TN 35 (11-07)
SI 02301.201 Description of SSI Posteligibility (PE) Events
This section describes suspension, stop payment and termination events and how to reestablish eligibility. The PE events are identified on the Supplemental Security Record (SSR) by the payment status code (PSC) in the PSY field (SM 01305.001). SI 02301.215 describes the PE events by PSC, effective suspension and reinstatement dates and gives manual notice requirements and references.
IMPORTANT: The term “eligible” in this subchapter means that a recipient meets all eligibility requirements for part or all of a past or current month(s). See SI 00501.001 for the basic SSI eligibility requirements.
A suspension of SSI benefits is required when a recipient is not eligible. It is always effective the first day of a month. For example, if the effective date is January 1, that entire month of January is the first suspension month. Generally, a recipient has 12 consecutive months after the effective date of a suspension to have benefits reinstated if he or she is eligible again. A recipient may have more than 12 months to have benefits reinstated when a condition in SI 02301.205B.2 applies.
Section 689 of Public Law 109-163, effective January 6, 2006, provides that blind and disabled children of military personnel stationed overseas have 24 months (instead of the 12 month suspension period) to have payments reinstated after a suspension, see SI 00501.415. It also provides that military-related individuals who become SSI ineligible as a result of their spouse or parent(s) being called to active military duty (including the Reserve or National Guard) have 24 consecutive months after the suspension (instead of 12 month suspension period) to have benefits reinstated without having to file a new application. Military-related individuals are aged, blind or disabled spouses residing in the United States or blind or disabled children residing in the United States or overseas. These individuals affected by PL 109-163 may have more than 24 months if SI 02301.205B.2 applies.
NOTE: SI 01310.170 explains how deeming applies when the deemor is absent from the household due to military service.
2. Stop Payment
A stop payment is an interruption in payment. It is not a loss of eligibility. Payments may be reinstated for past or current month(s) on a stop pay record regardless of the period in nonpay. If you find ineligibility in a stop pay period, benefits must be suspended subject to the rules of administrative finality in SI 04070.001.
A stop payment only happens when:
The FO is searching for a representative payee, PSC S08, GN 00502.100,
A recipient is eligible, but due no payment, PSC E01, SI02005.020,
A recipient is section 1619(b) eligible and due no payment, PSC N01 for 1619(b), SI 02302.000, or
A recipient receives temporary institutionalization (TI) benefits and the system defaults to PSC S09 waiting for the FO to input a living arrangement change, SI 00520.140.
A termination event ends SSI eligibility. Generally, if a recipient does not appeal a termination, he or she must file a new application to reestablish eligibility. A termination event only happens when a recipient:
no longer has a disabling impairment, PSCs N07 and N08,
voluntarily requests benefit termination, PSC N19, or
dies, PSC T01.
NOTE: See DI 55002.055 and DI 55002.060 for the effect of termination on a Ticket-holder. See GN 02602.055 for instructions when an individual deceased on SSA records is alive.
A reinstatement is a resumption of benefits for a past or current month(s) that the recipient is eligible. A new application is not required. Reinstatement is effective the first month or earliest day in a month that a recipient is eligible. Proration of payments may apply for a month following a month in PSC N02, N03, N06, N07, N08, N13, N22 or N23 (SI 02005.008).
IMPORTANT: The rules of administrative finality do not apply when reinstating benefits. Those rules only apply to paying benefits after an incorrect suspension or termination was reopened and revised based on good cause (SI 04070.001). That is, a prior determination was changed.
5. Required Due Process Notices
Suspension, reduction or termination of SSI benefits are adverse actions that require written advance notice. The advance notice gives the reason for the action, 60 days for the person to appeal and 10 days to appeal and continue payment at the same amount until there is a decision on the reconsideration request. See SI 02301.300 about due process protections and required advance written notices
SI 02301.210 - Reinstatement
SI 02301.300 - Due Process Protections
SI 02301.215 - Summary of Posteligibility Suspension, Stop Payment and Termination Events by Payment Status Code (PSC)
SM 01305.001 - Payment Status Code