TN 7 (10-14)
SI 02309.006 Gerontology Limited Issue KC Diary
Effective October 2014, we expand our system’s selection criteria by introducing the KC diary. This diary requires technicians to conduct interviews with Supplemental Security Income (SSI) recipients who will attain age 90 in the fiscal year or who are already over age 90. This new section provides procedures and processing instructions for handling those interviews and documenting the new Development Gerontology (DGEN) screen.
The KC diary replaces the Title XVI Centenarian Project. The criteria for this diary are below,
The KC diary is available on StaRZ & Stripes, The Next Generation
(SSTNG), MI Central Workload Listings, and CHINET’s SSI Diary
Workload Control Application.
B. The purpose of the KC Diary
1. Determine if the recipient is alive
In the past, we issued a small percentage of SSI payments to deceased recipients. Interviewing the recipient and the representative payee, if applicable, allows us to verify the recipient is still alive.
2. Ensure program integrity
We must verify the identity of the recipient who is receiving SSI payments. To ensure program integrity, immediately refer a case to the Office of the Inspector General (OIG) if you suspect fraud at any time. For instructions on OIG referrals for recipients selected for the KC diary, see SI 02309.006C.7.
3. Determine recipient capability
We presume a legally competent adult recipient is capable of managing or directing someone else to manage his or her SSI payments. If during the interview, it becomes apparent that the recipient is not handling his or her payments or is incapable of continuing to do so, develop for a representative payee. For more information on representative payees, see GN 00502.001.
4. Ensure payment accuracy
We must review all eligibility factors and resolve all payment discrepancies.
The KC diary indicates that technicians must interview SSI recipients by initiating a scheduled redetermination (RZ) or a limited issue (LI) RZ. For general information on RZs, see SI 02305.001. For LI information and processing instructions, see SI 02305.015.
C. Preparing for a gerontology interview
Telephone contact is our preferred method for conducting a gerontology interview.
A management official decides whether a home visit interview is necessary on a case-by-case basis. The following are examples of when a home visit interview may be appropriate:
The recipient or representative payee, if applicable, requests a home visit interview;
The recipient or representative payee, if applicable, may have conditions that impair effective telephone communication; or
You are unable to verify the recipient or representative payee’s identity during the telephone interview.
Before sending the recipient an appointment letter, review the recipient’s Social Security records (e.g., SSR and Number holder Identification (NUMI) record). Identify any discrepancies (e.g., date of birth, payment history) so that you can resolve the discrepancies with the recipient during the interview.
1. Send the interview notice
Send an interview notice to the individual and his or her representative payee, if applicable. The interview notice(s), along with the Spanish translations are available in the StaRZ & StriPEs—The Next Generation (SSTNG).
After you determine how you will conduct the interview, send one of the following notices:
a. Telephone interview
Use Form SSA-L502 (Telephone Interview Letter) to schedule a telephone interview with the recipient and representative payee, if applicable. For a sample SSA-L502, see NL 00701.136.
b. Home visit interview
Use Form SSA-L501 (Home Visit Letter) to schedule a face-to-face interview with the recipient and representative payee, if applicable at his or her residence. For a sample SSA-L501, see NL 00701.135.
If the appointment letter comes back as undeliverable, follow the instructions in GN 02605.060.
2. Able to reach recipient or representative payee by phone
If the recipient or representative payee answers the phone, inform him or her you are calling to conduct the interview. If asked to reschedule the interview, do so and inform the recipient or representative payee that you will send a letter notifying him or her of the new date and time. Remind him or her of the importance of being available at the time of the rescheduled interview. If the recipient requests third-party assistance, advise that the third-party representative must be present during the rescheduled interview. For more information on third-party assistance, see SI 02309.006E.
3. Unable to reach recipient or representative payee by phone
If you reach a voicemail, leave a detailed message that includes your name, the office you are calling from, your office phone number and reason for your call. Do not release any personally identifiable information (PII). Send a new appointment notice to the recipient or representative payee. If you cannot leave a voicemail, document the attempted phone contact(s) (e.g., number of attempts, days and times attempted) on a MSSICS Development Worksheet (DW01) screen or SSA-5002 (Report of Contact) stored electronically, for non-MSSICS cases. Initiate a home visit interview.
4. Must reschedule the interview
Allow only two rescheduled appointments.
If it is necessary to reschedule the interview:
Call the recipient or the representative payee, if applicable, to reschedule the interview based on the date and time that he or she requests;
Mail a new interview appointment letter to the recipient and the representative payee, if applicable. The letter must provide the new date and time of the appointment. If the new appointment is less than 1 week from the original appointment, an appointment letter is optional, but confirms that all parties will be available at the appointment time. Include the following language in the appointment letter when scheduling the final (third) appointment: “We have tried to schedule an appointment with you twice. Each time we rescheduled, you were unavailable. It is very important that you keep this appointment. If you do not keep this appointment, we may suspend your SSI payments until we speak with you.” and
Add a remark to the DW01 screen to document the reason for rescheduling. For non-MSSICS cases, add remarks to an SSA-5002 (Report of Contact) and fax remarks into the non-disability repository for evidentiary document (NDRED).
5. Unable to locate recipient
A suspension of SSI eligibility for “whereabouts unknown” is proper when we cannot locate a recipient, and determine his or her current SSI eligibility and correct payment amount. Exhaust all efforts to locate and contact the recipient. Contact any interested person or source that you believe may have contact with the recipient, such as a financial institution, benefit source, medical treatment source, or social service agency. If you are unable to locate the recipient, suspend his or her payments using S06 (Whereabouts Unknown). For more information on S06 suspension, see SI 02301.240.
6. Recipient or representative payee fails to keep appointments
After you exhaust all efforts and the recipient or representative payee, if applicable fails to keep the appointment and his or her mail has not been returned undeliverable, suspend the recipient’s payments using N20. For more information, see SI 02305.021 and SI 02301.235.
7. Recipient may be deceased
If you suspect the recipient is deceased, suspend payments according to SI 02309.006C.5. and SI 02309.006C.6. (in this section). Immediately refer the case to OIG using Form e8551 (Reporting Form for Programmatic Fraud). Complete the e8551 as follows:
Section I Program Affected: Title XVI Aged;
Section II Allegation: XVI Deceased Payee;
Section II Subject Type: Unknown Subject (deceased individual cannot be at fault) or representative payee if there is one associated with the record. If you select “Unknown Subject”, input the recipient’s address in Section II, Subsection I. This ensures the correct Office of Investigations Field Division receives the referral; and.
Section V Summary: Include “Gerontology LI” in the description. This will help OIG properly catalog the referral.
Include the outcome of your development with the United States Postal Service and financial institution. Additionally, provide as much information as possible such as your contacts with any social service agency, homeless shelter, benefit source, or medical treatment source.
Annotate the DGEN screen showing that you referred the case to OIG. For more information on the e8551, see GN 04124.001.
D. Conducting the gerontology interview
When conducting a gerontology interview:
Verify the identity of the recipient and representative payee, if applicable, before the interview begins using the procedures to establish identity as noted in GN 00203.020.
NOTE: If you cannot establish identity during the initial appointment, a home visit interview may be necessary. Consult with management and mail Form SSA-L501 (Home Visit Letter) to schedule the second appointment.
IMPORTANT: If the recipient has a representative payee, you must speak with and identify the recipient to ensure he or she is alive.
Develop any additional post-eligibility issues. These issues include:
Using MSSICS, open a Redetermination or Limited Issue event to create the DGEN screen during the interview. Completing this screen ensures you document all applicable information to clear the diary.
NOTE: You may record additional remarks on the DW01 screen or Report of Contact (DROC).
For MSSICS cases, complete the DGEN screen and build the SSR. NOTE: If all development is complete, then the system will allow you to close the limited issue. If any part of the development is incomplete or the development screens do not show “development complete”, then the system will not allow you to close the limited issued.
For non-MSSICS cases, develop all post-eligibility issues, delete the diary via direct SSR update (the UDIA screen) and complete the 1719b to clear the LI. Document the interview on an SSA-5002 (Report of Contact) and fax into NDRED. For additional information about development documentation, see MSOM MSSICS 022.012 or MSOM MSSICS 022.029.
E. Third-party interview assistance
During the interview, the recipient may request assistance from a third-party. The purpose of a third-party helper is to assist the recipient with conducting his or her business with us. A third-party helper may be a relative, friend, or other individual who does not have access rights to the recipient’s information. When the third-party helper assists with the interview, complete the following steps:
After identifying the recipient, obtain the recipient’s permission to speak with the third-party helper.
Document the third-party helper’s name, telephone, and relationship to the recipient on the DW01 screen.
NOTE: If it appears that the recipient needs a representative payee, refer to GN 00502.020.
Continue the interview process per SI 02309.006D in this section.
F. Recipient is outside of the country
You may discover that a recipient is out of the country. Immediately obtain the complete foreign address and telephone number. If the reporter alleges he or she does not know how to contact the recipient, initiate unable to locate procedures found in SI 02301.240. It may also be an indication of death. For death cases, see SI 02309.006G.
If the recipient is residing outside of the country and the foreign address is available, follow procedures found in SI 02301.225.
G. Gerontology death cases
Follow these instructions upon receiving a report of the recipient’s death:
Obtain proof of death following regular policy guidelines. (For preferred evidence of death, see GN 00304.005.)
Post the proof of death to the Evidence Screen (EVID) in the Shared Processes menu. For more information on the EVID screen, see MSOM EVID 001.003.
REMINDER: If the date of death is posted on the SSR without proper documentation on the EVID screen, you cannot use it as verified evidence of the recipient’s death. You may use death data on the Numident as proof of the recipient’s death if certain requirements are met. (For use of Numident death data, see GN 00304.100B.3.)
Terminate payments based on the verified date of death. Terminate SSI payments following instructions at SM 01301.375 through SM 01301.380.
If the report of death is not timely and we paid at least 2 months of SSI payments after the date of death, submit a referral to the Office of Inspector General (OIG) via Form e8551. Follow the instructions in SI 02309.006C.7. to complete the e8551. (For more information on the e8551, see GN 04124.001.)
Post the following remark on the SSR:
“Gerontology Limited Issue- KC Diary (Month and Year)-recipient is deceased.” Include your FO code, initials or unit.