Identification Number:
SI 02006 TN 16
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Windfall Offset and Effect on Title XVI Payments
Type:POMS Transmittals
Program:Title XVI (SSI)
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 020 – Benefits and Payments
Subchapter 06 – Windfall Offset and Effect on Title XVI Payments
Transmittal No. 16, 02/05/2019

Audience

FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, 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.

This update corrects minor deficiencies in SI 02006.203 and SI 02006.210

Summary of Changes

SI 02006.210 Field Office Representative Fee Adjustment Procedures Summary and Worksheets

Updated "N TAC" to "NT TAC";

Changed the word "uncollectable" to "erroneous" to match "NT TAC";

Capitalized "T" in "Title" throughout the document;

Deleted excess periods throughout the document;

Spelled out "retroactive" instead of leaving the incorrect abbreviation of "retro." throughout the document;

Consolidated rows in Section C Step Action Chart to eliminate excess rows.

SI 02006.215 Record Corrections, Payments, and Notices

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

Updated "N TAC" to "NT TAC";

Capitalized "T" in "Title" throughout the document.

SI 02006.210 Field Office Representative Fee Adjustment Procedures Summary and Worksheets

A. Introduction

This section summarizes step-by-step procedures and provides worksheets to assist Field Offices (FOs) in subtracting the authorized fees for representatives (attorneys and non-attorneys) from retroactive Title II benefits in offset cases, as required by SI 02006.200 and SI 02006.205. Title XVI offset will seldom apply after 09/07/95.

See subsection SI 02006.210B. for the chart of step-by-step procedures and subsections SI 02006.210C.SI 02006.210F. for the exhibits of worksheets SSA-2894 and SSA-2877 and charts of completion instructions and notes.

The worksheets SSA-2894 and SSA-2877 (see SI 02006.210D. and SI 02006.210F.) should be locally reproduced.

B. Procedure - development of fee adjustment

STEP

ACTION

1

Is the fee authorized and known at the time you are ready to process offset?

If yes - compute title II offset using the adjusted Title II income determined as explained in step 4, below. Take no other actions or steps.

If no - compute offset using the reported Title II amounts without regard to a fee. (See SI 02006.205B.2.b. and SI 02006.205C.3. for required notices.) Tickle the case for 90 days pending receipt of the fee determination notice (see SI 02006.205B.2. and SI 02006.205C.2.) Follow up after 30 days per SI 02006.205C.2. Proceed to step 2 when a copy of the notice or information is received.

2

Upon receipt of a fee authorization notice in fee petition cases or when the claimant/representative notifies you that a fee has been determined, or upon completion of preparation of the notice based upon the Title XVI past-due benefits, use the notice as the source of the needed fee information (per SI 02006.202.)

NEVER USE THE FACT OF WITHHOLDING OR THE AMOUNT WITHHELD AS THE BASIS FOR THIS ACTION.

In fee agreement cases, use the information on the MBR in the ATTY Fee line for the authorized Title II portion of the fee for the primary and any auxiliaries. Then compute the Title XVI portion of the fee per SI 02006.203.

Proceed to step 3.

3

Evaluate the fee petition notice per the guidelines in SI 02006.202B.3. –
SI 02006.202B.5., or as appropriate.

Proceed to step 4.

4

  • Obtain SSI, MBR, and PHUS queries to obtain the information needed (per SI 02006.205D.).

  • Complete SSA-2894, “Offset Case Authorized Fee Worksheet” (Exhibit 1) and subtract the entire fee from the tTitle II benefits beginning with the first month they were regularly due (SI 02006.200C.1.).

NOTE:: 

For fee agreement cases the “fee” means the total amount of the Title II fee plus the Title XVI fee. For fee petition cases this means the total amount authorized in the notice.

5

Is this a Title II or Title XVI offset case?

  • If Title II, proceed to step 6.

  • If Title XVI, proceed to step 12.

6

To evaluate per SI 02006.200C.2., determine whether the amounts of Title II income remaining (column D on the SSA-2894) are different from any of the type W amounts posted for the months of the offset period.

If yes, proceed to step 7.

If no, proceed to step 11.

7

The requirements in SI 02006.200C.2.b. apply. Determine the affected months. These are:

  • Each month in the offset period that, after subtraction (as shown in column D on the SSA-2894) has a remaining Title II amount of zero or less than the type W posted, and the following 2 months of SSI eligibility.

    NOTE:: 

    These are months in which the unchanged type W amount did not, in the original Title II offset computation, yield countable income (CI) that stopped payment computation (e.g., for the month of December 1997, a Federal benefit rate of $484 but CI of $500 based on type W of $520 and no State supplementary payment (SSP) involved).

  • Proceed to step 8.

8

As required by SI 02006.200C.2., compute the month-by-month changes. Complete SSA-2877, Adjusted Title II Income and Title II Offset Worksheet, (Exhibit F.) for the affected months. This worksheet can be used to simultaneously compute “new” FAM's and SAM's for the affected months, and also the difference between these amounts and the previously computed amounts that were based on the original type W income. The previously computed amounts are the WFA and WSA on the SSR in automated Title II offset cases and the new FAM and new SAM in manual (SSA-4346-U2) computation cases. (See SI 02006.215B.1.a. which explains why in some cases the Title II type A or W postings cannot be changed and when systems computations cannot be used.) Process the total underpayments (Federal and SSP) manually as computed in section F. of the SSA-2877. See step 9.

If preferred when computation of the countable income is complex, use the SSI eComputations personal computer computation program in place of columns C. through E.6. of the SSA-2877. Remember to use the adjusted title II income less the fee. Keep in mind the COLA coordination rules (see SI 02005.010 -
SI 02005.015).

Proceed to step 9.

9

  • See SI 02006.215B. for an explanation of systems limitations and payment methods. In the absence of systems limitations, correct the offset by deleting and reposting. Otherwise, issue an A-OTP for the total underpayment amount.

  • Add an erroneous (NT TAC) decision through the Overpayment Decision (UOPD) screen in Direct SSR Update. See SM 01311.280B. and MSOM BUSSR 004.008 .

  • Suppress any systems generated notice for the overpayment created by completing the CMSC screen. See MSOM MSSICS 023.006 .

  • Proceed to step 10.

10

  • Use the instructions in SI 02006.200C.2.b. (There is no remaining Title II from before the offset period that can be counted as income in the PMA month.) If this change is material, adjust the type A UM for the month(s) retroactive Title II benefits were received and posted to the SSR to the regularly due Title II income amount. See SI 02006.201.

  • Process any underpayment or correction of an overpayment amount along with the actions taken per step 9.

STOP HERE

11

  • Instructions in SI 02006.200C.2.a. apply. This is a Title II offset case in which the amounts of Title II income remaining on the SSA-2894 are the same as the type W UM amounts posted to the SSR for each of the months of the offset period. Since the amounts are the same, there is no change in the Title II offset computations. Verify this before proceeding.

  • Go to step 15.b. (same procedure as for Title XVI offset cases).

12

Title XVI offset was initially applied. If this is a Title XVI offset case, determine whether the amounts of Title II income remaining (column D on the SSA-2894) are different from any of the type G amounts posted to the SSR for the months of the offset period.

  • If no, proceed to step 15.

  • If yes, proceed to step 13.

13

CAUTION: In an initially denied case in which an underpayment could be due, all development which had previously been deferred may be required prior to further action. See SI 02006.005 for appropriate tolerances. If an IAR authorization form is in the file, follow SI 02003.000. See SI 02006.215A.1. Determine whether the system could compute and release an underpayment caused by the change in type G UM to the title II income remaining amounts shown in column D on the SSA-2894:

  • If yes, transmit the changed type G UM amounts and suppress the notice.

  • If no, compute manually to pay via A-OTP.

  • In either case, combine the action with any required per step 14. Also prepare notices per SI 02006.215A.3. See step 14.

14

SI 02006.200C.2.b. applies. There is no remaining Title II from before the offset period that can be counted as income. If this change is material, adjust the type A UM for the month(s) retroactive Title II benefits were received. See SI 02006.201. Process any underpayment or correction of an overpayment along with the actions taken per step 13.

STOP HERE.

15

  1. a. 

    SI 02006.200C.2.a. applies. You are at this step because you have a Title XVI offset case in which the amounts of Title II income remaining on the SSA-2894 are the same as the type G UM amounts posted to the SSR for each of the months of the offset period. Since the amounts are the same, there is no change in the Title XVI offset computations. Verify this before proceeding to b.

  2. b. 

    SI 02006.200C.2. and SI 02006.201 apply. The type A UM for the month of receipt of the retroactive (retro.) Title II check posted to the system must be adjusted if the change would make a difference in SSI determinations: The change makes no difference if the regularly due Title II received each month is enough to cause ineligibility or the individual is ineligible in the month(s) of receipt of the retroactive Title II for other reasons. In this case, send a notice of no change per SI 02006.215A.3. Otherwise, per SI 02006.200B.1., use the total retroactive remaining for months before SSI DOE (column E. of the SSA-2894) as the retroactive amount (PMA) to add to the regularly due Title II (CMA) to determine the correct type A UM amount for the month of receipt.

CAUTION: If retroactive Title II benefits were received in more than 1 month, see SI 02006.200B.2. Transmit the changed type A UM, suppress the systems notice, and prepare the notices required per SI 02006.215A.3. (See SI 02006.215B.2. for Title II offset cases.)

NOTE:: 

Follow the special notice procedures in NL 01001.010 if the notice will be sent to a claimant, beneficiary, or representative payee who alleges being blind or visually impaired.

STOP HERE.

C. Procedure — completion of the SSA-2894

STEP

ACTION

1

Enter the requested data in sections I and II.

  • Identify a month by using its numerical abbreviation, e.g., for January 1988, use “1/88.”

    Refer to the MBR query for the Title II entitlement data for item 1. Enter the effective month and amount of each MBP.

  • For item 2, the entry is the month after the original MOET. This is the date the first Title II check would have been received if it had been received when due.

  • For items 3 and 4, if the first Title II payments were in 1984 or later, use the PHUS query to identify the dates and amounts. Item 3 is the date the first monthly Title II check really was received. If the data is essential for the first payments before 1984, the data may have to be obtained from the Title II claims file.

  • For item 5, refer to the notice or other proof of the fee determination for the fee amount and the name and address of the representative. Remember to show the total fee (Title II + Title XVI) in fee agreement cases.

  • For items 6-10, refer to the appropriate fields of the SSR query. To decide if development was curtailed in a denial, refer to the SSI claims file.

2

Section III. provides lines to list separately only 18 months. The months that should be listed separately are those where part of the authorized fee is subtracted from the Title II. Other months should be grouped together if the amount of Title II regularly due is the same (the amount entered in column B). If the lines do not suffice despite this consolidation, complete the listing on the back of the worksheet after entering “Section III. (continued).”

In some situations it may be necessary to adjust one or more months of current benefits if the total fee is not used up by adjusting the retroactive Title II benefits.

  • Column A, begin with the first month Title II was regularly due (item 2 of section I.) or the SSI date of eligibility (item 6 of section II.) whichever is earlier.

  • Column B, enter the amount based on the data in item 1 of section I., keeping in mind that MBP's are regularly due the month after they are effective.

  • Column C, enter the amount in column B or the remaining amount of the authorized fee for the last month part of the fee is subtracted. This is the amount of money that you are using each month to adjust for the attorney fee. Adjust the full amount of the Title II benefit until you use up the attorney fee. Usually the last month you adjust will be a partial month adjustment only.

  • Column D, enter the difference of column B minus column C. This is the amount of type W or type G income remaining for each month after the adjustment.

  • Complete column E only for months before the SSI date of eligibility (item 6 in section II). Enter the amount in column D or, for an entry of a group of months, the amount in column D times the number of months.

  • Total the entries in column C and check to make sure this total is the same as the authorized fee in item 5 of section I. If it isn't, correct section III as necessary.

  • Total the entries, if any, in column E and enter the result.

  • Answer the questions in F by checking “Yes” or “No.”

D. Exhibit — SSA-2894

To view this form, go to SSA-2894.

E. Procedure - notes for filling out SSA-2877

COLUMN

NOTE

A

List all months affected by the adjusted type "'W” or “G” income. If the windfall offset computation is out of balance (an excess or negative offset applies), then list all months in the windfall period.

NOTE: Columns B - D2 = SSI Eligibility Computation

B

Use amount of Title II income remaining, if any, as shown in column D on the SSA-2894.

C

If the Federal living arrangement is B and there is no corresponding type "J" income in the UMIH segment of the SSID (usually a record not in RIC G), include the VTR.

If column B equals zero, then column C equals the total of the UMC and the ENC from the CMPH segment of the SSID.

If column B equals the type "W" income in the UMIH segment of the SSID for the same month, then column C equals the total of the WUM and the WEN from the WCMP segment of the SSID.

If column B is greater than zero but less than the corresponding type "W" entry in the UMIH segment of the SSID, then column C equals the total of the UMC and the ENC from the CMPH segment of the SSID plus the total* from column B.

*Determine whether any or all of the $20 general income exclusion can be used to reduce the total in column B.

This is the new FCI based on the attorney fee adjustment.

X

The Federal payment amount for Federal living arrangement A, based on the date in column A.

D1

Compare the amount in column C with the amount in column X. If eligible, enter “E.” If ineligible, enter “N” in this column and zero in the FAM (column E3).

D2

If ineligible, enter zero in the SAM (column E6).

NOTE: Column D3 - E6 = SSI Payment Computation

D3

If eligible, enter the budget month (BM).

If column B equals zero then the BM is the same as the BM in the CMPH segment of the SSID.

E1

FBR for the month in column A or, if the Federal living arrangement is D, enter $30 (or $25 for months before 7/88) in column E1.

If there is no OS for this variation, enter zero in column E6.

E2

If the amount is available for the BM in column C, enter the amount from column C. Otherwise, obtain it from the SSID.

Consider COLA coordination (SI 02005.015) if Title II income is received.

E3

Enter the remainder of column E1 minus column E2.

E5

Enter the remainder, if any, of column E2 minus column E1.

E6

Enter the remainder of column E4 minus column E5.

NOTE: Columns F1 - F6 = Computation of the underpayment to be paid by one-time payment (OTP).

F1

Enter the amount from column E3 unless proration is involved (pre-September 1996). If proration applies and column B equals zero, then the FAM equals the FAM in the CMPH segment of the SSID. Otherwise, determine the prorated amount per SI 02005.005.

F2

If offset is automated, enter the WFA from the WCMP segment of the SSID. If offset is manual, enter the new FAM from the SSA-4346 offset worksheet. This is the amount the recipient would have been due if Title II had NOT been adjusted for attorney fees and had been paid when it was due.

F3

Enter the remainder of column F1 minus column F2. This is the amount of the federal underpayment for this month.

F4

Enter the amount from column E6 unless proration is involved. If proration applies and column B equals zero, then the SAM equals the SAM in the CMPH segment of the SSID. Otherwise, determine the prorated amount per SI 02005.005E. or SI 02005.005F.

F5

If offset is automated, enter the WSA from the WCMP segment of the SSID. If offset is manual, enter the new SAM from the SSA-4346 offset worksheet.

F6

Enter the remainder of column F4 minus column F5. This is the amount of the OSS underpayment for this month.

F. Exhibit—SSA-2877

To view this form, go to SSA-2877.

SI 02006.215 Record Corrections, Payments, and Notices

A. Procedure - Title XVI Offset Cases

1. Adjusted Title II Income Changes SSI Determinations

a. Underpayments

An underpayment for a month caused by adjusting Title II income will be paid only if a claimant/recipient is eligible for the month based on all factors of eligibility. (See SI 02006.005.) The computations, which the system can do if no limitations apply, follow the rules for SSI computations and differ from prior computations for the same months only because of the Title II income change. Enter the changed Title II income amounts as type W or type A income depending on the month involved. See 3. below for required notices.

  • When an underpayment exists, decide if the system can process it. If manual computations are required, use RMA rules. Before entering data for payment, decide if no SSI payment was previously made and b. below applies.

b. SSI Development Previously Curtailed

  • Development of eligibility factors may have been curtailed under the guidelines in SI 02006.005. If so, develop and fully resolve all eligibility factors before entering changed data for payment.

  • In a denied claim for which an SSI payment was never made, send the underpayment caused by reopening the prior determinations to the State/County due interim assistance reimbursement (IAR) if the claimant authorized it. (The SSR would show either code N or R in the GRC field of the MPMT segment of the SSIRD (see SM 01601.865)). If the code is N, the system would pay the claimant rather than send the payment to the State/County. Refer to SM 01901.100 B.7. in the instructions for A-OTP that explains entry of address data that would be needed to pay the State/County. Refer to the regional instructions that provide the name and address of the State/County agency that corresponds to the code in the GRC field. If the code is R and no systems limitations apply, delete the existing offset and retrigger a new one using the adjusted Title II amounts. The system will send the UP to the state or county.

c. Reduced Overpayment

A reduced overpayment for 1 or more months caused by adjusting the Title II income can occur either as the only result of the FO's action or in addition to an underpayment for 1 or more other months. If no systems limitations apply, enter the appropriate title II income data to the SSR so that the system will compute the correct overpayment.

2. No Change Cases

Do not enter the changed Title II type A amounts. However, send a notice to the claimant with a copy to the representative (see 3 below.). (See the example in SI 02006.220 A.2.)

3. Notices

a. Requirements

Suppress any system-generated notices and manually prepare and send notices explaining the revised determination(s) and the results of underpayments and/ or reduced overpayments to both the SSI recipient and the representative. Also, notify each if the adjustment of the Title II income made no difference in prior SSI determinations.

NOTE:: 

Follow the special notice procedures in NL 01001.010 if the notice will be sent to a claimant, beneficiary, or representative payee who alleges being blind or visually impaired.

b. Types of Notices

Use an SSA-L8100-U2 (Notice of Revised Determination) to notify the recipient and the representative of an underpayment. Also, use an SSA-L8100-U2 to notify the recipient of a reduced overpayment when that is the only result. However, use the SSA-L8166-U2 (Supplemental Security Income Notice) to advise of a no-change situation. Use the paragraphs necessary for a complete notice (i.e., exclusion from counting as resources paragraphs, IAR paragraph, Medicaid paragraph, etc.) as appropriate per NL 00804.100 ff.

c. Language To Explain Changed Determinations

In underpayments and reduced overpayments, use the following paragraphs to explain the reasons for the change.

“You had monthly income which must be considered in figuring your payment as follows:

Your social security benefits (before deductions for Medicare medical insurance premiums) of $$$.00 for MM/YY, $$$.00 for MM/YY and/or $$$.00 for MM/YY through MM/YY.

In figuring your SSI before, we used $$$.00 for MM/YY, $$$.00 for MM/YY and $$$.00 for MM/YY, as your monthly social security income. These were the amounts before deductions for Medicare premiums, if any. However, fees of $$$.00 were approved to pay the representative in your social security claim. We subtract these fees from the social security income we count.”

If the SSI recipient has a representative payee, substitute for “ you ” and “ your ” in the paragraph, the recipient's name, “he” or “she,” or “his” or “her,” as appropriate.

In the second paragraph, enter the amounts and the month(s) and year(s) that apply after subtraction of the fee. In the third paragraph, enter the prior amounts of Title II income and the months and years they apply. In the third paragraph, enter the amount of the authorized fees.

B. Procedure - Title II Offset Cases

1. Adjusted Title II Income Changes Amounts in Offset Period

a. System Limitations Always Apply

Systems limitations apply when the Title II retroactive benefits have been released per MBR/PHUS and offset applied. In these situations you cannot change the data in the system and have it pay the correct amounts.

  • The unearned income data in the SSR UMIH segment will generally not include type A UM entries for the months before the last 2 months in the Title II offset period. (The data may include type A UM entries if dual entitlement is involved or type W UM entries if the Title II offset computation was automated.)

  • Should the FO attempt to enter type A UM entries based on the adjusted Title II income, the system would compute an overpayment rather than an underpayment for months in the Title II offset period.

  • Instead, manually compute the underpayment and use the A-OTP facility to make payment. See SI 02006.210 B.8.

b. A-OTP Payment

Refer to SM 01901.000 ff. for instructions on A-OTP. Refer to SM 01311.280 which provides instructions for use of the NT TAC which is used to resolve erroneous systems-computed overpayments. When paying by A-OTP, the FO should enter NT TAC data in the amount of the A-OTP to correct the increase in the overpayment amount in the system and prevent an alert.

2. Adjusted Title II Income is Type A for First Month of Title XVI Payment

a. Systems Capability Exists

The FO can use the system to help when the retroactive Title II benefits are paid in 1 of the last 2 months of the extended offset period or later and the type A UM entry must be decreased. The FO can enter adjusted Title II income for a month of receipt of retroactive Title II as type A UM entries to compute and pay underpayments (or correct overpayments) through the system.

The automated system can compute the true overpayment/underpayment from PE changes in the offset period following an automated Title II offset computation done after January 15, 1984, with some exceptions (see SM 01320.600). The WIN code indicates the necessary action for correctly reviewing, and processing PE events when Title II offset applied (see SM 01320.021). If the WIN code is “F,” “I,” or “R,” the systems computations are always correct. This includes those for PE changes in type A UM for months, such as the last 2 months of an extended offset period, that have a zero (0) type W UM amount posted.

b. Both Systems Capability and Limitations Apply

If the adjusted Title II income changes are both for months when data should not be entered and for months when they can be, the FO can use the A-OTP and the NT TAC procedures for the earlier month and also correct the type A amounts for the later months.

3. Notices

See A.3. above.

C. MSSICS 4.4 Support for Attorney Fee Recomputation

Effective 5/27/97, in some cases, use MSSICS to trigger an automated windfall offset computation using type “W” amounts adjusted for the attorney fees. In situations in which the PSC/ODIO asks the FO to recalculate the offset amounts because the attorney fee plus the calculated FOA/SOA exceed the total retroactive Title II benefits, use the CWIN screen and the ISSA screen to trigger an automated computation using the adjusted Title II amounts.

This procedure can be used only if the following conditions exist:

  • The Title II retroactive benefits have not been released, (i.e., a 6W diary is present).

  • There is an active MSSICS pending file.

  • For MSSICS cases that were seeded, the windfall period cannot begin before the Seed Date.

D. References

  • MSOMMSSICS 015.013 Completion of the ISSA Screen

  • SI 02006.203 Fee Agreement Process — Authorization of Title II and Title XVI Representative Fees and Determination of Amount to Subtract, and

  • SI 02006.210 Field Office Representative Fee Adjustment Procedures Summary and Worksheets


SI 02006 TN 16 - Windfall Offset and Effect on Title XVI Payments - 2/05/2019