TN 35 (11-07)
SI 02301.205 Suspension and Reestablishing Eligibility
Section 1631(j)(1)(B) of the Social Security Act;
20 CFR 416.1320;
Public Law 109-163, Section 689
This section explains when to reinstate SSI benefits or take a new application to reestablish eligibility again after a suspension. It reflects the SSI suspension and reinstatement policy in SI 02301.201B.
SSI recipients generally have 12 consecutive months after the effective date of a suspension to have benefits reinstated without filing an application.
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 the 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.
A suspension is always effective the first day of a month for that entire month. After the 12 month suspension period (or the 24 month suspension period) ends, a new application may be required to reestablish eligibility.
NOTE: SI 02301.201B.1. explains how to count the first month in the suspension period. Also, references in this section to the 24 month suspension period apply only to individuals affected by PL 109-163.
B. Procedure — When to Reinstate – A Suspension is on the Record
1. Before the 12 (or 24) Month Suspension Period Ends
Reinstate benefits before the suspension period ends when a recipient reestablishes eligibility for a nonpay month(s). See the example at SI 02301.205E.1.
IMPORTANT: The system automatically terminates a record (PSC T31) after 12 consecutive suspension months are posted unless an exception exists (see SM 01801.305). However, a record will be in T31 status before the 12th suspension month ends due to computation periods and run dates. In those cases, reinstatement may be proper. See the example at SI 02301.205E.1.
2. After the 12 (or 24) Month Suspension Period Ends
Reinstate benefits after the suspension period ends when:
A recipient appeals the suspension and reestablishes eligibility during the administrative appeal process or civil suit; see example at SI 02301.205E.3., or
There is a favorable appeal decision on the suspension determination (including a favorable Federal Court decision), or
SSA reopens and revises a suspension determination under the rules of administrative finality in SI 04070.001.
C. Procedure – When to Take a New Application – Terminate a Record
1. New Application
Take a new application when you cannot reinstate benefits following SI 02301.205B. See the example at SI 02301.205E.2.
2. Terminate an Active Record
Terminate an active record to take a new application when the record has been in a suspense status code listed in SI 02301.215B. over 12 (or 24) consecutive months and:
The record is not in GK or statutory benefit continuation status (see SM 01601.790C.18. for the code G in the CMPH field), and
An appeal is not pending (see SM 01601.685C., field L, for the different appeal codes A, C, H, R, and O) and
The 60 day period to appeal the suspension has expired. See SI 04005.012 on how to count the 60 day period and SI 04005.015 about good cause for extending the time limit.
NOTE: If there is an underpayment on a record, pay the underpayment, if due, before terminating the record.
D. Procedure — A Suspension is Not on an Active Record
When a recipient is currently eligible and receiving benefits and you discover a past period of ineligibility, input the correct data to the record subject to the rules of administrative finality (SI 04070.000). Do not terminate a record because a past period of ineligibility was 12 (or 24) months or longer if the recipient is currently eligible.
NOTE: If a recipient is currently ineligible and benefits are suspended retroactively for 12 (or 24) consecutive months or longer, the system will automatically terminate the record 95 days after the last payment unless an exception in SM 01801.305 applies.
1. Reinstate Benefits – Record is T31 – New Application not Required
In December 2005, the recipient receives a Notice of Planned Action to suspend his benefits effective January 1, 2006 for excess resources. January 2006 is the 1st suspension month posted to the record. The recipient contacts the field office in December 2006, the 12th suspension month, and shows he spent down his resources in November 2006. He is eligible again effective December 1, 2006. The record is T31. (The CMPH field shows T31 effective January 1, 2007.) The field office establishes a new start date record to reinstate benefits because he regained eligibility in the 12 month suspension period, see SM 01901.015 for OTP and approval review processes.
2. Take A New Application – Record is T31
The recipient in example 1 contacts the field office in December 2006 and shows that his resources fell below the limit on December 15, 2006. He would not be eligible again based on resources until January 1, 2007. Because January 2007 is beyond the 12 month suspension period, he must file a new application to get SSI.
3. Reinstate Benefits during the 60 Day Appeal Period – Appeal Filed
In December 2006, the field office sends a Notice of Planned Action to suspend benefits retroactively effective January 1, 2006 for excess resources. The recipient appeals the suspension during the 60 day appeal period and reports he exhausted his resources. He is eligible again based on resources effective January 1, 2007. Because he filed an appeal and regained eligibility in the 60 day appeal period, the field office reinstates benefits effective January 1, 2007.
NOTE: If the recipient in this example did not file a timely appeal (good cause did not exist), he must file a new application. The date he requested to file an appeal will be the protected filing date for the application.
SI 00601.010 – Filing Applications
SI 00601.037 – Closing Out Leads and Protective Filings
SI 02101.002 – SSI Underpayment Due – Individual Alive
SI 02301.201 – Description of Posteligibility (PE) Events
SI 02301.210 – Reinstatement
SI 02301.215 – Summary of Suspension, Stop Payment and Termination Events by Payment Status Code (PSC)
SM 01801.001 – Terminations and History File Processing
SM 01801.305 – Criteria for Terminating Active Master Records