SI ATL00501.500 Title XVI Nondisability Tolerances For Development Of Hyatt And Samuels Cases
The Office of Supplemental Security Income has approved some non-disability issue development tolerances to help field office staff assist Hyatt and Samuels class members establish eligibility for Title XVI while not taxing local relationships with third parties who are frequent sources of evidence (e.g., employers, financial and medical institutions and landlords).
Use the following guidelines to determine when the tolerances for these two court cases apply:
Current Eligibility (Including 2 Years Prior to Initiation of Non-disability Development)
Retroactive Eligibility (Period Prior to 2 Years Before Initiation of Non-disability Development)
General rule for retroactive period: Exercise thoughtful discretion when developing these periods of time. Many years have passed since events affecting eligibility and payment amount have occurred and documentation usually required may no longer be available. Individuals cannot be expected to have complete evidence in their possession or total recall of events from the past. Development of these retroactive periods requires that you reach reasonable and fair decisions given the allegations you receive, limited evidence that may be presented, and eligibility factors as they currently exist in the person's claim.
Question the individual about the full period of retroactivity. Use current eligibility factors as an indicator of issues to consider for further development (e.g., current income, resources, and living arrangement). Document only those items, which differ from current eligibility and affect eligibility or payment amount (see next bullet). In addition, obtain a written statement from the individuals regarding all other eligibility factors. For example: after documenting (following the guidance in the next bullet) an individual's veterans benefit, living arrangement, and period of institutionalization, the field office obtains the following statement: “I have never had any other income than my veterans benefit. My resources have never exceeded $1,500. I always have lived in North Carolina and never have been outside the United States. I never have been married.” (The statement regarding resources can serve as an expedient for those situations where resources are alleged always to have been low: i.e., the individual does not have to say that resources never exceeded $1,500, $1,600, etc., in each respective year.)
O when an issue requires further development, accept evidence in the individual's possession, apply the specific tolerances listed in SI ATL00501.500B, and use allegations when there is no evidence to the contrary. The specific tolerances do not attempt to cover all situations. Each tolerance can be used in conjunction with evidence and allegations about the issue at hand but cannot override documented contrary evidence.
Contact with third parties should be minimized for any verification required for these past periods.
B. Specific Tolerances
1. General Eligibility
Marital Status: Accept the individual's allegation about all martial changes for retroactive period.
Citizenship/Alien Status: Assume the individual's current citizenship/alien status existed in the retroactive period.
Absence from the United States: Accept the individual's allegation about departure and return dates.
Wages: For the individual and deemors, use any evidence that is presented and allegations of when wages were received. Using that information and amount on the DEQY, determine the allocation of wages during the alleged period of work for the year. If the period of work is unclear, allocate wages over the entire year.
AFDC: Accept the individual's allegation of when AFDC was received, including the termination date, and the number in the grant. Use the historical charts for each State's AFDC program showing maximum grant for family size, SI ATL00501.500, Exhibit A (North Carolina) and Exhibit B (Tennessee). Determine the incremental portion using the chart.
VA: Request that the VARO provide their adjusted payment rates (what should have been paid) for this period. Similar to our MBR, the adjusted payment rates are available on their computers rather than actual payment rates for retroactive periods. The VARO can use the adjusted payment rates to compute dependent augmentation rates. Annotate the SSA-L1103 to say:
“Hyatt or Samuels Case. Please provide the adjusted payment rates (rate of pay) for the period (beginning date) to (month before the 2 year period prior to the initiation of development date).”
SSA-L1103's should be sent to the VARO through the parallel field office.
Miscellaneous Sources of Possible Income: Accept the individual's allegation of the amount, when received, and intended recipient. For alleged loans, no contact with the lender is required.
Deeming: Do not input information about ineligible children in the unearned income field of the SSR if the information does not affect the deeming computation, e.g., parent has needs based payment.
Interest: Do not count interest income less than $7 a month.
3. Living Arrangements/In-Kind Support and Maintenance
LA: Base the household living arrangement on the individual's allegation.
ISM: Use the PMV if it is supported by the individual's allegation. If rebuttal is sought, base the determination on the individual's allegation.
LA-D: Apply LA-D or LA-A for a stay in a medical facility based on the individual's allegation of time in a Medicaid facility and the individual's understanding about how the bill was paid.
N02: Base N02 on the individual's allegation of time and place. Use the PMV when ISM for partial months of institutionalization is appropriate or base the rebuttal decision on the individual's alleged estimate.
(Instead of specific tolerances for such items as the automobile or life insurance, follow this general tolerance.)
Question the individual about retroactive resources for the entire retroactive period. Accept allegations of retroactive resource eligibility, absent evidence to the contrary (for example, an IRS interface alert).