TN 18 (01-17)

SI 02260.030 Impede Effective or Efficient Administration of Title XVI of the Act (Administrative Waiver)

A. Definition of impede effective or efficient administration of Title XVI of the Act

When the nationwide average cost to recover an overpayment equals or exceeds the amount of the overpayment, recovery would impede effective or efficient administration of Title XVI of the Act.

B. Policy for administrative waiver

1. When we will not recover an overpayment

Generally, we will not recover a Supplemental Security Income (SSI) overpayment if the original overpayment amount (not the balance) is:

  • Less than $1.00; or

  • Between $1.00 and $30.00, and the Automated Overpayment Notice System (AONS) cannot issue an overpayment notice.

In these two situations, we presume the individual is without fault.

Never administratively discontinue waiver development on an overpayment without a specific request from the overpaid person, representative payee, or legal guardian.

2. A recipient requests a waiver or reconsideration – and the original overpayment amount is $1,000.00 or less

  1. Effective September 27, 2008, we may administratively waive recovery or adjustment, i.e., administratively discontinue waiver development, on an overpayment if the original amount (not the balance) is $1,000.00 or less.

  2. We do not use administrative waiver development discontinuance policy unless the recipient (or representative) makes a specific written or oral request for waiver or reconsideration.

  3. If the recipient requests a waiver or reconsideration and the amount of the original overpayment (not the outstanding overpayment balance) is $1,000.00 or less, we administratively discontinue waiver development unless, from the facts apparent on the face of the waiver or reconsideration request, we believe there is an indication of fault on the part of the overpaid recipient. In such a case, we will conduct full waiver or reconsideration development.

  4. We never administratively discontinue waiver development if the recipient (or their representative payee) has engaged in double check negotiation (DCN), regardless of the overpayment amount. Requests to waive overpayments resulting from DCN require special processing. For DCN processing instructions, see GN 02406.300, Original and Courtesy or Replacement Check Cashed – Double Check Negotiation (DCN) – Potential Overpayment.

  5. Technicians must review all case information and initiate corrective actions when applicable to update the record before making waiver or reconsideration determinations. If the overpayment remains after all case information is current, refer to SI 02260.001, Basic Requirements Concerning Supplemental Security Income (SSI) Overpayment Waiver. For rules of administrative finality and general reopening policies, refer to SI 04070.010, Title XVI Administrative Finality – General Reopening Policies.

3. Indications of fault on the part of the recipient (or his or her representative)

We assume that there is an indication of fault if the overpayment resulted from:

  1. A willful misstatement by the overpaid recipient (or representative); or

  2. Concealment of facts or fraud, which directly or indirectly caused the overpayment; or

  3. The recipient’s acceptance of any payment that he or she knew or should have known was incorrect; or

  4. The recipient did not return one of the payments in a DCN situation.

A determination that the overpaid recipient (or representative) is liable for repayment of the overpayment is not, in and of itself, an indication of fault.

C. Procedures for recovering an overpayment that impedes effective or efficient administration of Title XVI of the Act

1. Situations when we will not recover an overpayment

  1. We presume the overpaid recipient is without fault, the system automatically waives recovery or adjustment of payments, and we do not issue an overpayment notice if:

    • The original overpayment is less than $1.00 or

    • The original overpayment is at least $1.00 and no more than $30, and the system cannot issue an AONS notice.

  2. You may presume the liable overpaid recipient is without fault and waive recovery for any month:

    • The overpayment was caused by countable resources exceeding the applicable resource limit by $50.00 or less, and

    • The evidence clearly shows there was no willful and knowing failure to report the excess resources.

    If these conditions exist, recovery impedes the effective or efficient administration of Title XVI. For policy and procedures on overpayments due to the recipient’s resources exceeding the applicable limit by $50 or less, see SI 02260.035, SSI Overpayment Waiver When Recipient’s Countable Resources Exceed the Limit.

2. When to consider a request for reconsideration a request for waiver

If the amount of the original overpayment is $1,000.00 or less and the overpaid recipient files a request for reconsideration, consider the request for reconsideration a request for waiver.

Do not develop the reconsideration request unless there is an indication the liable recipient is at fault. Rather, administratively discontinue development and waive the overpayment. Document the waiver request per SI 02260.030C.5. For indications of fault, see SI 02260.030C.3.

3. Indications of fault

Determine that there is a rebuttable presumption that there is an indication of fault if the overpayment resulted from any of the following:

  1. Fraud (intentionally providing false statements or deceitfully withholding information in order to obtain payments not rightfully due); or

  2. The recipient’s acceptance of any payment that he or she knew or should have known was incorrect; or

  3. The recipient did not return either the original or the replacement payment in a DCN situation.

A determination that the overpaid recipient (or representative payee) is liable for repayment of the overpayment is not, in and of itself, an indication of fault. For information on liability for SSI overpayments, see SI 02201.020 or SI 02201.021.

4. Overpayments due to double check negotiations

  1. If the recipient alleges non-receipt, never administratively discontinue waiver development before Treasury resolves the non-receipt claim under normal operating procedures. If Treasury determines that the check was forged, do not waive or administratively discontinue the DCN overpayment. Rather, resolve the overpayment on the record with an erroneous overpayment decision NT TAC. For instructions on the use of the NT TAC, see SM 01311.280, Uncollectible and Erroneous Overpayment Decisions, and MSOM BUSSR 004.002, Overpayment Menu (UOMN) through MSOM BUSSR 004.008, Overpayment Decisions (OUPD).

  2. If Treasury determines the liable recipient cashed both checks or the recipient does not request Treasury intervention, you must still make an independent determination of whether the recipient accepted both the original and the replacement payments. Unlike a forged check situation, an overpayment can exist when the individual kept both the original and the replacement payments he or she received through direct deposit at a financial institution. Accepting both payments is an indication of fault. The technician must conduct full waiver development, even if the original amount of the overpayment is $1,000.00 or less.

  3. If you determine the recipient was at fault because he or she accepted both payments, you can resume (or begin) overpayment adjustment or recovery at a rate of recovery of up to 100 percent. For policy and procedures on recovery at the 100 percent rate of adjustment, see SI 02220.016A.2.e, SSI Overpayment – The 10 Percent Rate of Adjustment.

5. Documentation requirements for administrative waiver request

Document the waiver request in a statement containing the:

  • Requester’s full name;

  • Requester’s relationship to the overpaid recipient;

  • Overpayment amount;

  • Overpayment period;

  • Overpayment sequence number;

  • Documents and records we used to make the waiver determination; and

  • Method we received recipient or payee’s request for waiver (phone request on MM/DD/YY, or in-office request this date, etc.).

For MSSICS cases, use the DROC screen to record the required statement. For non-MSSICS cases, record the statement on a SSA-5002 Report of Contact and fax into the non-disability repository for evidentiary documents (NDRed).

6. Overpayment period

Unlike Title II overpayments, you can discontinue recovery or adjustment of overpayments of $1,000.00 or less for each overpayment period. For instructions on the overpayment period, see SI 02201.005C, Supplemental Security Income (SSI) – What is an Overpayment?

Each overpayment period for which we issue an initial overpayment notice is an initial determination.

You must evaluate a waiver or reconsideration request against each separate overpayment period. Do not split an overpayment of more than $1,000.00 into two or more amounts for the purpose of administratively discontinuing waiver development of the total overpayment.

Systems application of a separate Overpayment Sequence (OPSQ) number in the OPSQ segment of the SSR does not, by itself, indicate a new overpayment period. For a discussion of the OPSQ segment of the SSR, see SM 01310.220, Overpayment Sequence Processing-Systems Computed Excess Payments (TOPs).

7. Examples of when we can and cannot administratively discontinue waiver development

EXAMPLE 1: We conducted a redetermination in November 2015. We verified the recipient’s wages for the period December 2013 through October 2015. The verified wages indicated the SSI recipient received excess payments of $100 in March and April 2014; $175 in November 2014; and $150 in August and September 2015. The overpayment period began in March 2014 (the first month of incorrect payment) and ended in December 2015 (the month we issued the initial overpayment notice). The total amount of the excess payments ($200 + $175 + $300) in the overpayment period was $675. The overpaid recipient requested a waiver of the overpayment. The decision maker determined the recipient was not at fault. Because the total amount of the excess payments in the overpayment period ($675) was not more than $1,000.00, we applied the administrative waiver policy and discontinued waiver development for the total amount of the overpayment.

EXAMPLE 2: The same situations as in Example 1, except the amounts of the excess payments were $350, $325 and $450. The total overpayment was $1,125. Because the total amount of the excess payments in the overpayment period ($1,125) was greater than $1,000.00, we could not apply the policy to administratively discontinue waiver development to the total amount of the overpayment. Nor could we apply the policy to administratively discontinue waiver development for any of the recipient’s excess payments in the overpayment period--$350, $325, and $450.

D. Systems considerations for administrative waiver

1. Waiver decision

The waiver (UOWV) screen provides reason codes to document the reason for the waiver decision. For direct waiver input information, see MSOM BUSSR 004.009, Waiver (UOWV). Use Reason number 5 (Approved – Administrative) ONLY if the amount of the overpayment is $1,000.00 or less. Never apply Reason number 5 to any overpayment exceeding $1,000.00.

2. Waiver approval notice

Usually, when a technician inputs a waiver approval decision, AONS generates a waiver approval notice. For exceptions to AONS, see SM 01310.305, AONS Notice Exclusions. For information on manual notices, see NL 00801.010, Manually Prepared Notices, and NL 00803.205, Notice of Waiver Decision-Waiver Approved.

E. References

  • SI 02260.001 Basic Requirements Concerning SSI Overpayment Recovery

  • SI 02220.016 SSI Overpayment – The 10 Percent Rate of Adjustment

  • SI 02260.035 SSI Overpayment Waiver When Recipient’s Countable Resources Exceed the Limit

  • SI 02201.005 Supplemental Security Income (SSI)-What is an Overpayment?

  • SI 02201.005 Supplemental Security Income (SSI) What is an Overpayment?

  • SI 02201.020 Supplemental Security Income (SSI) Overpayment: Who is Liable (Responsible) for Repayment? Living Overpaid Individual

  • SI 02201.021 Supplemental Security Income (SSI) Overpayment: Who is Liable (Responsible) for Repayment? Overpaid Individual is Deceased

  • SI 02220.016 SSI Overpayment – The 10 Percent Rate of Adjustment

  • SI 02260.001 Basic Requirements Concerning Supplemental Security Income (SSI) Overpayment Waiver

  • SI 02260.010 Development of Without Fault for a Supplemental Security Income (SSI) Overpayment Waiver

  • SI 02260.035 SSI Overpayment Waiver When Recipient’s Countable Resources Exceed the Limit

  • SI 04070.010 Title XVI Administrative Finality-General Reopening Policies

  • GN 02406.300 Original and Courtesy or Replacement Check Cashed-Double Check Negotiation (DCN) Potential Overpayment

  • GN 02406.310 Request for Reconsideration of DCN Overpayment or Forgery Determination

  • NL 00801.010 Manually Prepared Notices

  • NL 00803.205 Notice of Waiver Decision – Waiver Approved

  • SM 01310.220 Overpayment Sequence Processing – Systems-Computed Excess Payments (TOPs)

  • SM 01310.305 AONS Notice Exclusions

  • SM 01311.280 Uncollectible and Erroneous Overpayment Decisions-N TAC and NT TAC

  • MSOM BUSSR 004.002 Overpayment Menu (UOMN)

  • MSOM BUSSR 004.008 Overpayment Decisions (UOPD)

  • MSOM BUSSR 004.009 Waiver (UOWV)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502260030
SI 02260.030 - Impede Effective or Efficient Administration of Title XVI of the Act (Administrative Waiver) - 01/23/2017
Batch run: 01/23/2017
Rev:01/23/2017