TN 13 (01-15)

SI 02260.040 Adverse Changes in Financial Circumstances Following a Waiver Denial

Citations:

Social Security Act §1631(b)(1)(B)
;

20 C.F.R. §416.553

A. Policy for an adverse change in financial circumstances following an overpayment waiver denial

A liable overpaid recipient may request a subsequent waiver at any time, even if we have started payment adjustment (withholding) or if he or she started making installment payments.

If the recipient is without fault in causing the overpayment, and provides proof of an adverse change in his or her financial situation following a waiver denial, review his or her waiver request. Do not refund any funds withheld to recover the overpayment in months prior to the first month of an adverse change in the recipient’s financial circumstances.

If the recipient meets the requirements of defeat the purpose or deemed defeat the purpose of Title XVI of the Act, we may waive:

  • further adjustment; or

  • recovery of the outstanding balance.

Refer to SI 02260.020 for information on when to determine that an overpayment recovery meets defeat the purpose of Title XVI of the Act.

B. Waiver determinations due to an adverse change in financial circumstances

When you are making waiver determinations due to an adverse change in circumstances consider the following:

  1. A waiver of adjustment or recovery of the overpayment is effective with the first month we determine the liable overpaid recipient meets the requirement of defeat the purpose or deemed defeat the purpose of Title XVI of the Act. For information on defeat the purpose of Title XVI of the Act, see SI 02260.020.

  2. A subsequent adverse change in the recipient’s financial circumstances that meets the requirements of defeat the purpose or deemed defeat the purpose of Title XVI of the Act is not a reopening of the previous waiver determination. Therefore, the rules of administrative finality do not apply. For information on Title XVI administrative finality and general reopening policies, see SI 04070.010.

EXAMPLE: Sheila is an SSI recipient who was overpaid $2,500 due to excess income. In March 2013, we discovered the overpayment during a redetermination (RZ). The overpayment period was January 2012 through March 2013. We reviewed Sheila’s records and determined she was not at fault in causing the overpayment. Sheila submitted her paystubs timely; however, we did not post her wages until the March 2013 RZ.

Sheila was still working in March 2013; therefore, she was able to repay the $2,500 overpayment. Sheila requested a waiver of the overpayment. After conducting a personal conference, we denied her waiver because she had the ability to repay.

In August 2014, Sheila filed a waiver request on the remaining $620.00 balance. She reported she is no longer working, and needs her entire SSI monthly payment to meet her current ordinary and necessary living expenses.

We may approve Sheila’s waiver of the remaining $620.00. Sheila is an SSI recipient who is without fault in causing the overpayment. She needs all of her monthly SSI payment to meet current ordinary and necessary living expenses. Recovery is deemed defeat the purpose of Title XVI of the Act.

EXAMPLE: Ann is an SSI recipient who has a $3,000 overpayment, which she was without fault in causing. She has three ineligible children under age 18 in her household who do not receive income. When we discovered Ann’s overpayment she had $6,800 in total resources, consisting of a burial plot valued at $6,000 (which is excluded), and $800 in her checking account (which is countable). Ann agrees to make monthly installments of $100 to repay the $3,000 overpayment.

After six months of making the monthly installment payments, Ann requests a waiver of the remaining $2,400 overpayment. She made the six monthly installments from her checking account, so her balance is now $200.

We may approve Ann’s waiver of the remaining $2,400, as continued recovery would reduce her total resources below the $6,200 amount allowable in her situation, and defeat the purpose of Title XVI of the Act. For defeat the purpose of Title XVI of the Act, see SI 02260.020.

C. How to determine when a subsequent waiver is not an adverse change in financial circumstances

Do not find adjustment or recovery will defeat the purpose of Title XVI of the Act if:

  • The li