Effective Dates: 09/13/2001 - Present Previous | Next

TN 10 (09-01)

SI 00601.080 Adjudicating Supplemental Security Income (SSI) Claims--General

CITATIONS:

Section 1631(e) of the Social Security Act,
20 CFR 416.200 and 416.203

A. Policy

When all development, verification and documentation requirements are met, the adjudicator must make a prompt eligibility determination for all months in the evaluation period (see SI 00601.008B.6. for the definition of the evaluation period). Adjudication can never be delayed solely to establish eligibility in a future month. See SI 00601.010B.3. for when a claim may be taken in advance of eligibility and effectuated as an allowance. The date the adjudicator makes the eligibility determination is called the adjudication date (see GN 01010.001B.4.).

SSI claims generally may not be partially adjudicated. However, in certain situations adjudication is permissible prior to completion of full development, verification, and documentation requirements. See the pertinent POMS instructions for the issue(s) involved; e.g., see SI 00830.005A regarding adjudication before completion of full development of unearned income.

B. Procedure

1. How to develop

Gather all the necessary information to adjudicate the claim.

  1. a. 

    Use the telephone when possible to speed development.

  2. b. 

    Complete the initial application and related forms (e.g., SSA-8010-BK, SSA-8006-F4, SSA-4641-U2, etc.) unless development is deferred per SI 00603.001 through SI 00603.040 and obtain the necessary signatures at the time of application. When taking a teleclaim, mail all forms to the applicant for signature (see SI 00601.040 for the notice requirements).

  3. c. 

    Assess the need for a representative payee or new representative payee if the situation warrants.

  4. d. 

    Ensure that any overpayment from a terminated record is carried forward onto the new record. (See SI 02220.011 for reconciliation of overpayment debt on a terminated record.)

2. How to verify

Verify allegations as follows:

a. Claimant/Recipient

Ask the claimant/recipient or his/her representative payee to provide readily available evidence.

b. Third parties

Contact third parties, including outside sources, directly when:

  • •

    it would speed development,

  • •

    the claimant is unable to provide the information/evidence, or

  • •

    an ineligible spouse, parent, or household member refuses to cooperate and you need to verify information which affects a factor of eligibility or payment and the claimant is unable to provide it.

3. How to document

Support the adjudicative determination by recording information in the Modernized Supplemental Security Income Claims System (MSSICS) claim or claims folder as follows:

  1. a. 

    Record claimant and third party allegations on a form or electronic screen containing the penalties for fraudulent statements unless POMS instructions specify otherwise.

    EXCEPTION: Unless POMS instructions state otherwise, use the MSSICS Report of Contact (DROC) screen or a Report of Contact (RC) form to record nondisability eligibility data when it is clear that the claim will be denied or the allegation will result in ineligibility based on the data.

  2. b. 

    Record, on the MSSICS DROC screen or on RC, information that does not require the claimant's or third party's signature.

    EXAMPLE: An ineligible spouse, parent, or household member refuses to give information directly to SSA and the claimant has attempted to obtain the information in good faith. Document the MSSICS claim using the DROC screen to show that the ineligible person refuses to cooperate.

    NOTE: See GN 00301.295 and GN 00301.300 for guidelines on reducing nonessential material.

  3. c. 

    Use an informal determination as required by GN 01010.365.

  4. d. 

    Add any documents received from other sources that contain information/evidence used to adjudicate the claim or decide on an action.

C. References

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500601080
SI 00601.080 - Adjudicating Supplemental Security Income (SSI) Claims--General - 09/13/2001
Batch run: 06/25/2013
Rev:09/13/2001