VB 02005.305 SSA-2032-BK — Request for Waiver of Special Veterans Benefits Overpayment Recovery or Change in Repayment Rate
A Form SSA-2032-BK, Request for Waiver of Special Veterans Benefits Overpayment Recovery or Change in Repayment Rate will be used when a debtor requests waiver of an SVB overpayment or change in repayment rate, except as provided in VB 02005.305A.2. Policy guidelines for use of the SSA-2032-BK follow. The Form SSA-2032-BK is available in paper form in CPSs and at the Federal Benefits Unit (FBU). Additionally, the form can be found in printer-friendly versions at VB 02005.308; and, through the Region 9 SVB Intranet site.
1. Uses for the SSA-2032-BK
The SSA-2032-BK is used to:
Make a waiver determination which considers fault, financial circumstances and whether recovery would be against equity and good conscience;
Request a change in the rate of withholding to less than the 10 percent rate (see VB 02020.005 and VB 02005.215);
Determine ability to repay and financial circumstances when a compromise offer of less than 80 percent is offered (see sensitive instructions SI 02220.031);
Refer a claim for recovery by civil suit (see SI 02220.035B.1.).
2. SSA-2032-BK Unnecessary
It is not necessary to complete an SSA-2032-BK when:
Equivalent information, in writing and over the person’s signature (or that of his/her representative payee, legal counsel, etc.) is in file. Even if incomplete, consider this document as a waiver request; or,
Determining whether approval of a waiver as an administrative discontinuation of recovery is warranted as the overpayment is $500 or less. Instead, document the request by obtaining a signed SSA-795 stating the overpaid person’s name and account number, the overpayment amount and the debtor’s request for waiver.
NOTE: When the request is made by telephone, obtain this information on an SSA-5002.
3. Completion Without SSA Participation
The SSA-2032-BK may be completed without SSA assistance. When the debtor, his/her representative payee, legal counsel, etc., requests an SSA-2032-BK, it should be provided. However, interviewing personnel are strongly encouraged to help in the completion of the SSA-2032-BK to ensure that:
The explanation of without fault relates to the facts surrounding the overpayment;
The financial statements accurately reflect the person’s current circumstances; and
Any contradictory statements are resolved.
NOTE: Offer assistance to the person requesting the form at the time the request is made.
B. Description of the SSA-2032 BK
1. SSA-2032-BK Page 1, Name of Beneficiary
When the form is needed, page 1 is always completed. It provides identifying information for the beneficiary and any representative payee, including spaces in which to write the Social Security number of each. It also begins the collection of information about the use of the overpaid benefits.
2. SSA-2032-BK Section I, Without Fault Determination
Section I is completed only if waiver is requested. This section collects the information needed to determine whether the liable person was at fault in causing the overpayment. The answers must thoroughly explain the person’s involvement in the overpayment situation.
3. SSA-2032-BK Section II, Financial Statement
Section II asks for a detailed description of the person’s income and assets from all sources and the expenses of the household. It is used in situations involving waiver request, request for change in repayment rate, referral for recovery by civil suit and compromise offers of less than 80% of the overpayment.
Follow this procedure for completing the SSA-2032-BK.
1. Before Completing the SSA-2032-BK
Prior to the interview, review any documents that directly relate to the overpayment (e.g., the overpayment notice, a current SSR query, the folder, etc.).
Before completing the form, carefully interview the person to be sure that the SSA-2032-BK is necessary and, if it is, which sections must be completed.
2. Completion of the SSA-2032-BK
a. For SSA Use Only
The interviewer will show the period and amount of the overpayment.
b. Question 1
List the names and SSNs of the beneficiary (and the representative payee, if applicable). Complete items 1A and 1B.
c. Question 2
Check the appropriate block(s) to indicate what type of relief the person is seeking.
Check block A if waiver is requested.
Check block B if the SVB recipient wants to repay the overpayment at a rate other than the lesser of 10 percent of the maximum SVB payment amount or the amount of the person’s monthly benefit.
Check block C if the person no longer receiving SVB wants to make installment repayments.
NOTE: Until procedures are implemented under P.L. 108-203, The Social Security Protection Act of 2004, for cross-program recovery of Retirement/Survivors benefits and SSI benefits to recover SVB overpayments, those overpayments not waived may be recovered from SVB recovery, through refund, installment payments or TRO, as explained in VB 02005.120A.3.
3. SSA-2032-BK, Section I — Information About Receiving the Overpayment
Provide the following information about how the overpayment occurred:
Section I is the basis for the fault determination of a waiver determination. Secure answers that thoroughly explain the overpayment situation.
If the overpayment is caused by more than one event, secure a separate explanation of why the person believes he/she is without fault for each event.
If a person requests a lesser repayment rate or compromise settlement and not a waiver, do not complete Section I of the SSA-2032-BK. Complete only Section II.
When administratively discontinuing recovery (i.e., granting waiver based on the policy in VB 02005.315) because the overpayment amount is $500 or less, do not complete an SSA-2032-BK. Instead, document the request by obtaining a signed SSA-795 stating:
The overpaid person’s name and account number;
The overpayment amount; and,
The person’s request for waiver.
NOTE: When the request is by telephone, secure the above information on an SSA-5002.
4. Completion of Section I — Individual Questions
a. Question 3
Secure a complete statement of why the person believed the overpaid monies were due, his/her understanding of the provisions involved in the overpayment and why the person believes he/she is without fault. Have the person explain any actions, conversations, notices or letters that affected his/her understanding of the law and reporting responsibilities.
b. Question 4
If the person reported, get a description of what actions he/she took to report and what, if anything, he/she did after the report. If he/she did not report get an explanation of the person’s understanding of the reporting responsibilities in his/her own words. This question gives the person an opportunity to explain why he/she did not report a change. If the understanding is incorrect, explain the provisions, making sure the person understands. Document in the “Remarks” section or on a Report of Contact the person’s final understanding of his/her reporting responsibilities. Record this on the SSR. This should help to prevent additional overpayments and prevent later allegations of misinformation.
c. Question 5
Use the response to this question in conjunction with information about past overpayments on the master beneficiary record (MBR), supplemental security record (SSR) and the folder, if available. It helps determine the overpaid person’s understanding of reporting responsibilities and the ability to recognize recurring and related events. Do not question the person’s veracity if our records show a prior overpayment that the person failed to report. Instead, ask questions that may help the person remember that a similar type of overpayment occurred and its relationship, if any, to the current circumstances. Give the person an opportunity to explain why he/she believes the current overpayment is different from the prior overpayment. If the person’s response is that he/she does not remember, record the answer.
5. SSA-2032-BK Section II — Your Financial Statement
The interviewer can help the person complete Section II if the person wants SSA assistance. However, if it is more expeditious or the person requests, Section II may be mailed to the person for completion and signature. Be sure to show the person’s name and the SSN under which the overpayment occurred. When a representative payee and a recipient are both liable for an overpayment (see VB 02005.110), collect separate Financial Statements from each.
NOTE: If the person wants only an against equity and good conscience finding, do not collect a Financial Statement.
b. Credibility of Answers
Accept reasonable allegations about living expenses, income, assets, etc. When information appears incorrect or impossible and verification is needed, see GN 02250.250 for guidelines.
c. When Not to Complete Section II
Collect answers to all questions in Section II unless the overpaid person is currently eligible to receive cash public assistance.
NOTE: SVB is not cash public assistance for purposes of completing this form. If the person is receiving cash public assistance, the only Section II questions requiring answers are questions 6, 7 and 8. The person requesting waiver should then skip to the signature and contact information page. Waiver will be approved if the person is otherwise without fault, the answers to Questions 6A and 6B are ‘No’ and the answer to Question 8A is ‘Yes’, since recovery would defeat the purpose of Title VIII.
d. A Recent Redetermination
Do not complete questions 9-17 when the same information was recently obtained on a MSSICS redetermination form or other form signed as part of an SVB redetermination.
e. Transfer of Resources
In order to determine eligibility for SSI, SSA must determine the value of an individual’s resources at the first moment of the month. Transferring ownership of a resource may affect the value of an SSI recipient’s countable resources, which in turn can affect SSI eligibility. Under the Foster Care Independence Act of 1999, (P.L. 106-169) effective 12/14/99, transferring ownership of a resource for less than fair market value can result in a period of ineligibility for SSI.
Therefore, when an SSI recipient requesting waiver of an SVB overpayment alleges that a resource has been transferred, (or a rep payee makes that allegation on the SSI recipient’s behalf), it is necessary to develop this issue in order to determine the effect on SSI eligibility in considering whether defeat the purpose applies based on SSI eligibility.
NOTE: If SSI ineligibility occurs as a result of resource transfer, full defeat the purpose development is still necessary (see VB 02005.325).
f. Assets and Income
The answers should reflect the total monthly income of the waiver requester, regardless of whether the overpaid person is currently eligible for SSI or SVB. Use the current month’s income. When there is self-employment income, show one-twelfth of the anticipated net earnings for the year. Total assets should include all net resources of the waiver requester. Net resources are those remaining after the allowable exclusions are deducted.
6. Completion of Section II — Individual Questions
a. Question 6
This question helps you determine whether recovery with respect to that amount of the overpayment in the person’s possession will not defeat the purpose of the Title VIII (see VB 02005.325). Remember that possession of incorrectly made payments, (or proceeds from payments in identifiable liquid resources which accumulated during the overpayment period) means recovery will not defeat the purpose of Title VIII.
b. Question 7
c. Question 8
A person receiving SSI at the time the form is completed does not have to answer any more questions.
d. Question 9
This item allows the waiver requester to list persons and describe his/her relationship (spouse, child, parent, friend, etc.) with those who live with AND depend on him/her for support.
e. Question 10
See VB 02005.305C.5.f. Part A—Do not include the proceeds of any current month’s income listed in Question 14, such as cashing a paycheck to pay regular expenses (food, rent, etc.). That is, do not count the same money twice.
Part B—If the answers indicate that the person is receiving income from assets, include that income on line L of Question 14.
f. Questions 11-13
See VB 02005.305C.5.f.
g. Question 14
See VB 02005.305C.5.f. Include the person’s income from all sources and the income of a spouse, if applicable. Indicate to whom the income belongs. Total each column to show household income. Convert all income to monthly totals: multiply weekly income by 13, then divide by 3; divide quarterly income by 3; divide yearly income by 12.
h. Question 15
Show “cc” in the expense line if the expense (e.g., clothing) is also listed in line F (credit card payments). Show average monthly household expenses in the amount column. Household expenses are for all household members, not just overpaid person. Multiply weekly expenses by 13, then divide by 3; divide quarterly expenses by 3; divide yearly expenses by 12. Include in “Expense Remarks” any expenses unique to only one household member as well as any unusual or very large expenses.
i. Question 16
j. Question 17
The required explanation helps to determine if the person has any income or resources not shown on previous questions or if he/she is going into debt each month.
k. “FOR SSA USE ONLY”
When item 16A exceeds item 16B, enter the difference in the top block. When item 16B exceeds item 16A, enter the difference in the lower block.
l. Question 18
The answer will help determine if you should look beyond the immediate comparison of income and expenses from Question 16.
NOTE: Refer also to Questions 10D and 11C in the determination of ability to repay. Recall that the “family” car and the property where a person lives are not counted as an asset.
D. Office Receiving the Waiver Request
Fax and then mail the signed waiver request to the CPS/FO having jurisdiction, if this is not the receiving office. See VB 00901.015 and VB 00901.025.
Advise the waiver requester that filing a waiver request stops recovery of the SVB overpayment effective with the month it is filed.