DI 60075.065 Appeal Process for Promoting Opportunity Demonstration (POD) Overpayments
When a POD participant reports monthly earnings higher than the offset threshold amount, we will apply a $1 for $2 benefit offset, following the procedure set out in DI 60075.040. An overpayment occurs when a POD participant submits a late earnings report or when we need to apply additional benefit offset based on the annual earnings posted at the end of the year. The master beneficiary record (MBR) displays POD overpayments by the type of event (TOE) code of 80 with an explanation of BOND/POD DEMO. Since POD overpayments have the same type-of-event (TOE) code (80) as Benefit Offset National Demonstration (BOND) overpayments, it is important to distinguish between the two in order to send the appeal to the correct location. To distinguish between a POD overpayment and a BOND overpayment:
View the Special Message field on the MBR - Special Message will explain whether the beneficiary is in either the POD or the BOND;
View the HISTDEMO on the MBR for a DPI of DP; and
View DCF DEMO screen for DPI of DP and Start and Stop dates of participation.
A POD participant may request reconsideration or waiver of the overpayment. The specialized unit within the servicing PC has jurisdiction of reconsideration requests on POD overpayments, including updating the Debt Management System (DMS) with a detailed explanation of the reconsideration decision and faxing this determination into the electronic folder (eView or NDRED). The field offices (FO) are responsible for processing waiver requests and hearing requests (hearing requests are forwarded to OHO per GN 03103.080A.1.). POD cases are work issues and should be flagged and faxed into Paperless with the HA 501 NONDIB-ALJ Hearing Req (NON-DIB) barcode. This option is available through I-Main Production for Non-PC users. Use TOEL Appeal RHEAR.
A. POD participant inquires about overpayment
1. Overpayment event type is BOND/POD DEMO and Special Message/HISTDEMO/DCF indicate POD participation
Abt assists POD participants with notice explanation and waiver or reconsideration forms. For more information on Abt call center staff, see DI 60075.025B.
a. Waiver inquiry
If the beneficiary decides to request a waiver:
follow usual procedures to post the informal waiver request in Debt Management System (DMS) to stop overpayment recovery (for more information on waiver request, see GN 02201.034);
send the notice in DPS titled “Request for Waiver Cover Letter”;
send a Form SSA-632-BK (Request for Waiver of Overpayment Recovery or Change in Repayment Rate) to the beneficiary;
send an email to the appropriate POD central email account (DI 60075.050A) for the servicing PC requesting an explanation of the overpayment in DMS if unable to determine through notices.
b. Reconsideration inquiry
If the beneficiary is in the FO to file a reconsideration on a POD issue, take the following actions:
secure the Form SSA-561-U2 (Request for Reconsideration);
update DMS to stop overpayment recovery;
store the SSA-561, including supporting documentation if provided, in eView or NDRED;
return the SSA-561 and all supporting documentation to the beneficiary;
refer the beneficiary to the POD Call Center (1-888-771-9188) after providing reconsideration forms; and
send an email to the appropriate POD central email account (DI 60075.050A) for the servicing PC, notifying them of the action you have taken. State in the email that the reconsideration is for a POD overpayment.
c. If the beneficiary is not in the FO
If a beneficiary is not in the FO but inquiring about a POD overpayment, refer the beneficiary to the POD Call Center. The POD Call Center (1-888-771-9188) will direct the beneficiary to the POD counselor who supplies the beneficiary with appropriate forms to file the overpayment appeal.
2. Overpayment event type is not POD
Follow existing rules for processing any other overpayments on the beneficiary’s record (including Disability DIB Cessation), even if he or she has a POD overpayment on the ROAR, or is currently in POD. For overpayment processing instructions, see GN 02201.001.
If the specialized work groups within the PC receive a reconsideration for a non-POD overpayment, they take the following actions:
receipt into DMS and transfer to the FO of jurisdiction,
fax into the electronic folder eView or NDRED, and
send an MDW to the FO of jurisdiction.
B. FO procedure to process a POD waiver
The FOs are responsible for processing waiver requests and hearing requests (hearing requests are forwarded to OHO per GN 03103.080A).
If a POD participant decides to file a waiver, follow these procedures:
1. Waiver inquiry
If the beneficiary, representative payee, or authorized representative wants to file a waiver, follow the usual procedures to post the informal waiver request in DMS to stop overpayment recovery. Send the notice in DMS titled “Request for Waiver Cover Letter” with the form SSA-632-BK.
2. Waiver received in FO
If the beneficiary returns the form SSA-632-BK directly to the FO, follow the usual procedures to post the waiver request in DMS. Check DMS for an explanation of how the POD overpayment occurred. If an explanation is not in DMS, send an email to the appropriate POD central email account within the servicing PC requesting an explanation of the POD overpayment. The PITAG (PC 1-6) or I&E (PC7) Unit will review the case and provide an explanation in the debt management system. The FO should continue development needed for the waiver.
3. Waiver received in PC
Prior to transferring the waiver request to the FO, the PC posts an explanation in the debt management system to explain how the overpayment occurred. Determining without fault and the inability to re-pay is the FO’s responsibility. The PC notifies the FO of the waiver request via Modernized Development Worksheet (MDW), including a summary of any evidence submitted, and faxes all evidence into eView or NDRED.
4. National 800 Number Network (N8NN) process for POD waiver requests
If you receive a call from the beneficiary, representative, or authorized representative requesting an explanation of an overpayment notice, refer the person to the POD Call Center (1-888-771-9188).
If the beneficiary, representative payee, or authorized representative calls and states that he or she wants to file a waiver, continue to follow procedures in TC 26001.080. Refer the caller to the POD Call Center for assistance.
C. FO procedure to process POD reconsideration requests
The PITAG (PCs 1-6) and I&E Unit (PC7) within the servicing PC is responsible for making a decision on POD overpayment reconsideration requests. If the field office receives a reconsideration request on a POD overpayment:
input the reconsideration request in DMS;
fax the Form SSA-561-U2 and any accompanying evidence into the eView or Non-Disability Repository for Evidentiary Document (NDRED) as appropriate;
email the POD centralized account for the servicing PC indicating the beneficiary is requesting a reconsideration on a POD overpayment. For additional information about reconsideration requests, see DI 60075.075A.1.b, in this section;
return the SSA-561 and any accompanying evidence to the beneficiary; and
refer the beneficiary to the POD Call Center (1-888-771-9188).
D. National 800 Number Network (N8NN) procedure to process POD reconsideration requests
1. Request for reconsideration
If you receive a call from a beneficiary, representative payee, or authorized representative requesting to file reconsideration on an overpayment and he or she is a POD participant or is representing a POD participant, refer the caller to the POD Call Center (1-888-771-9188). Inform the caller to file all reconsideration requests for POD overpayments through Abt Associates. Abt will provide the POD participant with the necessary SSA-561-U2 form to file a reconsideration.
2. Reconsideration follow-up
If you receive a call from the beneficiary, representative payee, or authorized representative requesting a status of the reconsideration filed by or on behalf of a POD participant, direct the caller to the POD Call Center (1-888-771-9188).