TN 2 (03-05)

SI 00530.015 Good Cause Provision

NOTE: On April 1, 2009, SSA changed its policy of not paying fleeing felons. Follow the instructions below only for felony warrants with offense codes 4901, 4902, or 4999. Follow the Martinez settlement instructions in GN 02613.860 GN 02613.885 for all other felony warrant codes.

On May 9, 2011, SSA changed its policy and no longer suspends or denies benefits or payments based solely on a probation or parole violation warrant (i.e., warrants with offense codes 5011, 5012, 8101, 8102, or 9999 or “Blank” and an offense charge symbol of “probation or parole violation”). Follow the Clark Court Order instructions in GN 02615.100 GN 02615.190 for all probation or parole violation warrants.

We will make additional changes to this section, as necessary, in the future.

A. Introduction

Effective January 2005, the Social Security Protection Act (SSPA) of 2004 provides a “good cause” exception requiring the Commissioner to not suspend an individual’s benefit, and/or repay any previously withheld benefit under certain circumstances. The SSPA also gives the Commissioner the discretionary authority to find good cause for not suspending an individual’s benefit and/or repay any previously withheld benefit based on mitigating circumstances if the individual establishes that the offense underlying the warrant and imposition of the probation or parole (as well as the violation of probation or parole) was both nonviolent and not drug-related.

SSA will evaluate the reasons why a recipient did not satisfy his/her warrant. This includes analysis of the incoming warrant information, verification of the warrant information by the Office of the Inspector General (OIG), information provided by the recipient, and review of the recipient’s Social Security records. This evaluation will determine whether there is good cause to continue payments. First we look for mandatory good cause. If that is not found we look for discretionary good cause based on mitigating circumstances.

NOTE: See SI 00530.015B.2.b for instructions on applying good cause when the beneficiary lacks the mental capacity to resolve the warrant.

B. Policy

1. Mandatory good cause

The statute mandates that SSA not suspend an individual’s SSI payment, and/or repay a previously withheld payment, if:

a. Court of competent jurisdiction

A court of competent jurisdiction has

  • found the individual not guilty of the criminal offense or probation/parole violation; or

  • dismissed the charges relating to the criminal offense or parole/probation violation; or

  • vacated the warrant for arrest of the individual for the criminal offense or probation/parole violation; or

  • issued any similar exonerating order or taken similar exonerating action (e.g., the criminal offense on which the warrant is based is either no longer considered a crime punishable by death or confinement of more than one year or no longer enforced).

OR

b. Individual erroneously implicated

The individual was erroneously implicated in connection with the criminal offense by reason of identity fraud.

2. Discretionary good cause

If good cause cannot be found based on mandatory good cause, recipients will be given the opportunity to establish good cause based on mitigating circumstances. Good cause based on mitigating circumstances will be found if the factors in either Option A or Option B are met. If the required factors are not present on the warrant or in SSA records, SSA cannot establish good cause unless the recipient provides the needed evidence.

a. Option A

Find good cause if:

  • The criminal offense or probation/parole violation on which the recipient was charged or convicted was non-violent and not drug related. For a probation/parole violation the original offense was also non-violent and not drug related; and

  • The recipient was not convicted of or pled guilty to any subsequent felony crimes since the warrant was issued; and

  • The law enforcement agency that issued the warrant reports that it will not extradite the fugitive or is unwilling to act on the warrant.

b. Option B

Find good cause if:

  • The criminal offense or probation/parole violation on which the recipient was charged or convicted was non-violent and not drug related For a probation/parole violation the original offense was also non-violent and not drug related; and

  • The recipient was not convicted of or pled guilty to any subsequent felony crimes since the date the warrant was issued; and

  • The warrant is/was the only existing warrant and was issued 10 or more years prior to the date the Fugitive Felon Match processed the current warrant information; and

  • The recipient lacks the mental capacity to resolve a warrant as evidenced by one of the disability diagnostic codes listed in SI 00530.920; or is incapable of managing payments; or is legally incompetent; or Social Security has appointed a representative payee to handle his/her payments; or is residing in a long-term care facility, such as a nursing home or mental treatment/care facility..

3. When good cause may be requested and established

a. Mandatory good cause

Recipients may request mandatory good cause at any time. The time for making this request is not limited by Administrative Finality.

b. Discretionary good cause

Recipients may request discretionary good cause at any time up to 12 months from the date of the Notice of Planned Action notifying them of the planned fugitive suspension.

c. Good cause establishment period

Once either mandatory or discretionary good cause is requested, recipients have 90 days from the date of the request to provide the evidence necessary to show good cause. If, at the end of the 90-day period, the recipient has not submitted the necessary evidence, good cause will be denied.

4. Proof of good cause

The recipient must provide evidence to support a claim for good cause for not satisfying a warrant and that evidence must meet the following requirements.

NOTE: For purposes of this procedure “official” means:

  • Information about the claimant or warrant is on the letterhead of the court, appropriate law enforcement agency or probation/parole agency that issued the warrant or court document; and

  • The person signing the document has knowledge that the facts presented in the letter are correct and have been verified by the issuing agent.

Good Cause Criteria

Evidence Needed

  1. The court found the individual not guilty of the crimes or dismissed the criminal charges or withdrew the warrant.

  • A copy of the court docket indicating the individual was found not guilty of the criminal charges or a copy of the court decision showing that the individual was found not guilty of the criminal charges.

  • A copy of the court docket indicating charges were dismissed or another official court or law enforcement agency document stating that it dismissed the criminal charges.

  • A copy of the court docket or another official warrant issuing agency document indicating the warrant in question was withdrawn.

  1. The law enforcement agency that issued the warrant reported that someone else used the recipient’s identity fraudulently.

An official document from the court or the warrant issuing agency stating that the warrant was erroneously issued in the individual’s name.

  1. The criminal charges on the warrant are non-violent and not drug related.

An official copy of the arrest warrant. The warrant must include the criminal charges on which the individual is wanted. Evaluate the charges using the chart in SI 00530.910B.2.

Other documents, including but are not limited to, such as a docket, a conviction notice, or a plea agreement.

For probation/parole violators only.

  1. The original criminal charge on which the recipient was convicted and granted probation or parole, was nonviolent and not drug related.

Court documents describing the trial proceedings and the criminal charges on which he/she was originally convicted. Examine the criminal charge(s) on the documents and classify the crime by the categories on the chart in SI 00530.910B.2.

  1. Was the recipient convicted of another felony since the warrant was issued?

A statement over the penalty clause on the SSA-795 as to whether they have been convicted of or pled guilty to any such crimes since the date of the warrant.

  1. Law enforcement will not extradite the recipient or is unwilling to arrest the recipient for the warrant.

An official document from the warrant issuing law enforcement agency stating that it will not extradite the individual for the charges on the warrant or that it will not take action on the warrant for his/her arrest. If this information has already been reported on the OI-5D, this documentation is not needed.

  1. The recipient is incapable or legally incompetent.

A copy of the court order that appointed a conservator or guardian to handle the recipient’s affairs or that declared him/her legally incompetent. If SSA already has this information or the claimant has a representative payee, the documentation is not needed.

  1. The recipient is residing in a long-term care facility.

A statement over the penalty clause on the SSA-795 that the recipient is residing in such a facility. If SSA already has this information or the claimant has a representative payee, this documentation is not needed.

C. Procedure - evaluating OI-5D report and SSA records to determine if good cause applies

1. Receipt of warrant information

The FO will receive all unsatisfied warrant information from the Fugitive Felon Matching Operation for Title II only, Title XVI only and concurrent cases for action.

2. Evaluation of OI-5D and other SSA records

a. OI-5D

Some good cause criteria can be determined by reviewing the OI-5D for the following information:

  • Type: Fugitive Felon or Parole or Probation Violator

  • Date of Warrant: MM/DD/YYYY

  • Law Enforcement Agency Action Indicator: X (See SI 00530.925 for values for this code.)

  • Fugitive Indicator: X (See SI 00530.930 for values for this code.)

  • Originating Felony Charge(s): Burglary (This field contains information on the original criminal offense on which the recipient was convicted before probation/parole was granted.)

  • Remarks: Parole Violation (Aggravated Assault). (This field may contain information about the criminal charge that caused the probation/parole violation. It may also include information about other relevant charges.)

b. SSR

  • On a disability claim, check the medical diagnosis code (DIG) found on the DISB line of the SSR. See SI 00530.920 for diagnostic codes used for good cause reasons.

  • If the recipient has a rep payee, check REP PAYEE line to determine if recipient is legally incompetent.

  • Verify if recipient has a period of prisoner PSY N02/N22 for prisoner suspension on the SSR. This period of suspension may be a clue that the recipient was previously incarcerated for his/her underlying crime before he/she was granted probation/parole. If the PSY N02/N22 period is subsequent to the warrant information, the warrant may no longer be active.

c. PUPS

If the unsatisfied warrant is for a probation or parole violation, check the PUPS record for information on the recipient’s original offense. Determine the criminal offense and compare it to the list of offense codes in SI 00530.910B.2. If the offense is listed in one of the violent or drug related categories, the offense for the underlying criminal charge is considered violent or drug related. If the offense is not listed in one of the categories listed in SI 00530.910B.2., assume the underlying criminal offense before probation/parole was granted was not violent and not drug related. Check the PUPS record to determine if the warrant date precedes the prisoner suspension period. If so the warrant may have been satisfied when the recipient was arrested and confined.

3. Multiple criminal offenses on the same warrant

There may be multiple offense codes listed on the same warrant. One offense code will be listed in the offense code field on the OI-5D. Other offenses will be listed in the Remarks section of the OI-5D. The Remarks section may also contain additional probation/parole violation offense codes. Evaluate each offense independently to determine if good cause applies. If good cause is found for one offense but not for another, good cause is not found and the suspension will begin. For example, a person charged with smuggling diamonds (non-violent felony) and aggravated assault (violent felony) will be suspended based on the violent criminal offense - the aggravated assault.

4. Underlying criminal offense for probation/parole violators

If you cannot determine via the Originating Felony Charge(s) on the OI-5D, the PUPS record or other information in the SSA file, the underlying criminal charge for the crime the recipient committed before he/she was granted probation/parole, SSA cannot make a determination about the nature of this crime (i.e., if the crime is a felony or a misdemeanor or if it was non violent and not drug related). The recipient must provide evidence from the State or county in which the crime was committed as to the nature of the crime (i.e. not violent and not drug related) and also the penalty for the crime in order to meet the burden for establishing good cause based on mitigating circumstances.

5. Recipient is deceased

If the OI-5D comes back from OIG indicating LEA code of “K,” (Fugitive Deceased), take the following actions:

STEPS

ACTIONS

1

Evaluate whether administrative good cause may apply to the criminal charges on the deceased recipient’s warrant.

2

If:

  • Good Cause applies process per SI 00530.015E.

  • Good Cause does not apply-- Suspend benefits N25 per SI 00530.010 for the period of probation/parole violation suspension before the date of death.

    Add the following information to the REMARKS field on the SSID:

    “FF16 Probation/Parole Violator Suspension—Recipient Deceased XX/XX/XXXX - Warrant #, Date of Warrant: XX/XX/XXXX, Type of Warrant: XXXXXX; Offense Code: XXXX. Good Cause Does Not Apply”

    Post overpayment to SSR.

3

Prepare OI-5E per SI 00530.200E.

4

Do not send notice to a deceased recipient. If overpayment exists and a representative payee was contingently liable, send notice to the payee.

6. Recipient resides in a long-term care facility

  • For good cause purposes, deem recipients residing in a long-term care facility to be incapable even if they are their own payee. Develop the need for a payee (see GN 00502.000).

  • If the recipient leaves the long-term care facility and still does not have a representative payee, reopen the good cause determination and make a new determination based on whether the recipient currently meets the good cause requirements.

7. Documenting the determination

If good cause is found:

  • Annotate the REMARKS field of the SSR with: “FF16—Warrant XXXXXXX, dated MM/DD/YYY, NCIC code: XXXXX ‘GOOD CAUSE WAS ESTABLISHED’ FF16 suspension does not apply.”

  • Prepare an OI-5E per SI 00530.200E. Add the good cause Indicator (see below) to the OI-5E to document if good cause was found.

    CODE

    Good Cause Reason

    MID

    Warrant was issued incorrectly because of identity theft or other identity issue.

    MNG

    Individual found not guilty of the criminal offense.

    MCD

    Criminal charges were dismissed.

    MWW

    Warrant was withdrawn.

    MCC

    Criminal charges were otherwise cleared.

    DNP

    Law enforcement not taking action on the warrant.

    DMC

    Mental condition impairs capability to resolve the warrant (based on impairment code).

    DRP

    Individual has a representative payee, is incapable or incompetent.

    DNH

    Individual is residing in a long-term care facility such as a nursing home or mental treatment facility.

  • Annotate the EVID screen on the SHARED Process on the SSA Main Menu with the Good Cause Determination explaining the current circumstances and the reason(s) and evidence the recipient provides for requesting good cause and SSA’s justification for establishing good cause.

Step 1

From the Main SSA Menu (SC00), Select SHARED PROCESSES (#4), then enter the SSN and select ESTABLISH, and EVIDENCE (#1)

Select Program #1

Select Type # 3 (Unless this is a claims action, then select type #2)

Document Submitted as Proof of the Following Event/Issues: Select “Other”

Document Event Date: Enter the Date Good Cause Determination was Made

Step 2

Skip to Document Type: Enter “FF Good Cause Determination”

Step 3

Skip to Comments: Enter: “FF16 Good Cause Determination—Good Cause Applies Based on Mandatory Good Cause/Mitigating Good Cause Circumstances.”

Step 4

Input Your Personal identification information in the following fields:

  • Name

  • Position

  • Office Code

and include the current date in the date field.

NOTE: Go to Step #5. The reason for the good cause decision must be documented to reflect the specific reasons and evidence that used to find good cause.

Step 5

Skip to the field “Additional Evidence” and Enter “Y.

Provide the specific type of good cause you are granting the recipient (i.e., Mandatory good cause or Mitigating Circumstances (Discretionary good cause). List evidence used to make good cause determination.

NOTE: The same good cause determination will apply to Title XVI and Title II if the cases are concurrent. Prepare only one determination.

D. Exhibit - good cause information in SSA records and on the OI-5D

Use the following chart to find Good Cause information in SSA records (SSR) and on the OI-5D.

Good Cause Criteria

Available Information

  1. Was the offense non-violent and not drug related?

OI-5D

Refer to SI 00530.910 for list of 4-digit Offense Codes.

  • If the offense code is not in one of the categories on the chart then assume crime is nonviolent and not drug related.

  • If the crime can not be categorized because the description is not clear, refer to SI 00530.150 for instructions.

  1. Probation and Parole Violators only - Was the underlying criminal offense before probation or parole was granted, non- violent and not drug related?

OI-5D

  • Originating Felony Charge(s): Burglary, etc.

  • Remarks: Name of criminal charges for the fugitive

SSR:

History field shows period of LAF N02/N22.

PUPS

PUPS records shows period of confinement for underlying criminal offense.

  1. Was the recipient convicted of any subsequent criminal charges for crimes that carry a penalty of death or imprisonment for more than 1 year?

OI-5D

Date of Warrant: MM/DD/YYYY (Date LEA issued warrant for the recipient’s arrest)

SSR

Period of N02/N22 prisoner suspension on the SSR. Suspension period starts after date of warrant.

PUPS

PUPS record indicates a period of confinement. The confinement date is after the warrant date. A conviction date is on PUPS. The conviction date is later than the date of the warrant.

  1. Will the law enforcement agency (LEA) that issued the violation warrant extradite the recipient or is the LEA willing to act on the warrant?

OI-5D

LEA Code: code is D

  1. Was the unsatisfied warrant issued 10 or more years prior to the SSA Run Date on the OI-5D?

OI-5D

Date of Warrant: MM/DD/YYYY (Date LEA issued warrant for the recipient’s arrest)

SSA Run Date: MM/DD/YYYY

  1. Does the recipient have a mental impairment that that would prevent him/her from resolving the unsatisfied warrant?

SSR

DIG Code (XXXX) in DISB data line on the SSR has one of the codes listed in SI 00530.920.

  1. Does the recipient have a rep payee or is recipient incapable/incompetent.

SSR

REPY Data line shows representative payee. To determine competency refer to SM 01601.565C.18. for CO codes.

NOTE: If any of the above factors are unknown by SSA or cannot be determined at the time you are reviewing the SSA records or warrant information, process the case per SI 00530.010. The recipient must provide the evidence or information to make a good cause determination.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500530015
SI 00530.015 - Good Cause Provision - 06/06/2013
Batch run: 06/06/2013
Rev:06/06/2013