Identification Number:
SI 00601 TN 24
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:General Applications and Interviewing Policy
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 006 – The SSI Application Process
Subchapter 01 – General Applications and Interviewing Policy
Transmittal No. 24, 01/31/2020

Audience

OCO-OEIO: CR, FCR, FDE, RECONE;
OCO-ODO: CR, CST, CTE, CTE TE;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

 

Summary of Changes

SI 00601.110 Closeout - Failure to Cooperate (N18) - Initial Claims

Subsection C

Added the POMS reference DI 11018.005, Field Office Responsibilities in a Failure to Cooperate-Insufficient Evidence Decision (FTC) for processing disability claims.

SI 00601.110 Closeout - Failure to Cooperate (N18) - Initial Claims

A. Policy

1. General

A claimant is ineligible for Supplemental Security Income (SSI) if he or she fails to provide the requested information/evidence within the specified time period described in SI 00601.100C and you are unable to obtain the information/evidence needed after providing assistance and pursuing all leads as described in SI 00601.110B.2.

This also applies if the claimant's prospective representative payee, who is the legal guardian or parent with custody of a minor child, or if an alien's sponsor or sponsor's living-with spouse, fails to comply with the request.

NOTE: Regarding Zebley class members see SI 02101.007D.4.

NOTE: Distinct policy applies when using N18 to deny a claim for failure to give permission to contact financial institutions. For the permission to contact financial institutions policy, see SI 00601.110A.3.

2. Exceptions

A claimant is not ineligible for SSI based on failure to cooperate if:

  • a third party or prospective representative payee other than those listed in SI 00601.110A.1. or SI 00601.110A.3. fails to provide the requested information/evidence, or

  • you cannot obtain the information/evidence from the third party, the claimant has acted in good faith and you can determine eligibility and payment based on the information in file, or

  • ineligibility can be based on another denial reason.

3. Permission to contact financial institutions

a. General

A claimant is ineligible for SSI if he or she or any deemor(s) fail to give SSA permission to contact any financial institution, and request any financial records that financial institution may have about them. Payment status code N18 is used to deny the claim if either the claimant or a deemor fails to give permission to contact financial institutions. This policy varies slightly from general N18 usage policy since failure by the claimant or any deemor to give permission to contact financial institutions may result in a denial of the claim. We provide detailed information about permission to contact financial institutions as a requirement for SSI eligibility, see SI 00515.001.

b. Good cause

In some situations, we may provide a good cause exception from the requirement that the deemor give SSA permission to contact financial institutions. We provide detailed information about how to develop and document good cause for a deemor’s failure to give permission to contact financial institutions, see SI 00515.001 and SI 00515.002.

c. Close out

Standard 30-day closeout procedures should be used if permission cannot be obtained from a claimant or deemor not present at the time of the interview. For additional information regarding requesting information or evidence, see SI 00601.100.

NOTE: If the claim is denied due to failure to give permission to contact financial institutions, record in the remarks of the SSR the reason for the denial, see SI 00515.001C.3.

B. Procedure

1. Obtaining information and evidence

Follow the procedures for requesting information and evidence and offering assistance in SI 00601.100C and SI 00601.120.

NOTE: The SSA-L8009-U3 or the Financial Permission Request Letter (see SI 00515.001C.1.c.) must allow at least 30 days for compliance.

Try to obtain the information and evidence from other sources if a third party other than those listed in SI 00601.110A.1. (e.g., employer, relative, household member) fails to cooperate.

2. Providing assistance

If the individual in SI 00601.110A.1. or SI 00601.110A.3. fails to provide the requested information/evidence by the expiration of the 30-day closeout period, attempt to contact the individual by telephone to determine if additional time is needed and offer assistance. Make several attempts to call at different times on different days. If you do not reach the individual or he or she is uncooperative:

  • Review the claims file, for names of relatives, friends or medical treating sources such as doctors/clinics who may be able to provide assistance.

  • Pursue any known sources of assistance including contacts with community organizations established through outreach activities.

3. Develop new representative payee

Develop for a new payee if the prospective representative payee, who is other than the legal guardian or parent with custody of a minor child, cannot be located or fails to cooperate. If you cannot locate the payee who is the legal guardian or parent with custody of a minor child follow SI 00601.110B.7.. If he or she fails to cooperate, follow SI 00601.110B.4.

4. When to deny

Deny the claim (N18) for failure to cooperate if the individual in SI 00601.110A.1. or SI 00601.110A.3. does not comply with the request and you are unable to obtain the information/evidence after exhausting all leads. If the claimant submits the requested evidence after denying the claim and it is within the reconsideration period, treat the new evidence as a reconsideration request. Follow instructions for reconsideration procedures in SI 00601.110B.9.

5. Documentation

When using N18 to deny a claim:

  • Document the basis for the failure to cooperate denial (e.g., copy of SSA-8009-U3, Report of Contacts (RCs), Financial Permission Request Letter, describing attempts to contact).

  • Annotate the remarks portion of the appropriate Modernized Supplemental Security Income Claims System (MSSICS) screen(s) or the CG field on the SSA-450-SI with the factors of eligibility not established.

6. Claimant's whereabouts unknown

If a claimant’s whereabouts are unknown:

  • Attempt to locate the claimant per SI 02301.240D if the claimant's whereabouts are unknown (e.g., SSA-L8009-U3 is returned by the post office). Also, follow the procedures in the first and second bullets of SI 00601.110B.2. See GN 02605.060 (Title XVI Undeliverable Notices) for the policy on reissuing a notice.

  • Follow the procedures in GN 02605.060, if you locate the claimant. Before reissuing the SSA-L8009-U3 or the Financial Permission Request Letter, revise the closeout date to give the claimant a full 30 days to respond.

  • Deny the claim the day after the SSA-L8009-U3 or Financial Permission Request Letter closeout period expires if you are not able to locate the claimant.

  • Document the file per SI 00601.110B.5.

  • See additional instructions for processing disability claims, DI 11055.085.

7. Representative payee whereabouts unknown

If a representative payee’s whereabouts are unknown:

  • Attempt to locate the prospective payee if his or her whereabouts are unknown per SI 00601.110B.6.

  • Deny the claim the day after the SSA-L8009-U3 closeout period expires if you could not locate the prospective payee. However, develop for a new payee if the claimant's whereabouts are known and the prospective payee is other than the legal guardian or parent with custody of a minor child.

  • Document the file per SI 00601.110B.5.

8. Spouse's whereabouts unknown

In a couple's claim where one member's whereabouts is unknown:

  • Attempt to locate the missing spouse if his or her whereabouts are unknown per SI 00601.110B.6.

  • Deny only the missing spouse's claim the day after the SSA-L8009-U3 closeout period expires if you are not able to locate the missing spouse.

  • Adjudicate the remaining spouse's claim based on the couple computation rules in SI 00501.154.

  • Develop for a new payee if the missing spouse originally applied to become payee for the claimant.

9. Appeals

Follow the reconsideration procedures in SI 04020.010 through SI 04020.060 if the claimant or his or her representative payee contacts SSA within the 60-day appeals period following the receipt of the denial notice.

10. Reopening when failure to cooperate is involved

Determinations for failure to pursue or cooperate, etc., can be reopened if the claimant/appellant subsequently pursues or cooperates, even though they were correct when made if we did not follow the correct procedures before issuing the denial, see SI 04070.010C.1.

NOTE: Determinations for failure to give permission to contact financial institutions cannot be reopened.

C. References


SI 00601 TN 24 - General Applications and Interviewing Policy - 1/31/2020