TN 14 (03-98)

SI 02006.100 Excluding Title II Offset Cases from Underpayment Review

A. Introduction

1. SSI Underpayment (UP) Review

The FO generally must conduct a prepayment review of an SSI UP if the UP equals or exceeds a “review threshold” (currently, $5,000). The FO generally authorizes release of the prospective SSI benefits and the UP at the same time. See SI 02101.025. Note also installment payment (SI 02101.020) and dedicated account requirements (SI 02101.010) for large SSI underpayments.

2. Two-Input Process

However, the FO can decide to release prospective benefits and delay release of the UP. See SI 02101.025E.2. Some of these cases will be subject to title II offset because SSI benefits are due for one or more months in the Title II retroactive period. As a result of systems changes made to implement the 9W diary procedure, release of the prospective SSI benefits will trigger automated offset.

3. Exclusion from UP Review

By excluding certain title II offset cases from review, we speed up issuance of SSI retroactive benefits.

B. References

  • Title II Offset Criteria, GN 02610.005

  • Systems Offset Processing, SM 01320.005

C. Policy

 

1. Calculation of UP “At Risk”

The UP is only “at risk” to the extent that it exceeds the title II offset amount. We risk an OP by eliminating the review. The amount “at risk” is the UP minus the potential title II offset for the underpayment period.

  •   SSI UP

    - Offset amount in UP period

      Amount at risk

2. Exclusion Decision

Exclude a case from UP review if the amount “at risk” is less than the review threshold.

3. Relationship to Other Case Review Requirements

  1. Exclusion of a case from UP review does not remove the UP period from subsequent review and correction by the FO. For example, the FO must review that period during the next redetermination under the rules and selection criteria in SI 02305.001.

  2. There are two reasons for this:

    • the FO may discover that the amount at risk is in fact an overpaid amount; or

    • an additional UP may exist.

  3. If any factor used to compute the UP and the title II offset amount are incorrect, see SI 02006.010 for computing the true OP or UP.

D. Examples

 

1. Case Excluded From Review - Amount At Risk = 0

a. Facts re: SSI UP Computation

  • UP period = February - December 1997;

  • UP for February - December = $484 per month;

  • Total UP = $5,324.00;

  • FO decides to issue SSI benefits prospectively and withhold the UP pending completion of its review. SSI benefits for January 1998 are issued.

b. Facts re: offset

  • First title II benefit: $520 in January 1997;

  • Due $520 title II income in February -December 1997;

  • Retroactive title II benefits are not paid until the FO resolves the SSI UP.

  • If we had paid the $520 title II income due each month on time, he/she would have been due $0 SSI. The offset amount would be $484.00 per month for February on.

c. Risk Computation

  • February - December 1997:

$484.00 SSI UP per month
- 484.00 Potential offset per month
$ 0 At risk

 

 

  • Summary

$5,324.00 SSI UP
- 5,324.00 Potential offset
$ 0 At risk

d. Exclusion Decision

Amount at risk is less than review threshold. Case is excluded from UP review and the UP is released.

2. Case Excluded From Review - Amount At Risk is Less Than Review Threshold

a. Facts re: SSI UP computation

  • UP period = February - December 1997;

  • UP for February - December - $484 per month;

  • Total UP = $5,324.00;

  • FO decides to issue benefits prospectively and withhold the UP pending completion of its review. SSI benefits for January and February 1998 are issued.

b. Facts re: offset

  • First title II benefit: $320 in January 1997;

  • Due $320 title II income in February -December 1997;

  • Retroactive title II benefits are not paid until the FO resolves the SSI UP;

  • If we had paid the $320 title II income due in February through December on time, he/she would have been due $184.00 per month for February on. The offset amount would be $300 per month for March on.

c. Risk Computation

  • February - December 1997:

$484 SSI UP per month
- 300 Potential offset per month
$184 At risk per month

 

  • Summary

$5,324.00 SSI UP
- 3,300.00 Potential offset
$2,024.00 At risk

d. Exclusion Decision

Amount at risk is less than review threshold. Case is excluded from UP review and the UP is released.

E. Process - Interaction of Underpayment and Offset

 

1. Case Under Review

When a case is under review, and SSI benefits are issued prospectively while SSI benefits for prior months are withheld, the system posts UP's for prior months.

2. Title II Offset Computation

The system is able to perform the title II offset computation when there is an SSI UP as long as there is an SSI payment due for a month in the windfall period.

F. Procedure

 

1. Excluding a Case From Review

The FO compares the UP to the potential offset amount for the months in the UP period. If the amount at risk is below the review threshold, it ceases its review and releases the UP as appropriate given any installment or dedicated account requirements.

2. Documenting the Exclusion

Do the exclusion computation on an SSA-5002 (“Report of Contact”). If you can determine that there is no money at risk, or that the risk is low, without writing down a month-by-month computation, state why you are excluding the case from review on an SSA-5002. In either case, put the SSA-5002 in file.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502006100
SI 02006.100 - Excluding Title II Offset Cases from Underpayment Review - 07/28/2005
Batch run: 01/27/2009
Rev:07/28/2005