TN 13 (07-11)

SI 02101.025 Basic Requirements of Supplemental Security Income (SSI) Underpayment (UP) Review

A. Introduction to underpayment review

Adjudicators must review large SSI UPs to ensure that we develop all factors of eligibility in accordance with current Program Operations Manual System (POMS) instructions. There is an especially high risk of error in these cases because of the large payments.

B. Definitions

1. Prepayment review

A prepayment review is a review of the non-disability eligibility factors before authorizing payment.

2. Low Risk Cases (LRCs)

Low-risk cases (LRCs) are those SSI initial claims (ICs) with characteristics, which are not error-prone.

3. UP at risk

UP at risk is the SSI UP amount, minus the potential Title II offset for the UP period per SI 02006.100.

4. Adjudicator

An adjudicator is a claims representative (CR) or above, who performs the prepayment review. The adjudicator can be the person who made the original determination.

5. Reviewer

A reviewer is a CR or above, and is someone other than the adjudicator. The reviewer examines the file after the adjudicator has completed the prepayment review, but before the release of the UP. The reviewer completes the Underpayment Process (UOUP) screen to release the UP.

C. Prepayment review policy

1. When a prepayment review is required

A prepayment review is required for any SSI case (initial claim (IC), or post eligibility (PE)), if an UP of $5,000 or more is due through the month prior to the current computation month (CCM). For a definition of the CCM, see SM 02101.001 unless:

  • The case involves Title II offset and the SSI UP “at risk” is less than $5,000 per SI 02006.100; or

  • The case is a low-risk criteria (LRC) case as described in SI 02101.025C.2.

2. Criteria for LRCs

A case meeting LRC criteria has all the following characteristics for all months of the UP period:

  • an initial claim;

  • An individual record (TMR = DI, BI, etc.);

  • an automated computation;

  • the payment status code is C01 or E01; and

  • any one of the following:

If the living arrangement is:

AND there is no chargeable income, or there is:

And there is:

“B” continuously

Earned income less than $65 per month

No other income

 

Type A (Title II benefits)

 

 

Type G (Title II benefits)

 

 

Type W (Title II benefits)

 

 

Type I (deeming allocations)

 

 

Type J (systems posted VTR)

 

 

Type RL (rental/lease),

Type RH (royalties/honoraria)

Type RI (interest/dividends), totaling $5 or less per month)

 

“A” continuously

Any countable income that is listed for living arrangement “B”

General assistance grant reimbursement (GA/GR) involvement and no State supplement category

Congregate Care (as defined in SI 01401.001C.3.)

Any countable income that is listed for living arrangement “B”

No other income

3. The prepayment review

An adjudicator and a reviewer perform the prepayment review.

4. Administrative finality

The rules of administrative finality apply to UP cases. For administrative finality rules, see SI 04070.010.

D. How the system processes UPs of $5,000 - $49,999.99

1. UP withheld

When the system computes a UP of $5,000 - $49,999.99, it holds the UP and sets a U2 diary until the FO authorizes release of the UP.

After the prepayment review, the FO accesses the Direct SSR Update to provide authorization for release of the UP through the UOUP screen. To view the UOUP screen, see MSOM BUSSR 004.018. The FO will release the UP to the beneficiary or representative payee unless one of the following criteria is met:

  • Interim Assistance Reimbursement (IAR) applies;

  • Direct fee payment to an authorized representative;

  • Installment only payments (the system will automatically release the payments); or

  • Dedicated account case (the system will set all appropriate diaries, issue an alert and release an automated notice to the representative payee).

NOTE: For UPs of $50,000 or more, see SI 02101.055.

2. UPs released

The system releases a UP of $5,000 or more (except dedicated account cases) after:

  • Completion of the UOUP screen (for UOUP screen information, see MSOM BUSSR 004.018 and SM 01311.661 (PE));

  • Force due(s) (for instructions on when to use force due procedures, see SM 01701.001); or

  • One-Time Payment(s) (OTPs) (for instructions on the OTP process, see

    SM 01901.001 and MSOM BUSSR 003.022 - MSOM BUSSR 003.025). See Also:

For cases involving Interim Assistance (IA), see the following references:

  • SI 02003.020, Field Office Processing of IAR Authorization.

  • SI 02003.022, Processing eIAR Field Office Intervention Cases.

  • SI 02003.023, Processing eIAR Exception Cases.

  • SI 02003.025, IAR Payment Processing for Exception Cases and Proration Cases.

  • SM 01005.623, Grant Reimbursement (GR) Field.

  • SM 01005.627, Exception Processing (GR).

  • SM 01311.662, Processing Interim Assistance Reimbursement (IAR) from an SSI Underpayment

For cases involving dedicated accounts or installment payments, see the following references:

  • SI 02101.010, Past-Due Benefits Payable – Individual Alive Under Age 18 with Representative Payee – Dedicated Account Required.

  • SI 02101.020, Installment Payments of Large Past-Due Benefits – Individual Alive.

  • SM 01301.450, Special Action Code (SZ).

  • SM 01311.661, How to Resolve a U2 Diary to Release Underpayments of $5,000.00 or More

3. Alerts and diaries

The following are diaries and alerts generated by the system:

Diary

Condition

U1

UP is greater than $4,999.99 and less than $50,000; option ‘RELEASE UNDERPAYMENT/LOW RISK' selected from the Underpayment Processing (UOUP) screen; and the Low Risk Profile (LRP) criteria were not met.

U2

UP is greater than $4,999.99 and less than $50,000.

U3

UP exceeds $49,999.99 after the second installment payment has been issued.

U4

NOT AUTOMATED DEATH

Indicates the record contains a verification code of ‘U' in the UPV field of the MPMT segment (UPV: U).

AUTOMATED DEATH

Posted when a record's composition changes from eligible couple to eligible individual due to the death of one member of the couple.

After the FO selects the appropriate code from the UOUP screen, the system may set additional diaries and generate additional alerts for installment and/or dedicated account cases as shown in the following chart:

Diary

Condition

EA

Dedicated account - awaiting account establishment and payment.

IN

Dedicated account - Installment – automated one-time payment (AOTP) required.

I9

IAR FO Intervention –

Within 25 workdays from the FO transmission of the UOUP transmission and the IA agency eIAR transmission, eIAR requests FO intervention (assistance).

eIAR detects possible missing/erroneous SSR computations. eIAR is awaiting the FO review and corrections, if applicable, to the IAR Automated One-Time Payment (A-OTP) One-Time Payment Amount (UPOP) utility screen.

Alert

Condition

E1

Dedicated account - EA diary
pending - awaiting account establishment and payment.

I6

Dedicated account - Installment - IN diary pending AOTP required for installment payment.

See Also:

For instructions on resolution of these diaries and alerts, see the following references:

  • SI 02003.022, Processing eIAR Field Office Intervention Cases.

  • MSOM BUSSR 003.024, Example 4.

  • SM 01005.470, SZ Edits and Alerts.

  • SM 01301.450, Special Action Code (SZ).

  • SM 01301.470, SZ Reject and Alert Conditions – Procedure.

  • SM 01311.660, Overview of SSI Underpayment Processing

  • SM 01311.661, How to Resolve a U2 Diary to Release Underpayments of $5,000.00 or More

  • SM 01311.662, Processing Interim Assistance Reimbursement (IAR) from an SSI Underpayment

  • SM 01311.668, Processing Payments in Installments from an SSI Underpayment

  • SM 01311.669, How to Resolve a U1 Diary

  • SM 01311.670, How to Resolve a U3 Diary

  • SM 01311.675, How to Resolve a U4 Diary.

E. Procedure for management, adjudicator, and reviewer responsibilities

1. Management responsibilities

Take the following steps to process UP alerts:

  1. Control UP alerts using a control log until payment reflects on the SSR; and

  2. Make employees aware of their responsibilities in the process.

NOTE: SI 02101.110 is an example of the control log management is required to use.

2. Adjudicator responsibilities for prepayment review

Conduct a prepayment review if the UP is $5,000 or more, unless:

  • Title II offset reduces the UP at risk to less than $5,000; or

  • The LRC criteria outlined in SI 02101.025C are met.

3. Adjudicator responsibilities for preparing UP for release

Follow these steps to prepare the UP for release:

STEP

ACTION

1

Determine whether all benefits due on the record can be paid without delaying the recurring check.

  • If YES, go to step 2.

  • If NO, release the recurring payment. go to step 2.

2

Determine whether the case meets the LRC criteria:

  • If YES, go to step 4.

  • If NO, go to step 3.

3

Conduct the prepayment review. Query the OCSE online databases to determine if there are any undisclosed wages according to MSOM QUERIES 003.015 through MSOM QUERIES 003.018; unemployment compensation; or “new hire” information.

The query should include the individual and deemors. Follow the procedures in SI 00810.550. Go to step 4.

NOTE: If the FO receives an S2 alert for wages or U5 alert for unemployment compensation because of a central office database match, NEGATIVE VERIFICATION IS NOT REQUIRED.

4

Determine whether there is an interim assistance reimbursement authorization (IAR).

  • If YES, go to step 5.

  • If NO, go to step 7.

5

Determine whether a GR code is in the GRC field of the MPMT segment of the SSIRD.

  • If YES, go to step 7.

  • If NO, go to step 6.

6

Enter appropriate GR code and go to step 7. For grant reimbursement information, see MSOM MSSICS 023.006 and SM 01005.623.

7

Determine whether the UP must be released using A-OTP procedures per SM 01311.667, and SI 02003.023 and SI 02003.025 for IAR cases.

If YES, and this:

  • IS NOT a dedicated account case, after reviewer enters appropriate code on UOUP screen to release UP, follow instructions in SM 01901.015 and MSOM BUSSR 003.022 through MSOM BUSSR 003.025;

  • IS a dedicated account case, after reviewer enters the appropriate code on the UOUP screen to release UP, follow instructions in SI 02101.010, SM 01311.660 and SM 01901.015 and MSOM BUSSR 003.022 through MSOM BUSSR 003.025; or

  • IS an installment case with an exception, after reviewer has entered appropriate code on UOUP screen to release UP, follow SI 02101.020 and SM 01901.015 and MSOM BUSSR 003.022 through MSOM BUSSR 003.025.

If NO, go to step 8.

8

Determine whether the case involves an attorney.

  • If YES, complete the UFEE screen. Go to step 9.

  • If NO, go to step 9.

9

Determine whether the system will automatically generate a notice. If not, prepare a manual notice. Go to step 10.

10

Direct the case to the reviewer to verify and release the UP.

4. Reviewer responsibilities

Follow these steps for reviewer's responsibilities:

STEP

ACTION

1

Review the determination of the UP amount. Go to step 2.

2

Review the manual notice. Go to step 3.

3

Have any deficiencies corrected. Go to step 4.

4

Document the review:

MSSICS cases –

  • Create a MSSICS Report of Contact screen (DROC), and indicate that the reviewer completed the review.

  • Lock the DROC to protect the contents.

Non-MSSICS cases –

  • Create an SSA-5002 (Report of Contact) and indicate that the reviewer completed the review.

  • Store the SSA-5002 in the Non-Disability Repository for Evidentiary Documents (NDRED).

Go to step 5.

5

Complete the UOUP screen for release of the UP by entering the appropriate code on the UOUP screen. For UOUP data, see MSOM BUSSR 004.018.

Go to Step 6 if IAR is involved and the MPMT UPV of “V” is set.

Go to Step 7 if no IAR is involved.

6

After 25 work days from the date the UOUP screen was transmitted (UP $5,000.00 or more) and eIAR has not released the IAR payment, then:

  • Determine if there is an I9 diary and process accordingly;

  • If UPV of “V” is set and no I9 diary, do not delete the GRC; contact the RO.

7

The system releases the UP.

F. References

  • SM 01311.660, Overview of SSI Underpayment Processing

  • MSOM BUSSR 004.018, Underpayment Processing (UOUP).

  • MSOM MSSICS 023.006, Miscellaneous Data (CMSC).

  • SM 01005.624A, How the System Processes Data Input to the Grant Reimbursement (GR) Field.

  • SM 01005.625A, How the SSI System Updates the Grant Reimbursement Code (GRC).

  • SI 02003.022, Processing eIAR Field Office Intervention Cases.

  • SM 01005.623, Grant Reimbursement (GR) Field.

  • SI 02220.015, SSI Overpayment - Recovery By Adjustment.

  • SI 02201.015, SSI Netting/Offsetting Overpayments Against Underpayments.

  • SM 01311.165, Manual Netting.

  • SM 01311.661, How to Resolve a U2 Diary to Release Underpayments of $5,000.00 or More

  • SM 01311.669, How to Resolve a U1 Diary

  • SM 01311.670, How to Resolve a U3 diary.

  • SM 01311.675, How to Resolve a U4 diary.

  • SI 02101.010, Past Due Benefits Payable – Individual Alive Under Age 18 with Representative Payee - Dedicated Account Required.

  • MSOM MSSICS 023.006, Miscellaneous Data (CMSC).