SI CHI02220.005 Mandatory Review of Certain Title XVI Overpayment Dispositions (RTN 423 - 12/2012)

See SI 02220.005

A. Policy

Field Offices and Teleservice Centers must refer certain Title XVI overpayment dispositions to the Chicago Regional Office for approval by the Assistant Regional Commissioner of Management and Operations Support (ARC MOS). The overpayment dispositions that require ARC MOS approval are listed in SI 02220.005.

B. Procedure

1. MSSICS two-PIN process applies

When an overpayment disposition requires ARC MOS approval and the MSSICS two-PIN process is applicable, the FO or TSC will take the following action:

  • Complete the Mandatory Checklist for Disability Cessation Cases if appropriate. If the case is ready to be sent to the RO for review; (See SI CHI02220.005B.2)

  • Complete a Chicago Region SSI Overpayment Approval Request (exhibit attached). The form must be signed by the FO/TSC adjudicator and a FO/TSC management official to signify concurrence with the overpayment disposition.

  • Attach the request and the completed checklist to the front of the overpayment folder and route the folder to the following address:

    Social Security Administration
    MOS-CRSI SSI, 10th Floor
    SSI Policy Team-Two Pin Waiver
    600 W. Madison Street
    Chicago, IL 60661-2406

Do not transmit the disposition to MSSICS until ARC MOS approval is received.

Upon receipt of the folder, the mandatory ARC MOS review will be conducted. If the ARC MOS concurs with the FO/TSC recommended disposition, the SSI Policy Team will coordinate the transmission of the approval to MSSICS with the FO/TSC and will then return the folder to the FO/TSC. If the ARC MOS does not concur with the FO/TSC recommendation, the folder will be documented and will be returned to the FO/TSC.

      

EXHIBIT — CHICAGO REGION SSI OVERPAYMENT APPROVAL REQUEST

TO:    Social Security Administration
          MOS-CRSI SSI, 10th Floor
         SSI Policy Team-Two Pin Waiver         Date Referred to RO_________      
         600 W. Madison Street
        Chicago, IL 60661-2406

    

FROM: ____________________________        FO/TSC Code _____________
                                  (FO/TSC Name)

Recipient's Name: ____________________________________________

Recipient's SSN: _____________________________________________

FO/TSC Adjudicator Name ___________________      Phone #: _______________

Adjudicator's Signature: ______________________________________

Management Approver's Name: __________________     Phone #:_____________

Management Approver's Signature: _______________________________________

FO/TSC Recommended Disposition:

[  ] Waiver Approval

[  ]  Waiver Denial

[  ] Suspend Collection

[  ] Uncollectible

[  ] Compromise Settlement

[  ] Other:

Check one of the following referral reasons above.

            

2. Completion of the Mandatory Checklist for Disability Cessation Cases

  1. Has appeal of the medical cessation been exhausted and were all appeals pursued in good faith? Yes__   No__

  2. Was the initial overpayment notice issued 60 day after last decision? Yes__    No__

  3. Is the folder or all denial notices, including hearing decisions attached? Yes__   No__

  4. Is the correct cessation month posted to the SSR? Yes__   No__

  5. Is SSA-632 properly and fully completed and less than 1 year old? Yes__   No__

  6. Was SSA 632 completed after exhaustion of all appeals? Yes___    No____

If you answered “no” to any of the preceding questions, the file is not ready for referral. Please review the Explanation Page in SI CHI02220.005B.2. for the corresponding questions.

If you are not able to answer all of the questions, please contact the SSI Policy team at (312) 575-4225 for assistance.

If you answered “yes” to all questions, please refer file to the SSI Policy team.


Flags should be locally reproduced.

        

Explanation Page
Mandatory Checklist for Disability Cases

  1. Per GN 02201.009B.7, the initial overpayment notice is not to be sent until appeal of the medical cessation has been exhausted. Per SI 02260.007 2.c, in order to determine good faith, review the (cessation) file and any other available records and determine whether the appeal of the medical cessation was made in good faith. If a claimant fails to cooperate with the DDS in DHU processing of a reconsideration of a cessation, do not assume the appeal was made in good faith. Good faith cooperation with further levels of appeal will not change the determination based on a prior period of non-cooperation. If the individual cooperated with the processing of the appeal, assume that the appeal was made in good faith. In order to determine this, you need to review evidence in the medical cessation file (SSA-833, reconsideration determination, and hearing determination, etc,).

  2. Per SI 02260.007.3 do not send the overpayment notice during the 60-day appeal period, or when an appeal has been timely filed. Do not send the overpayment notice even when the title XVI case is listed on the “B3” diary list. Once the appeal period has expired and no appeal has been filed, or all appeals have been exhausted, follow normal overpayment notice procedures. Send a revised overpayment notice --When an overpayment notice is issued in error or the content is incorrect, a revised notice should be issued with the appropriate paragraph advising this notice revises previously issued notice dated XX/XX/XXXX.

  3. Refer to 1.

  4. Per SM 05905.041 the correct month of cessation should be reflected on the SSR (DISB - MG: T-MM/YY). The payment status of N07/N08 should be posted for the correct month (3rd month after cessation month). In order to determine this, you need to review evidence in the medical cessation file (SSA-833, reconsideration determination, and hearing determination, etc).

  5. Per SI 02260.005 the SSA-632-BK (Request for Waiver of Overpayment or Overpayment Recovery or Change in Repayment Rate) should be completed in full. Per GN 02250.115 the financial information should not be over 1 year old.

  6. If the overpayment notice was sent prior to exhaustion of all appeals and a SSA-632 was received, the waiver must be dismissed as no overpayment exists. If the claimant wishes to pursue a waiver, we should take a new SSA- 632 after the new notice has been released.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502220005CHI
SI CHI02220.005 - Mandatory Review of Certain Title XVI Overpayment Dispositions (RTN 423 - 12/2012) - 01/02/2013
Batch run: 01/02/2013
Rev:01/02/2013