TN 10 (09-01)
SI 00601.050 Withdrawal of Supplemental Security Income (SSI) Application
20 CFR 416.355 and 416.360
This section describes the policy and procedures for withdrawal of an SSI application.
NOTE: The systems payment status code for a withdrawn claim is N12.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, the application is treated 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
Raise the issue of withdrawal with the individual when there is some definite advantage to the individual. Three common situations for which you should raise the issue of withdrawal follow.
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 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 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 he/she would have otherwise 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 another person who would be a 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 filed at a Social Security office, at another Federal or State office we have designated to receive applications for us or with a person we have authorized to receive applications for us.
c. Definition of Filing Date
Generally, a withdrawal request is considered filed on the day it is received. 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 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
The request must specify the application being withdrawn; e.g., it should say, "SSI application filed 1/15/01” when there has been more than one application.
b. Reason for Withdrawal
The request must state the reason why the application is being withdrawn.
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. If this part of the statement is not obtained, the withdrawal can be approved without it if the file contains an explanation why it was not obtained and documentation of the explanation that was given.
NOTE: Advise the individual to contact the State agency prior to withdrawing the SSI claim to determine if repayment of interim assistance is required.
d. Effects of Withdrawal When It Is Disadvantageous
If the withdrawal is clearly disadvantageous, the request must contain a detailed description of the effects of the withdrawal. If this part of the statement is not obtained, the withdrawal can be approved without it if the file contains an explanation why it was not obtained and documentation of the explanation of the disadvantages that was given.
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 contain a statement 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 the 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 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
Every other person who would lose eligibility or whose payments would be reduced if the withdrawal is approved must consent in writing. Anyone who could sign an application for that person may give the consent. (See SI 00601.012 for proper applicant policy.) If consent is not obtained, the withdrawal cannot be approved.
NOTE: If another recipient refuses to give consent, try to obtain the refusal over the recipient's signature. If the other recipient will not cooperate in providing a statement, document the file.
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 he/she is responsible for payments lost in the mail.
NOTE: If the withdrawal reduces another recipient's payment or makes him/her 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 a SSI application, the withdrawal's effect on another person's SSI eligibility and payment amount for past months is limited by the rules of administrative finality. (See SI 04070.001-SI 04070.080 for the rules of administrative finality.)
REMINDER for couple 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. The amount to be refunded for the withdrawal is computed by calculating the difference between what the couple received with what the remaining eligible member would have been paid as an eligible individual with an ineligible spouse.
2. Effect of Withdrawal on Title II Payments
Adjusting the amount of title II that should have been withheld for title II offset is not limited by the rules of administrative finality.
Type of Income Affects Deeming Computation
Mr. and Mrs. Simons filed for SSI as an aged couple. Both members were receiving title II and Mr. Simons was receiving a Department of Veterans Affairs (VA) pension. They were advised that Mrs. Simons would receive more as an eligible individual with an ineligible spouse than they would both receive as a couple because Mr. Simon's VA pension is not deemed. However, Mr. Simons decided to pursue his claim for the Medicaid coverage. Three years later, Mr. Simons inquired about changing his decision. The claims representative (CR) advised Mr. Simons that although there was no time limit on filing a withdrawal request, withdrawal at this time could not affect his wife's payment back to her first month of eligibility because of administrative finality. A withdrawal would mean he would have to refund the SSI paid to him as a member of a couple from the first month of eligibility to the first month we could change his wife's status—approximately 2 years' payments. (NOTE: Mr. Simons would only have to refund the difference between what the couple received and what Mrs. Simons would have received after the wife's status changed because the payments he received as a member of a couple are deemed to have been paid to his wife.) As an alternative, the CR discussed the possibility of a voluntary termination with Mr. Simons. (See SI 02301.230 for the policy on voluntary termination.)
Title II Offset in a Couple Case
In 5/00, Mr. and Mrs. Andrews were awarded SSI payments as a couple based on an application filed in 3/00. In 9/00, Mrs. Andrews was awarded Social Security disability benefits with an entitlement date of 3/99. Her retroactive title II check was offset by the amount of SSI she had been paid for March through August. SSI eligibility ended for the couple because of the title II income.
In 7/00, Mrs. Andrews learned from her neighbor that virtually the same thing had happened to the neighbor, but the neighbor had been advised that withdrawal of his SSI application would prevent offset from being applied to the title II benefits, while his spouse would still be eligible for SSI. Mrs. Andrews 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 Mr. Andrews because of administrative finality, the FO approved the withdrawal. However, Mrs. Andrews would have to refund the SSI benefits paid to her.
Deeming to a Spouse and Child Lowers Payment to Child
In 1/01, Mrs. Neal filed for SSI for her son, Jeff, and for herself. Mrs. Neal has unearned income, her husband has wages, there is an ineligible child allocation, and Mrs. Neal is ineligible due to deemed income. Jeff's disability was allowed and he began receiving SSI. At a redetermination a year later, the CR noted that the payment to Jeff would be higher if Mrs. Neal was not on the record as a filer. (For an example of the computation involved, see SI 01320.650.) The CR explained the situation to Mrs. Neal and further explained that she could withdraw her application, as there was no time limit on doing so. She decided to withdraw her application. Applying the rules of administrative finality, the CR determined that the payment to Jeff could be increased all the way back to his first month of eligibility.
F. Policy -- denial vs. Withdrawal
A denial is preferable to a withdrawal if the person simply 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 someone who would be a proper applicant (see SI 00601.012);
give a reason for the cancellation; and
be received by SSA (see SI 00601.050D.1. for an explanation of "received by SSA") within 60 days after the date of the notice of withdrawal approval.
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 Rescinds Consent
An individual who gave consent to the withdrawal because it affected his/her payment may rescind consent within 60 days after the date of the notice of withdrawal approval. There is no exception to the time limit. Someone who would be 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 his or her behalf) is rescinded within the 60-day period, the FO should 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-VB 00102.010 are met, title XIX in 1634 States, 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.
NOTE: The only time you can get a printout from MSSICS is when you have an open initial claim or redetermination event. The statements MSSICS would print while in these events contain introductory language that is inconsistent with requesting a withdrawal.
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, sign and date your determination at the bottom, and provide your position title.
NOTE: If the withdrawal can be processed on MSSICS (see SI 00601.050K.), then you may document your determination of approval or nonapproval by using the Report of Contact (DROC) screen in addition to the paper record.
2. Hearing Filed
If the individual's claim is at the hearing stage of appeal when the withdrawal is requested, notify the hearing office immediately; obtain any necessary documentation per SI 00601.050D. and forward the request to the hearing office for the administrative law judge (ALJ) to decide.
K. Procedure -- effectuating the withdrawal through mssics
You may process the withdrawal through MSSICS by entering a denial code of N12 on the Adjudicative Decision (DADJ) screen.
NOTE: You must have a pending MSSICS 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 SSI based on the application for which the withdrawal request was made, 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 posteligibility 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 withdraw 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 req