TN 1 (08-94)

RS 01405.010 Determination of Coverage or Wages

A. Policy

1. Determination of Coverage or Wages

  1. a. 

    A determination of coverage or wages must be prepared whenever:

    • a substantive wage question is involved; or

    • in any other situation where wages are being added to or deleted from an individual's E/R based on an SSA determination.

  2. b. 

    The determination must:

    • show clearly the precise issue involved;

    • explain why the issue occurred; and

    • explain fully the basis for the determination.

      NOTE: The determination(s) should not simply state the conclusion.

2. Formal Determination

  1. a. 

    A determination of a coverage or wage issue is a formal determination.

  2. b. 

    All rules for preparing determinations in GN 01010.365 apply.

3. Jurisdiction

See RS 01405.005C. regarding jurisdiction.

4. Disagreements

If OCRO believes that an FO or PC determination is clearly inconsistent with POMS instructions, it will submit the determination, with a complete explanation as to the basis for disagreement, to the Division of Coverage, OISP (see address in RS 01404.215B.2.).

B. Procedure

When preparing a determination:

1. Form SSA-7010-U5

  1. a. 

    Show the determination in item 15 on Form SSA-7010-U5.

  2. b. 

    Use Form SSA-553 Special Determination, if the space in Item 15 is inadequate. See GN 01010.360 ff.

2. IRS Ruling

  1. a. 

    If there was an alleged IRS determination or ruling on the issue but a copy was not obtained, note this fact and the allegation as to the finding in item 15 on Form SSA-7010-U5.

    If a copy was obtained, review to see if it is consistent with the SSA determination.

  2. b. 

    See RS 01405.115B. for disagreement procedure.

3. Form SSA-7000-U5 Involved

Make a copy of this wage determination to attach to any SSA-7000-U5 prepared in conjunction with this corrective action.

4. SSA Terms/Abbreviations

  1. a. 

    Do not use SSA technical terms or abbreviations in these determinations.

  2. b. 

    Use concise language and spell - out abbreviations normally used by SSA.

C. References

How to Prepare a Formal Determination, GN 01010.390.

PC Responsibilities in Reviewing or Preparing Special Determinations, GN 01010.375.

Wages, RS 01401.000 ff.

Wage Exclusions, RS 01402.000 ff.

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RS 01405.010 - Determination of Coverage or Wages - 08/05/2002
Batch run: 07/03/2014