Effective Dates: 12/28/2023 - Present Previous | Next

TN 55 (12-23)

SI 00601.050 Withdrawal of Supplemental Security Income (SSI) Application

CITATIONS:

20 CFR 416.355 and 416.360

A. Introduction

This section describes the policy and procedures for withdrawal of an SSI application, cancellation of the withdrawal request, and situations where consent is involved.

NOTE: 

The systems payment status code for a withdrawn claim is N12.

B. Policy -- effect of withdrawal

When we approve a request for withdrawal of an application, we treat the application as though it was never filed.

NOTE: 

A withdrawal request does not become effective until the Social Security Administration (SSA) approves it.

C. Policy -- when to raise the issue of withdrawal

We raise the issue of withdrawal of an application with the individual when withdrawal provides some definite advantage to the individual. We raise the issue of withdrawal in the following situations:

NOTE: 

There may be instances where voluntary termination is a more reasonable alternative to withdrawal of the claim. (See SI 02301.230 regarding voluntary termination.)

1. Couple's case -- deeming yields more

In this situation, two individuals have filed (or receive payments) as a couple, but one member's income is such that the other member would receive more as an eligible individual with an ineligible spouse than the "couple" would receive. (See SI 00601.050E.3., Example 1.)

2. Couple's case -- windfall offset

In this situation, at least one member of a couple is subject to Title II offset and some SSI would be payable during the offset period to the member who does not withdraw, and the total Title II and SSI payable to the couple could be higher than if both remained eligible for SSI (consideration has to be given to the effect of SSI eligibility prior to and after the offset period). (See the Examples in SI 00601.050E. and SI 00501.154D.5.)

3. Deeming to spouse and child

In this situation, an eligible child receives less than they otherwise would have because a parent has filed for or has been eligible for SSI; the eligible parent has unearned income; there is an ineligible child allocation greater than zero; the ineligible spouse has earned income greater than $65; and deemed income makes the parent/spouse ineligible. (See SI 01320.650 for a further explanation of this situation.)

D. Policy -- conditions for approval of withdrawal

1. Written request filed with SSA

The request for withdrawal must be signed and filed with SSA.

a. Who must sign request

The claimant or proper applicant must sign the request. (See SI 00601.012 for a description of a proper applicant.)

b. Meaning of "filed with SSA"

A withdrawal request is considered filed with SSA when it is received at a Social Security office, another Federal or State office SSA has designated to receive applications, or with a person SSA has authorized to receive applications.

c. Definition of filing date

SSA considers a withdrawal request filed on the day it is received at a Social Security office. However, the U.S. postmark date may be used as the filing date if using the date the withdrawal request is received would result in a loss of payments or rights. If the postmark is unreadable or missing, use the date the request is signed or 5 days before the day it was received, whichever is later.

d. No time limit on filing

There is no time limit on when a request for withdrawal of an SSI application may be filed, but the date the withdrawal is filed could be material in determining whether other conditions for approving the withdrawal are met (see SI 00601.050D.3. and SI 00601.050D.4.).

2. Necessary elements of request

A withdrawal request must contain the following elements.

a. Specification of the application filing date

An individual requesting to withdraw their SSI application may have more than one prior filing on SSA records. The request must specify which SSI application the withdrawal request is for (e.g., SSI application filed January 15, 2020).

b. Reason for withdrawal

The request must state the reason or purpose for the withdrawal.

c. Acknowledgment of effect

The request must contain a statement acknowledging the effect withdrawal may have on Medicaid eligibility and a statement of the effect on interim assistance reimbursement, if applicable. The withdrawal can be approved without the acknowledgment statement if the file contains:

  • •

    An explanation for not obtaining the acknowledgment statement, and

  • •

    Documentation of the explanation provided to the claimant, recipient, or proper applicant.

NOTE: 

Advise the individual to contact the State agency prior to withdrawing the SSI claim to determine if the State requires repayment of interim assistance.

d. Effects of withdrawal when it is disadvantageous

If a withdrawal is clearly disadvantageous to an individual, the request must contain a detailed description of the effects of the withdrawal. The withdrawal can be approved without this description if the file contains:

  • •

    An explanation for not obtaining the detailed description, and

  • •

    Documentation of the disadvantages explained to the claimant, recipient, or proper applicant.

e. The benefits of denial over withdrawal

If a denial would serve the same purpose as a withdrawal but the individual insists on withdrawing, the request must state that the individual understands there is no need to withdraw the claim. A denial preserves appeal rights based upon that application, whereas a withdrawal does not; and a subsequent application will not be effective for the same period.

f. Explanation of conditional withdrawal

If an individual's desire for a withdrawal is based on the expected outcome of another event (i.e., the withdrawal is conditional), the request must contain an explicit explanation of the condition.

3. Claimant must be alive

The claimant must be alive at the time of filing the request.

4. Request filed after a determination is made

If the request for withdrawal is filed after a determination has been made on the application, in addition to meeting the requirements of SI 00601.050D.1., SI 00601.050D.2., and SI 00601.050D.3., the following conditions must be met:

a. Consent of others

Anyone who would lose eligibility to payments or whose payments would be reduced if the withdrawal is approved must consent in writing. A proper applicant who can sign an application for that individual may give the consent. (See SI 00601.012 for proper applicant policy.) If SSA cannot obtain consent, the withdrawal cannot be approved.

NOTE: 

If another recipient refuses to give consent, try to obtain a statement of the refusal with the recipient's signature. If the other recipient will not cooperate in providing a statement, document the file.

b. Repayment

All benefits already paid based on the withdrawer's application must be repaid or SSA must be satisfied that they will be repaid. One method of assuring repayment is by a one-time adjustment to a Title II underpayment (cross-program adjustment). See instructions on cross-program adjustment in SI 02220.020. Accept repayment in the form of cash, money order, cashier's check, certified or uncertified check. Inform the individual that they are responsible for payments lost in the mail.

NOTE: 

If the withdrawal reduces another recipient's payment or makes them ineligible, any overpayment created by the withdrawal on this recipient's record need not be repaid in order to approve the withdrawal. (See SI 00601.050E. for further information on the effect of withdrawal on another.)

E. Policy -- effect of withdrawal on other payments/benefits

1. Effect of withdrawal on another's Title XVI payments

Although there is no time limit on withdrawing an SSI application, administrative finality rules limit the withdrawal's effect on another person's SSI eligibility and payment amount for past months. (See SI 04070.001 through SI 04070.080 for the rules of administrative finality.)

REMINDER for couple's cases: When one member of a couple withdraws and the other remains eligible, SSI payments already made to the couple are considered payments to the remaining eligible member. Compute the amount to refund by calculating the difference between what the couple received and what the remaining eligible member would have received as an eligible individual with an ineligible spouse.

2. Effect of withdrawal on Title II payments

Adjusting the amount of Title II payments that should have been withheld for Title II offset is not limited by the rules of administrative finality.

3. Examples

  • •

    Type of income affects deeming computation

    Robert and Barbara filed for SSI as an aged couple. Both members were receiving Title II retirement benefits and Robert was receiving a Department of Veterans Affairs (VA) pension based on need. They were advised that Barbara would receive more as an eligible individual with an ineligible spouse than they would both receive as an eligible couple because neither Robert's VA pension nor their retirement benefits are deemed to Barbara. However, Robert decided to pursue their claim for the Medicaid coverage. Three years later, Robert inquired about changing their decision. The claims specialist (CS) advised Robert that although there was no time limit on filing a withdrawal request, withdrawal at this time would not affect their spouse's payment back to their first month of eligibility because of administrative finality. A withdrawal would mean they would have to refund the SSI paid to them as a member of an eligible couple from the first month of eligibility to the first month we could change their spouse's status based on administrative finality rules. (NOTE: Robert would only have to refund the difference between what the couple received and what Barbara would have received after the spouse's status changed because the payments they received as a member of an eligible couple are deemed to have been paid to their spouse.) As an alternative, the CS discussed with Robert the possibility of voluntarily terminating their SSI payments. (See SI 02301.230 for voluntary termination policy.)

  • •

    Title II offset in a couple's case

    In May 2018, Jesse and Pat were awarded SSI payments as an eligible couple based on an application filed in March 2018. In September 2018, Pat was awarded Social Security disability benefits with an entitlement date of March 2017. Their retroactive Title II check was offset by the amount of SSI they had been paid for March through August. SSI eligibility ended for the couple because of the Title II income.

    In July 2018, Pat learned from their neighbor that virtually the same thing had happened to the neighbor, but the neighbor had been advised that withdrawal of their SSI application would prevent offset from being applied to the Title II benefits, while their spouse would still be eligible for SSI. Pat visited the field office (FO) within the next week and requested a withdrawal. Since there is no time limit on the filing of a withdrawal and the rules of administrative finality do not apply to the adjustment necessary to the amount of the Title II benefits already paid and there is no adjustment to be made to the SSI payments received by Jesse because of administrative finality, the FO approved the withdrawal. However, Pat would have to refund the SSI benefits paid to them.

  • •

    Deeming to a spouse and child lowers payment to child

    Kelly filed for SSI for their son, Jeff, and for themselves. Kelly has unearned income, their spouse has wages, there is an ineligible child allocation, and Kelly is ineligible due to deemed income from their spouse. Jeff's disability was allowed and they began receiving SSI payments. At a redetermination a year later, the CS noted that Jeff's payment would be higher if Kelly was not on the record as a filer. (For an example of the computation involved, see SI 01320.650.) The CS explained the situation to Kelly and further explained that they could withdraw their application, as there was no time limit on doing so. They decided to withdraw their application. Applying the rules of administrative finality, the CS determined Jeff's payment could increase all the way back to their first month of eligibility.

F. Policy -- denial vs. withdrawal

A denial is preferable to a withdrawal if a claimant does not want to pursue the claim. A denial affords the claimant appeal rights.

G. Policy -- cancellation of withdrawal or consent

1. Claimant requests cancellation

The claimant may cancel a request for withdrawal. The cancellation request must:

  • •

    Be filed while the claimant is alive;

  • •

    Be signed by a proper applicant (see SI 00601.012);

  • •

    Give a reason for the cancellation; and

  • •

    Be filed with SSA within 60 days after the date of the notice of withdrawal approval. See SI 00601.050D.1. for an explanation of "filed with SSA".

EXCEPTION: The cancellation request may be honored if received after the 60-day time limit if the withdrawal was a conditional withdrawal and the condition did not materialize. (See GN 00206.055 for conditional withdrawal policy.)

2. Another individual rescinds consent

An individual who gave consent to the withdrawal because it affected their payment may rescind consent within 60 days after the date of the notice of withdrawal approval. There is no exception to the time limit. A proper applicant must sign this request. (See SI 00601.012 for determining the proper applicant.)

When consent from an individual (or proper applicant on their behalf) is rescinded within the 60-day period, the FO must advise the claimant that the rescission will nullify the withdrawal approval.

H. Policy -- scope of withdrawal

A withdrawal nullifies all classes of benefits covered by that application unless the withdrawal request specifically states that the individual does not want to withdraw a certain class of benefits (e.g., Title II). An SSI application is also an application for:

  • •

    Title II,

  • •

    Title VIII, if the eligibility requirements in VB 00102.001 through VB 00102.010 are met,

  • •

    Title XIX in 1634 States as defined in SI 01730.005, and

  • •

    Federally administered State supplementation.

However, if a separate Title II or Title VIII application was filed, it is not withdrawn when the SSI claim is withdrawn.

I. Procedure -- documenting a request for withdrawal

NOTE: 

There is no particular form for requesting a withdrawal of an SSI application.

1. Request prepared by the individual

If the individual submits a written request containing all the elements described in SI 00601.050D.2., do not request anything further.

2. Request prepared by FO

If you have the opportunity to prepare a document for the individual's signature, prepare it on a SSA-795 (Statement of Claimant or Other Person). If possible, generate the SSA-795 using the Consolidated Claims Experience (CCE) by selecting "add person statement" on the Person Statement screen in the CCE Development Menu.

J. Procedure -- documenting a withdrawal determination

1. Claim in the FO

No matter what form the withdrawal request takes -- a letter, SSA-795, etc., annotate "Withdrawal" at the top of the document and annotate "Approved" or "Disapproved" at the bottom. Annotate the reason for disapproval, if applicable, sign and date your determination at the bottom, and provide your position title.

NOTE: 

If the withdrawal can be processed in the CCE System (see SI 00601.050K.), then you may document your determination of approval or non-approval by using the Report of Contact screen in the CCE Development Menu in addition to the paper record.

2. Claim pending at the hearing level

If the claim is pending at the hearing level of administrative review when the individual files the request to withdraw the application, notify the hearing office immediately following standard local procedures (i.e., phone, email, or both) and confirm that an administrative law judge has not acted on the claim (e.g., by issuing a decision or dismissal). Obtain any necessary documentation per SI 00601.050D; process the request, either approving or disapproving the application withdrawal; and document the determination as outlined in SI 00601.050J.1. Forward the withdrawal request with the determination to the hearing office for further action, as necessary.

K. Procedure -- effectuating the withdrawal through the CCE System

You may process the withdrawal through the CCE System by entering a denial code of N12 on the Determination screen in the CCE Clearance Menu.

NOTE: 

You must have a pending SSI Claims system file with a Pending File Begin Date equal to the effective filing date to properly effectuate the withdrawal.

L. Procedure -- preparation of notices

See NL 00804.215 to view the paragraphs mentioned below.

1. Request refund

If the claimant has received Title XVI payments based on the application being withdrawn, and the payments are not being refunded by a cross-benefit adjustment, you may request the refund on a SSA-L8165-U2 using paragraph WDWM 50.

2. Withdrawal approved

a. Notice to claimant

Whether the withdrawal request is filed before or after effectuation of an initial claim, the notice of withdrawal approval is usually automatically generated by the system. However, if the system cannot process the action for some reason or if the withdrawal is conditional, issue a SSA-L8165-U2 with paragraphs 1500 and 1503 for an initial claim and paragraphs 2482 and 1503 for a post-eligibility withdrawal.

If the withdrawal is conditional, the notice must advise that the withdrawal was approved assuming a particular event would happen and describe the event. The notice should further advise the individual that if the event does not occur, the individual should contact SSA.

b. Notice to others

Send a SSA-L8155-U2 to anyone whose payment is adversely affected by approval of the withdrawal. Explain the reason for change in SSI eligibility or payment.

NOTE: 

This individual may not appeal the issue of withdrawal. However, this individual may rescind consent (see SI 00601.050G.).

3. Withdrawal disapproved

If the withdrawal request is filed prior to adjudication of an initial claim and it is disapproved, suppress the systems generated notice of award or denial and send a manual SSA-L8025-U2 (for an award) or an SSA-L8030-U2 (for a denial) and provide an explanation that the withdrawal request was disapproved and why. If the withdrawal request is filed after the claim is adjudicated, send a manual SSA-L8166-U2 with an explanation that the withdrawal request is disapproved and why.

4. Cancellation request approved

If the cancellation request is filed before effectuation of an initial claim and the cancellation request is approved, the automatic notice of award or denial of the claim is sufficient notification of our determination on the case. There is no need to explain that the individual requested a withdrawal of the claim and then requested cancellation of the withdrawal and we are approving the cancellation request.

If the cancellation request is filed after effectuation of the initial claim, the action you take depends on whether a notice of withdrawal approval has been issued.

  • •

    If a notice regarding the withdrawal's approval has not been issued, send a manual SSA-L8165-U2 with paragraph 2473.

  • •

    If a notice regarding the withdrawal's approval has been issued, send a manual SSA-L8151-U2 with paragraph 2473.

5. Cancellation request disapproved

If the cancellation request is filed before effectuation of an initial claim and the cancellation request is disapproved, issue a manual SSA-L8166-U2 with an explanation that the withdrawal request has been approved (paragraph 1500) and the cancellation request was disapproved.

If the cancellation request is filed after effectuation of an initial claim, the action you take depends on whether a notice of withdrawal approval has been issued.

  • •

    If a notice regarding the withdrawal's approval has not been issued, send a manual SSA-L8166-U2 explaining that the withdrawal request is approved (paragraph 2482) and the cancellation request is disapproved.

  • •

    If a notice regarding the withdrawal's approval has been issued, send a manual SSA-L8166-U2 with an explanation as to why the cancellation request was disapproved.

M. References

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500601050
SI 00601.050 - Withdrawal of Supplemental Security Income (SSI) Application - 12/28/2023
Batch run: 10/09/2024
Rev:12/28/2023