VB 01501.012 Processing Third-Party Reports
A third-party report is:
All third-party reports require independent verification of the report/event UNLESS the event is detected from a computer data match that is excepted from the Computer Matching and Privacy Protection Act of 1988 (CMPPA). (See VB 01501.013 for CMPPA exceptions.)
When a third-party report will result in an adverse action, a Notice of Planned Action must be sent to the beneficiary (unless legally incompetent) and payee before the report can be processed. The Notice of Planned Action will advise him or her of the pending adverse action and the effect the action have on benefits. In addition, the notice informs the beneficiary/payee of the Goldberg/Kelly provisions and advises him or her that SSA will process the report if an appeal is not filed within 10 days of his or her receipt of the advance notice.
B. Procedures — Verification of Third-Party Reports
All third-party reports must be verified by an independent source before the event can be processed. Failure to comply with SSA's requests for information or evidence may lead to a suspension of SVB payments for failure to provide information (see VB 01503.000).
1. Third-Party Report Filed/Received in Office Not Having Jurisdiction of SVB Claim (Other Than the FSP)
Fax and then mail the third-party report (and information obtained per VB 01501.010C.2.) to the CPS or FO having jurisdiction of the SVB claim.
2. Report Filed/Received in the FSP
Before referral to the CPS or FO having jurisdiction of the SVB claim:
Attempt to verify the third-party report with the beneficiary, payee or other independent source.
Document all efforts to verify the report on an SSA-5002 (or equivalent). (See VB 01503.000 for development procedures and timeframes when requesting information/evidence from the beneficiary and/or payee.)
Fax and then mail the third-party report along with verification (and/or documentation of efforts made to verify the report) to the CPS or FO with SVB jurisdiction.
3. Report Filed/Received in CPS or FO With Jurisdiction of SVB Claim
If verification of the third-party report has not been obtained, do not process the report. Obtain verification, or additional information/evidence, from the beneficiary and/or payee.
Depending on the outcome of the above verification development, continue as follows:
The third-party report is verified AND the report does NOT result in an adverse action
Process the report as first-party report (VB 01501.011).
The third-party report is verified AND the report results in an adverse action
Process per VB 01501.012C.
The third-party report is NOT verified — beneficiary fails to cooperate or comply with development requests
Process per VB 01503.000, Failure to Provide Information.
The third-party report is NOT verified because of the inability to locate beneficiary
Process per VB 01503.000, Whereabouts Unknown.
C. Procedure — Adverse Third-Party Report Verified
Prepare and send a Notice of Planned Action to the beneficiary (unless legally incompetent) and payee explaining the following:
the third-party event reported/detected;
how the event adversely affects SVB qualification, entitlement and/or payments;
SVB will continue (uninterrupted and at the same amount) until a decision is made at the first appeal level if the individual files an appeal within 10 days after receiving the Notice of Planned Action; and
the third-party report will be processed if no response to the Notice of Planned Action is received by the close of the 10-day Goldberg/Kelly due process period.
NOTE: Due to the variations in foreign mail delivery, presumption of an individual's receipt of the Notice of Planned Action within 5 days of the date on the notice per SI 02301.300E.5. will not always apply in SVB adverse actions. Allow 2 weeks mail time for the delivery of SVB advance notices PLUS the 10-day Goldberg/Kelly due process period before processing the adverse action unless the notice is handed directly to the individual or the Notice of Planned Action is mailed to a United States address. If the notice is handed to the individual or mailed to a United States address, use the timeframes in SI 02301.310C.2. and SI 02301.310C.3. for determining when the due process period ends.
Update the Intranet site (http://sfapp.sf.ad.ssa.gov/Title8/) with the following: (Entries will be needed in both the SUSPENSION and REMARKS fields.)
the effective date of the adverse third-party report;
the reason for the event;
when and by whom the event was verified;
the date the Notice of Planned Action is mailed or given to the beneficiary or payee; and
the Goldberg/Kelly due process expiration date. (See NOTE: above for determining this date.)
D. Procedures -- No Appeal Received to Notice of Planned Action
Process the third-party report as a first-party report.
E. Procedures — Appeal To Notice of Planned Action Filed Within 10 Days of Receipt -- Adverse Action Not Yet Taken
If the beneficiary/payee appeals the third-party report within 10-days after receipt of the Notice of Planned Action, and the adverse action has not yet been taken, process the appeal in accordance with VB 02502.010. Enter the appeals data to the “SVB Appeals Page” on the SVB Intranet site.
NOTE: If the appeal is filed in an SSA office not having SVB jurisdiction, enter the date the appeal was filed on the SVB Intranet site, fax and then mail the appeal to the CPS or FO having jurisdiction of the SVB claim.
F. Procedures — Appeal to Notice of Planned Action Filed After Adverse Action is Taken -- Good Cause Found for Not Filing Timely Payment Continuation Request
If good cause is found for a late appeal (i.e., more then 10-days after the receipt of the Notice of Planned Action), but the adverse action has already been processed, reinstate or adjust benefits to the amount payable before the adverse action was taken and process the appeal in accordance with VB 01501.012E. (Good cause for extending time limits is discussed in VB 02501.010.)
NOTE: Once benefits are reinstated under the Goldberg/Kelly provisions, benefits cannot be stopped or adversely adjusted again without sending the beneficiary (unless legally incompetent) and payee another advance notice.