TN 53 (02-06)

SI 01130.602 Restitution Payments for Misused Benefits


Social Security Act, as amended, §1613(a) , and §1631(a)(2)(E) .

A. Background

Effective March 2, 2004, the Social Security Act (The Act) was amended requiring SSA to reissue certain misused benefits to Title II, Title VIII, and Title XVI beneficiaries. This provision applies to all misuse determinations made on or after January 1, 1995.

The Act also excludes restitution for misused Title II, Title VIII, and Title XVI benefits from countable resources for 9 calendar months following the month the restitution is received. This exclusion applies to the individual or any other person whose income is deemed to be included in such individual’s income for SSI purposes.

B. Policy

1. Restitution

Payment to the beneficiary or the beneficiary’s representative payee in the amount equal to the benefits misused in the following situations:

  1. The misuse resulted from the Social Security Administration’s negligent failure to investigate or monitor a representative payee; or

  2. An organizational or individual payee misused the benefits, without regard to whether SSA was negligent.

2. 9-month Exclusion

The unspent portion of restitution (See SI 01130.602B.1.) made on or after March 2, 2004 is excluded from resources for the 9 calendar months following the month in which the restitution is received.

This exclusion applies to an eligible individual/couple and to any person (e.g., spouse, parents, essential persons, and alien sponsors) whose income is deemed to be included in the individual’s/couple’s income for SSI purposes.

C. Procedure - When to Develop the Exclusion

Develop the exclusion only if it would affect eligibility for regular or conditional SSI benefits, in that order.

REMINDER: Send a notice to the affected beneficiary/new payee explaining the restitution payment and the 9-month exclusion from resources (See NL 00703.213 - Repayment of Misused Funds – Notice to Beneficiary/New Payee.)

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

D. References

GN 00604.065, Misuse by an Organizational Payee or Individual Volume Payee Serving 15 or More Beneficiaries

GN 00604.070, Misuse by Payees Serving 14 or Fewer Beneficiaries

SI 01110.210, Excluded Resources

SI 01330.000, Deeming of Resources

SI 00810.120, Restored Benefits as Income