TN 13 (07-09)
RS 01404.254 Determining OIG Referrals and Conviction Status in regard to the "Ensign Amendment"
The referral of cases for review by OIG, as described below, is in accordance with SSA’s usual policies for prevention of fraud. It is unrelated to the question of whether the FY 2009 “Ensign Amendment” applies.
A. Who identifies potential cases for review by the Office of the Inspector General (OIG)?
A potential incorrect or fraudulent use of an SSN by an individual may be identified by any SSA employee (e.g., Workload Support Units (WSUs), 800# agent, service representative (SR), claims representative (CR)) who comes in contact with an individual whose earnings record and work history is in question and the individual states that he/she worked and has earnings under another SSN. The identification of these potential situations may occur in certain non-claim and initial claims situations under Title II, XVI, or TXVIII.
WSU’s and 800# agents should follow existing claims lead procedures to refer potential cases to the servicing field office (FO) for necessary action. Annotate “Potential Fraud Case” in the remarks section of the claims lead. 800# agents should not refer potential "Ensign" cases to the WSU or refer the claimant to the Internet.
B. Criteria for determining cases to refer to OIG
The determining factor in making a referral to OIG for the incorrect or fraudulent use of a SSN is whether the individual knowingly used a SSN that had not been assigned to him or her in an attempt to engage in work activity which he or she was not legally entitled to perform to obtain a right, benefit or privilege to which he or she was not legally entitled, or to avoid a legally imposed obligation or liability.
The nine digit number used in employment could be made up, owned by another person, or the claimant’s own Individual Taxpayer Identification Number (ITIN) (see RS 01404.250B.2. for definition of ITIN), which is issued by the Internal Revenue Service (IRS). A worker, e.g., a migrant field worker, who used an employer-supplied SSN while in their employ, may not have "knowingly" used the SSN with the implicit intent to commit SSN fraud.
EXCLUSION: A SSN made up of all 000’s. Employers are instructed by IRS to use all zeros when the employer is required to file a wage report and the employee has not yet received a SSN from SSA.
C. Referring cases to OIG
Report all potential Section 208(a) (6) or (7) violations to the Office of the Inspector General. (See GN 04111.010 for instructions on referring cases to the OIG.)
NOTE: Section 208(a) (6) makes it illegal for an individual to knowingly, and with intent to deceive, furnish false information with respect to wage records. Section 208(a)(7) makes it illegal for an individual to obtain Federally-funded benefits, including Title II benefits, or anything of value from any person, by using, with intent to deceive, either an SSN that was obtained with false information or the SSN of another individual, see: http://policynet.ba.ssa.gov/repository/ssact/title02/0208.htm .
D. When to refer “Ensign Amendment” cases to the servicing regional office (RO)
1. Send a request to the servicing RO when during the development of a Title II claim:
the NH lacks insured status on his/her earnings record and states that he/she worked and earned wages or SEI under a number other than the SSN assigned to him or her, or
the NH states he or she is involved in a pending court case, or was convicted in a federal court, on charges related to SSN use, or other evidence is presented that alerts Social Security staff to the potential for a federal court case.
2. Referring "Ensign Amendment" cases to the servicing RO
Provide the claimant's name, date of birth, address of record, other identifying information and other names and addresses used. The field office (FO) must send the referrals to the regional office Center for Program Support (CPS) staff; CPS will refer the case to the regional general counsel office. The FO must diary the case for 15 days using your office's diary procedures. Use the "425" listing code. The FO should follow-up with the appropriate CPS staff if a response has not been received after 15 days.
The regional counsel offices will query the Public Access to Court Electronic Records (PACER) database to determine whether the NH was convicted of working under a SSN that was not assigned to him or her for employment purposes.
The CPS staff will coordinate communications with the regional counsel office and then will provide a disposition for the claimant back to the field office that initiated the inquiry.
E. Appeal rights in cases denied due to "Ensign Amendment" provisions
If a NH is denied Title II retirement or disability benefits due to a conviction involving the wrongful use of an SSN, the determination may be appealed (RS 01404.258, Processing Requests for Earnings Records Corrections After a Disallowance Based on the “Ensign Amendment”)