, even if the beneficiary is due Clark relief.

Provide the AC with information on the Clark relief due the beneficiary. For instructions on emailing the Clark Court Order relief information to the AC, see GN 02615.130D.1 in this section. When the AC takes an action on all appeal issues, process the AC action. For relief processing instructions, see GN 02615.120.

3. HA-505 Transmittal by ODAR for Clark Court Order Cases

The OAO will use a transmittal form to return the case to the FO or PC after ODAR makes an appeal decision and Clark relief applies to the case. The OAO Clark Court Order transmittal form will look similar to the exhibit below.

Exhibit - OAO HA-505 Clark Court Order Transmittal Form

TRANSMITTAL BY OFFICE OF

DISABILITY ADJUDICATION AND REVIEW

DATE:

TO:

Social Security Administration

ATTENTION:

 

FROM: Office of Appellate Operations

RSI/SSI Branch

BY

(Claimant's Name and SSN)

Name xxx-xx-xxxx

 

(Wage Earner)(Leave blank if same as above)

 

ATTACHMENT(S): RSI File or SSI File [circle one]

Clark Court Order Case

 

The Appeals Council vacated the Administrative Law Judge's decision of [date] because, based upon the settlement in the Clark Court Order, a favorable revised reconsidered determination is possible.

Please review the case and issue a revised reconsidered determination. The notice of such determination should provide the claimant with the right to a hearing.

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202615130
GN 02615.130 - Title II Clark Court Order Administrative Appeal Processing - 02/06/2013
Batch run: 02/06/2013
Rev:02/06/2013