TN 9 (12-00)

SI 00502.152 Readjudication Of N13 Denials That Were Based On Alien Eligibility Law In Effect Prior To 8/5/97

A. Background

This section provides instructions related to individuals whose supplemental security income (SSI) claims were denied based on alien status (denial code N13) under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (P.L. 104-193 as amended by P.L. 104-208, the 1996 welfare and immigration reform law). These individuals may now be eligible under the alien eligibility provisions of the Balanced Budget Act of 1997 (P.L. 105-33), which was enacted on 8/5/97. The provisions in P.L. 105-33 are effective as if they were enacted as part of P.L. 104-193, as amended, which was effective on 8/22/96.

In addition, nonqualified aliens who were receiving SSI benefits on 8/22/96 may now be SSI-eligible under the grandfathering provision in P.L. 105-306, which was enacted on 10/28/98.

B. Policy

1. Readjudication of Claims Filed Prior to 8/22/96 and Denied Based on Alien Status (N13) on or After 8/22/96

POMS instructions in effect prior to the issuance of EM-97207 (dated 12/18/97) stated that aliens who were not receiving SSI benefits on 8/22/96 were subject to 1996 welfare and immigration reform law for the entire period in the life of their SSI applications, even if that included periods prior to 8/22/96.

EM-97207 changed those instructions. Under current policy, SSA applies the alien eligibility law that was in effect prior to 8/22/96 to any pre-8/22/96 period in the life of the individual's application. This policy applies to all aliens who filed for SSI prior to 8/22/96 or whose protective filing dates are prior to 8/22/96.

Pursuant to EM-97207, field offices (FOs) were to readjudicate SSI claims that had been denied N13 as a result of the POMS instructions that were in effect prior to the issuance of EM-97207.

IMPORTANT: Because these were readjudications--as opposed to reopenings--the rules of administrative finality did not apply.

The readjudication initiative described in EM-97207 also applied to:

  • individuals who applied for SSI prior to 8/22/96, who were denied on or after
    8/22/96 based on alien status under 1996 welfare and immigration reform law, and who had (or have) pending reconsiderations, hearings, or requests for Appeals Council review; and

  • the processing of hearings that were remanded to FOs for revised determinations of eligibility in light of the changes in law contained in P.L. 105-33.

IMPORTANT: Under current law, the alien eligibility of a qualified or nonqualified alien who received SSI benefits on 8/22/96 (or, as may be the case in a readjudicated claim, received benefits for 8/22/96) is "grandfathered." (See SI 00502.100A.2. and SI 00502.100A.7. for the categories of qualified and nonqualified aliens, respectively. See SI 00502.150 for the grandfathering rules that apply to qualified aliens and SI 00502.153 for the grandfathering rules that apply to nonqualified aliens.)

2. Readjudication of Claims Filed on or After 8/22/96 and Denied Based on Alien Status (N13) Under Pre-8/5/97 Law

Individuals who filed for SSI on or after 8/22/96 and were denied based on pre-8/5/97 welfare and immigration reform law may be eligible under the provisions of P.L. 105-33, which was enacted on 8/5/97. As instructed by EM-97207, FOs readjudicated these individuals" claims and awarded benefits, where possible, retroactively to the date of filing.

Because these were readjudications, not reopenings, the rules of administrative finality did not apply.

C. Procedure -- individuals who filed for SSI prior to 8/22/96 and were denied based on alien status (N13) on or after 8/22/96

IMPORTANT: If an individual contacting SSA needs language assistance, follow the guidelines in GN 00203.011 to ensure that a qualified interpreter is provided.

Central Office (CO) previously identified and referred to FOs approximately 8,500 denied (N13) claimants who, at the time of the systems selection in 1997, met the readjudication criteria described in SI 00502.152B.1. EM-97207 instructed FOs to send each of these individuals a come-in letter and to readjudicate the individual's previously denied claim.

Readjudication actions for most of the 8,500 cases have been completed. However, some cases may still be pending. Instructions contained in EM-97207 for the processing of the 8,500 cases are summarized below.

IMPORTANT: It is essential that any pending readjudications be completed as soon as possible.

1. CO/Regional Office (RO)/FO Processing

During 12/97, CO sent the ROs listings of individuals who had filed for SSI prior to 8/22/96 and who were denied based on alien status (N13) on or after 8/22/96. ROs referred the cases to servicing FOs. Upon receipt of the case listings, FOs sent each listed individual a manual come-in letter and subsequently readjudicated the individual's previously denied claim following the procedures below.

Cases containing pending appeal codes were included in the listings for RO and FO control purposes only. It was assumed that those cases were already under manual control in the FO. If the appeal code was accurate and up-to-date, the FO did not send a come-in letter to the individual.

2. Listings of Affected Individuals

FOs used listings provided by the ROs to identify individuals who had to be sent manual come-in letters. Before preparing a come-in letter, the FO obtained a current SSI query and verified that the record was still in N13 denial status. If the record was no longer in N13 status, EM-97207 instructed the FO to determine whether readjudication was still necessary.

EXAMPLE: The claimant, who was previously denied (N13) in 12/96, recontacted the FO in 10/97 (after the date cases had been selected for the readjudication initiative) to report that she had become a naturalized citizen. She filed a new initial claim and was awarded benefits beginning with 10/97. Pursuant to EM-97207, the FO reviewed the prior N13 denial to determine whether the prior claim needed to be readjudicated.

FOs reviewed listed cases containing pending appeal codes to ensure that the codes were accurate and up-to-date. If a final reconsideration, hearing, or Appeals Council decision had already been issued in the case, EM-97207 instructed the FO to input the correct PL field code and determine whether readjudication was still necessary.

3. Come-In Letters

The FO sent a come-in letter to each listed individual explaining that the SSI rules for people who were not U.S. nationals or citizens had changed and, as a result, the individual might be able to receive benefits even if his/her alien status had not changed. The letter asked the individual to contact the FO within 30 days and listed the types of evidence SSA needed to see.

4. Followup Letters to Nonresponders

If the individual did not contact the FO within 15 calendar days from the date of the come-in letter, the FO sent a followup letter. The 30-day closeout date included in the first letter was also included in the followup letter (unless the FO had negotiated a new date with the addressee).

5. Closing Out Cases Involving Nonresponders

If the individual did not respond by the applicable 30-day closeout date, the FO followed the closeout procedures in SI 00601.110.

EM-97207 emphasized the importance of making all possible efforts to obtain the information and evidence needed to readjudicate these cases.

A claimant was not to be found ineligible for SSI based on failure to cooperate (denial status N18) if:

  • a third party or prospective representative payee (other than those listed in SI 00601.110A.1.) failed to provide requested information or evidence; or

  • the FO could not obtain the information/evidence from a third party, the claimant had acted in good faith, and the FO could determine eligibility and payment based on information in file; or

  • ineligibility could be based on another denial reason.

Per SI 00601.110, before denying a claim based on failure to cooperate, the FO had to:

  • follow the procedures in SI 00601.100C. and SI 00601.120 for requesting information/evidence and offering assistance;

  • try to obtain the information/evidence from other sources, if third parties had failed to cooperate with SSA;

  • attempt to contact the individual by phone to determine if additional time was needed and to offer assistance;

  • review the case file for names of relatives, friends, or medical treating sources who might be able to provide assistance;

  • pursue any known sources of assistance including linkages with community organizations established through outreach activities--particularly important where a language barrier might have interfered with the claimant's ability to cooperate; and

  • develop for a new payee if the prospective representative payee (who was other than the legal guardian or parent with custody of a minor child) could not be located or failed to cooperate.

If the claimant's, payee's, or (in a couple's claim) the claimant's spouse's whereabouts were unknown, the FO followed the instructions in SI 00601.110B.6.

6. Denials for Failure to Cooperate (N18)

If a denial based on failure to cooperate was appropriate, the FO input denial code N18 and allowed the system to issue an automated denial notice (unless a manual notice was needed for some other reason).

7. Readjudicating Claims -- Determining SSI Eligibility

a. Using Prior Application

If the prior application was available (paper or MSSICS), the FO did not obtain a new application.

If the prior application was not available, the FO obtained another application but used the date of filing (DF) of the prior claim, if earlier than the application date (AP).

If the FO had to retrieve a prior file from a storage location, the FO did not delay taking any necessary readjudication actions--for example, requesting needed evidence.

b. Determining Alien/Citizen Status for Period Prior to 8/22/96

For the period beginning with the original application (AP) date (or the original date of filing (DF), if earlier), EM-97207 instructed the FO to determine whether the alien met the pre-8/22/96 alien eligibility policy in SI 00501.400 ff. and GN 00303.420 ff. during that period.

NOTE: For periods prior to 8/22/96, an individual who was lawfully admitted for permanent residence (LAPR) was potentially SSI-eligible based solely on that status. For periods prior to 8/22/96, an LAPR alien did not have to have 40 qualifying quarters (QQs) of coverage or military/veteran status to qualify for SSI. Similarly, prior to 8/22/96, an individual who was permanently residing in the U.S. under color of law (PRUCOL) (SI 00501.420) was potentially SSI-eligible based on that status alone (provided all other factors of eligibility were met).

FOs used evidence in file or evidence submitted by the individual to establish alien status for the period in question. If the alien alleged PRUCOL status and that status was not previously established, the FO verified the status under SI 00501.420 and SI 00501.430, with the following modifications (if Form SSA-4471 was required):

  • The FO annotated item 7 ("Other Information Attached") of Department of Homeland Security (DHS) Form G-845 as follows: "PRE-8/22/96 PRUCOL."

  • The FO did not diary for reverification.

EXCEPTION: If the alleged status was one of the qualified alien statuses listed in SI 00502.100A.2. and evidence of the qualified status was in file, the FO determined that PRUCOL status for the period prior to 8/22/96 was met and did not request verification from DHS.

8. Updating Other Factors of Eligibility

a. Disability Determination Needed

If a disability determination was needed, the FO obtained any needed disability forms and/or updated medical information already in file. The FO referred the case to the DDS for a medical determination following normal procedures.

The FO simultaneously updated/developed all nondisability factors of eligibility for the entire life of the application. FOs did not defer nondisability development pending receipt of the disability determination.

b. No Disability Determination Needed

  • File Already Contained Favorable Disability Determination

    If the file already contained a favorable disability determination that was rendered in connection with the claim then being readjudicated, no new disability determination was needed. Instead, the prior uneffectuated disability determination was used to effectuate the claim.

    If current development raised a question about continuing disability eligibility (see DI 13001.005 for events which may initiate a continuing disability review (CDR)), a CDR was to be conducted as soon as the claim was effectuated. However, if the only event involved was a matured medical review diary, the FO did not initiate a CDR. The case would be selected for a CDR through the CDR selection system.

    EM-97207 instructed the FO to update/develop all other factors of eligibility, including the individual's income, resources, and living arrangements.

  • Disability Was Not Pertinent to SSI Eligibility

    The FO updated/developed all other factors of eligibility, including the individual's income, resources, and living arrangements.

9. Individual Is SSI-Eligible

If after readjudicating the claim, the alien would receive SSI benefits ("receive" as defined in SI 00502.150B.1.) for the month of 8/96--for example, the alien would be in C01, E01, N01, N02, or N04--the alien would be able to receive SSI indefinitely, provided all other factors of eligibility continued to be met.

This is the case because the alien eligibility of an individual who received SSI benefits on (or for) 8/22/96 is "grandfathered." (See SI 00502.150 for information on the grandfathering provision that applies to qualified aliens who were receiving benefits on 8/22/96. See SI 00502.153 for information on the grandfathering provision that applies to nonqualified aliens who were receiving benefits on 8/22/96.)

IMPORTANT: If the individual was neither a PRUCOL nor LAPR alien during the period prior to 8/22/96, but subsequently adjusted to a qualified alien status, the individual could be SSI-eligible based on meeting the "blind/disabled and lawfully residing in the U.S. on 8/22/96" exception described in SI 00502.142. EM-97207 instructed FOs to be alert to situations where eligibility was possible for some, but not all, months within the life of the SSI application. In such situations, N13 payment status could be applicable for months prior to the first month in which the individual was eligible.

10. Individual Is SSI-Ineligible

a. N13 Denials

If the individual's alien status did not permit eligibility (the individual was neither a U.S. national/citizen nor an eligible alien), EM-97207 instructed the FO to deny the claim using denial code N13.

See the "IMPORTANT" note in SI 00502.152C.9. and the systems instructions in SI 00502.152C.11. for more information.

b. Denials Other Than N13

FOs followed normal systems input procedures (see SI 00502.152C.11. for more systems information).

11. Systems Input

a. Previously Denied Record in Terminated (T51) Status

If the previously denied record was in terminated status, the FO established a new record. (Alien systems instructions are contained in MSOM MSSICS 008.001 -1, SI 00502.142, and SM 01005.630 ff.)

b. Previously Denied Record Not in Terminated Status

The SSI system will not issue an automated award or denial notice if an award or denial notice has already been issued on a nonterminated record or the original (automated) notice was suppressed. Therefore, EM-97207 instructed the FO to terminate (T50) the prior denied record and establish a new record.

The T50 procedure also applied to claimants whose prior claims were denied N13 and who (following readjudication) would remain in N13. In such cases, a new SSI record for the readjudicated (N13) decision was to be established.

IMPORTANT: Under the readjudication initiative, all previously denied (N13) claimants had to receive new decisions in their cases.

D. Procedure -- N13 denials identified by CO-- individuals who filed for SSI on or after 8/22/96 and were denied based on alien status (N13) under pre-8/5/97 law

IMPORTANT: If an individual contacting SSA needs language assistance, follow the guidelines in GN 00203.011 to ensure that a qualified interpreter is provided.

On 1/12/98, CO mailed automated come-in letters to approximately 23,500 denied (N13) claimants who met the readjudication criteria described in SI 00502.152B.2. The letters were dated 1/17/98. All records in N13 denial status where the denial was input 8/22/96 through 9/12/97 received these come-in letters (with the exception of records containing pending appeal codes). CO provided the ROs with listings of individuals who were sent letters. The ROs subsequently sent each FO a listing of cases within the FO's service area. EM-97207 instructed FOs to readjudicate these individuals" previously denied claims.

Cases containing pending appeal codes were included in the listing for RO and FO control purposes only. It was assumed that those cases were already under manual control in the FO. Therefore, automated come-in letters were not sent in those cases.

Readjudication actions for some of these cases may still be pending. Instructions contained in EM-97207 for the processing of the 23,500 cases are summarized below.

IMPORTANT: It is essential that any pending readjudications be completed as soon as possible.

1. Followup Letters to Nonresponders

If the individual did not contact the FO by close of business 2/2/98, the FO sent a followup letter asking the individual to contact the FO by 2/16/98 (30 days after the date of the automated come-in letter), provided a later date had not been negotiated with the addressee.

2. Closing Out Cases Involving Nonresponders

If the individual did not respond by the applicable 30-day closeout date, the FO followed the closeout procedures in SI 00601.110.

EM-97207 emphasized the importance of making all possible efforts to obtain the information and evidence needed to readjudicate these cases. (See SI 00502.152C.5. for the mandatory closeout procedures that applied in these cases.)

3. Denials for Failure to Cooperate (N18)

If a denial based on failure to cooperate was appropriate, the FO input denial code N18 and allowed the system to issue an automated denial notice (unless a manual notice was needed for some other reason).

4. Readjudicating Claims -- Determining SSI Eligibility

a. Using Prior Application

If the prior application was available (paper or MSSICS), the FO did not obtain a new application.

If the prior application was not available, the FO obtained another application but used the date of filing (DF) of the prior claim, if earlier than the application date (AP).

If the FO had to retrieve a prior file from a storage location, the FO did not delay taking any necessary readjudication actions--for example, requesting needed evidence.

b. Determining Alien/Citizen Status Under P.L. 105-33

The FO reviewed the file for evidence of alien status (or U.S. national/citizen status) and applied the policies in SI 00502.001 ff. to determine whether the claimant was an eligible alien (or U.S. national/citizen). If not previously developed, the FO obtained needed information/documentation of alien status.

If the individual was an eligible alien (or U.S. national/citizen), the FO updated all eligibility factors per SI 00502.152D.4.c.

If the individual was not an eligible alien (or U.S. national/citizen), the FO followed the instructions in SI 00502.152C.11. to ensure that every individual received a new N13 denial notice.

c. Updating Other Factors of Eligibility

  • Disability Determination Needed

    If a disability determination was needed, the FO obtained any needed disability forms and/or updated medical information already in file. The FO referred the case to the DDS for a disability determination following normal procedures.

    EM-97207 reminded FOs that some of the claimants involved in this readjudication initiative might be SSI-eligible based on meeting the "blind/disabled and lawfully residing in the U.S. on 8/22/96" exception described in SI 00502.142. If a disability determination was needed for an aged alien, FOs were instructed to follow the instructions in SI 00502.142.

    The FO simultaneously updated/developed all nondisability factors of eligibility for the entire life of the application. FOs did not defer nondisability development pending receipt of the disability determination.

  • No Disability Determination Needed--File Already Contained Favorable Disability Determination

    If the file already contained a favorable disability determination that was rendered in connection with the claim then being readjudicated, no new disability determination was needed. Instead, the prior uneffectuated disability determination was used to effectuate the claim.

    If current development raised a question about continuing disability eligibility (see DI 13001.005 for events which may initiate a continuing disability review (CDR)), a CDR was to be conducted as soon as the claim was effectuated. However, if the only event involved was a matured medical review diary, the FO did not initiate a CDR. The case would be selected for a CDR through the CDR selection system.

    EM-97207 instructed the FO to update/develop all other factors of eligibility, including the individual's income, resources, and living arrangements.

  • No Disability Determination Needed--Disability Was Not Pertinent to SSI Eligibility

    The FO updated/developed all other factors of eligibility, including the individual's income, resources, and living arrangements.

5. Systems Input and Notices

FOs followed the systems instructions in SI 00502.152C.11. to ensure that every individual received a new initial claim award or denial notice.

E. Procedure -- readjudicating newly identified denied (N13) claims

IMPORTANT: If an individual contacting SSA needs language assistance, follow the guidelines in GN 00203.011 to ensure that a qualified interpreter is provided.

1. Identifying N13 Denials for Readjudication

In the course of routine business--for example, in conjunction with responding to an inquiry or processing a redetermination--the FO may identify an individual whose prior N13 denial meets the criteria for readjudication described in SI 00502.152B.1. or SI 00502.152B.2., but whose denial was not previously readjudicated and/or was not referred by CO to the FO for readjudication. In such a case, readjudicate the prior denial following the procedures below.

EXAMPLE: An alien who was lawfully admitted for permanent residence (LAPR) in 1994 filed for SSI in 7/96. In 12/96, the claim was denied based on alien status (N13).

In 2/97, the individual became a naturalized U.S. citizen and refiled for SSI. The 2/97 claim was allowed.

Since the individual was no longer in N13 denial status when (during late-1997) CO identified records meeting the readjudication criteria, the individual's prior N13 denial was not referred to the FO for readjudication. Upon identifying the prior N13 denial as meeting those criteria, the FO should readjudicate the denied claim.

2. Prior Claim Denied N13--Individual Still in N13 Denial Status

Readjudicate according to applicable procedures in SI 00502.152C. or
SI 00502.152D. any claim that:

  • was denied due to alien status (N13) using the welfare and immigration reform eligibility rules in effect prior to 8/5/97;

  • meets the criteria for readjudication described in SI 00502.152B.1. or
    SI 00502.152B.2.; and

  • shows no indication -- in the file or on the Supplemental Security Record
    (SSR) -- of having previously been readjudicated.

3. Prior Claim Denied N13--Individual Subsequently Refiled and Was Allowed

Apply the alien eligibility policies described in SI 00502.100 ff. and determine whether the individual was an "eligible alien" (and, if so, met all other factors of SSI eligibility) for the period beginning with the date the prior claim was filed and ending with the date the individual refiled for SSI.

a. Readjudication Results in Underpayment

Follow SSI one-time payment systems procedures to pay the underpayment (SM 01901.001 ff.).

Manually prepare an SSA-L8100-U2, “SSI Notice of Revised Determination," explaining the basis for the underpayment. (The SSA-L8100-U2 advises the recipient of his/her right to appeal the determination.)

Annotate the record in Remarks (RM field) to indicate that the N13 readjudication resulted in an underpayment.

b. Readjudication Does Not Result in Underpayment

No underpayment is due if:

  • under the alien eligibility rules described in SI 00502.100 ff., the individual was not an eligible alien during the period covered by the prior N13 denial; or

  • the individual is ineligible for the entire period in question due to a reason other than alien status--for example, due to excess income or resources.

Manually prepare an SSA-L8166, “SSI Important Information," explaining the reason the individual remains ineligible for the period covered by the prior N13 denial. (The SSA-L8166