SI ATL00501.500 Title XVI Nondisability Tolerances For Development Of Hyatt And Samuels Cases

A. General

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)

  • Undertake full POMs development for current eligibility as well as for the 2 years preceding the point non-disability development is initiated.

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.

2. Income

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 au