SI SF02220.005 Documenting the SSI Overpayment - $20,000 or Above (RTN 02 (12/2012)

A. Policy

The San Francisco Regional Office (RO) reviews overpayment determinations only when national instructions require RO concurrence. For cases not involving fraud, the following types of overpayment decisions require RO concurrence.

1. Cases requiring RO concurrence

Per SI 02220.005, the following overpayment determinations (made by the FO or an ALJ) require the concurrence of the Assistant Regional Commissioner for Management and Operations Support (ARC MOS) when the overpayment is $20,000 or more:

  • Waiver (approvals)

  • Unwilling to repay (DB TAC)

  • Unable to repay (DC TAC)

  • Unable to locate/out of the country (DM TAC)

  • Uncollectible (N TAC)

  • Erroneous (NT TAC)

  • Incorrect (Z TAC)

  • Compromise settlement (NY TAC) (See note below for other compromise offers that need RO concurrence.)

NOTE: Compromise settlement offers of an overpayment greater than $5,000.00 but less than $20,000.00, where the offer is less than 80% of the overpayment, must also be submitted for ARC MOS concurrence.

For those overpayment inputs that require a 2-PIN process, the input to approve the decision must be made the same day as the decision input (MSOM BUSSR 004.020). Do not make any inputs until contacted by RO staff. If RO staff concurs with the proposed decision, the RO will contact the field office to coordinate the inputs.

NOTE: RO concurrence policy applies regardless of whether the system will allow the input without a second PIN.

2. Cases not requiring RO concurrence

Overpayments of $20,000 or more that do not require RO concurrence include determinations to:

  • Collect an overpayment (D, G, or K TAC)

  • Deny a waiver

  • Refer to another agency (MJ, MO, MT, and MS TAC)

3. Fraud is suspected

  • Refer to OIG and post an MO TAC. Take no further recovery or waiver action until the OIG contacts you. (See SI 02201.005I and SI 02201.007)

  • If the fraud is under the jurisdiction of the Department of Justice (DOJ), post an MJ TAC – referral to Department of Justice, Program Integrity, or other agency.

B. Procedure before referral

  • Verify that administrative finality was properly applied. (SI 04070.010, SI 04070.015, SI 04070.040)

  • For waiver requests, verify that the correct individual is listed in Question 1.C. on the SSA-632 (SI 02260.005). If the request is for the recipient only, list the recipient in this section. If the request is for the payee, consider whether it should be treated as a request for relief from liability and processed as a reconsideration request rather than waiver. (SI 02201.020B.1)

  • Ensure all documentation related to the overpayment is available electronically.

Prepare the rationale for the proposed decision on a Report of Contact or SSA-5002. For general information on preparing formal and informal determinations, see GN 01010.360, GN 01010.365, and GN 01010.390. The rationale should include the following basic elements of a determination:

  • Issue – State the specific issue involved.

  • Facts – Include a concise statement of relevant facts, the evidence considered, records reviewed (e.g., systems records, case file, PACER, LexisNexis, TCIS), evidence not available and the reason not available, summary of reports of contact, discrepancies identified.

  • Determination – Provide a clear conclusion based on the listed facts and analysis. Do not repeat the facts as your sole conclusion. Describe how conflicting allegations have been resolved and how you evaluated the allegations or evidence accepted, including its probative value.

C. Referral procedure

  • Effective with receipt of this transmittal, all San Francisco field offices submitting overpayment determinations for RO concurrence must submit the request through vHelp. The RO will only accept requests for overpayment concurrence initiated through vHelp.

  • Unless requested by the RO, folders or other documents mailed, faxed, e-mailed, or delivered to the RO for concurrence will be returned without review.

D. RO action

1. RO unable to concur

If the RO reviewer is unable to concur with the proposed decision, the reviewer will notify the FO explaining the reason(s) for return or asking for additional information.

2. RO concurs with the request

The RO reviewer will complete a Report of Contact or SSA-5002 approving the request. The reviewer will notify the FO and request that a technician call to coordinate the necessary input. The FO should not make any systems input until contact with the RO has been made.

E. Systems inputs

Select the overpayment decision from the UOPD screen (MSOM BUSSR 004.008):

  • Waiver (approvals) - Selection 1

  • Unwilling to repay (DB TAC) – Selection 4

  • Unable to repay (DC TAC) – Selection 5

  • Unable to locate/out of the country (DM TAC) – Selection 8

  • Uncollectible (N TAC) – Selection 6

  • Erroneous (NT TAC) – Selection 7

  • Compromise settlement (NY TAC) – Selection 11

  • Incorrect (Z TAC) – Selection 12

F. Systems references

  • DB, DC, DM TACs - SM 01311.200

  • N, NT TACs - SM 01311.280

  • NY TAC - SM 01311.290

  • Z TAC - SM 01311.340

  • Waiver - MSOM BUSSR 004.009

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SI SF02220.005 - Documenting the SSI Overpayment - $20,000 or Above (RTN 02 (12/2012) - 05/26/2023
Batch run: 01/23/2024