Identification Number:
GN 02201 TN 52
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:General Information Title II, Title XVI, and Title XVIII Overpayments - Part I
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 022 – Overpayments
Subchapter 01 – General Information Title II, Title XVI, and Title XVIII Overpayments - Part I
Transmittal No. 52, 03/17/2021

Audience

PSC: BA, CA, CCRE, CS, DCR, DS, IES, LDCR, LDS, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BIES, BTE, CS, CTE, FCR, PETL, RECONR, RECOVR;
OCO-ODO: BTE, CCE, CS, CST, CTE, CTE TE, DEC, DS, DSE, PAS, PETE, PETL, RCOVTA, RECOVR;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This transmittal updates and moves up the subsection regarding Disability Benefit Continuation cases by clarifying an overpayment notice should not be issued when the individual is receiving statutory benefit continuation (SBC) payments during an appeal of a medical cessation determination. We also made minor changes for clarification and added a new example for the paid vs payable sentence.

 

Summary of Changes

GN 02201.009 Notification of a Title II Overpayment

Throughout this document, we changed “person” and “debtor” to “individual and capitalized the beginning of bulleted sentences and phrases. Due to the movement of old subsection H to subsection C, ever subsection after C is re-lettered.

Subsection A - We revised this subsection to clarify that we send an overpayment notice manually or via the automated system and capitalized the system application names.

Subsection B – We revised this subsection to:

· Add an example to the note in number 1 regarding the paid vs payable notice sentence,

· Add the specific waiver terms in number 3, and

· Bullet the sentence in number 7 for clarity and re-ordered for consistency.

Subsection C – We revised this subsection to:

· Move old subsection H, Disability benefit continuation, to this subsection,

· Explain statutory benefit continuation (SBC) cases, and

· Clarify that technicians do not send an overpayment notice when the overpaid individual is receiving SBC payments during an appeal of a medical cessation determination.

Old Subsection H – We moved this subsection to subsection C.

Subsection I – We revised this subsection to update the cross reference and clarify repaying any withheld monies when we have to re-issue the overpayment notice.

GN 02201.009 Notification of a Title II Overpayment

A. Notifying overpaid individuals

When you (or an automated system) discover an overpayment, send the overpaid individual a notice as soon as possible, explaining that they were overpaid, the reason for and the amount of the overpayment, and liability for repayment. If you discover the overpayment during an oral communication (telephone call or interview), advise the individual about the liability for repayment during the first oral contact. Document the conversation on the Debt Management System (DMS) Remarks screen. Always send written notice using the Manual Adjustment, Credit, and Award Data Entry (MACADE) system, AURORA, the Document Processing System (DPS), etc.

NOTE: For exhibit notices, see NL 00703.000 and for MACADE notices, see NL 00720.000.

B. What the notice must include

The overpayment notice must include the following information:

  1. 1. 

    The total amount of the overpayment and how and when it occurred, including:

    • The monthly amount the person was paid,

    • The monthly amount the person should have been paid,

    • Why a different amount was due, and

      NOTE: If the overpayment resulted from the entitlement of another beneficiary, inform the adversely affected beneficiary of the other beneficiary's name, relationship to the number holder (NH), and basis for entitlement of the new beneficiary (see PC Procedures for Handling Adverse Claims GN 01010.325).

    • The months involved.

    NOTE: You may use a single sentence, instead of a chart, when explaining what SSA paid versus what was payable if the overpayment period does not include multiple months or multiple money amounts. Single sentence example: "We paid you $3,000 for June 2019 and we should have paid you $1,500. Therefore, you are overpaid $1,500." Chart example for the notice:

    Notice chart example:

     

    What We Paid What We Should Have Paid
    $1,000.00 02/2017 – 11/2017 $500.00 02/2017 – 11/2017
    $1,500.00 12/2017 – 11/2018 $600.00 12/2017 – 11/2018
    $2,000.00 12/2018 – 11/2019 $700.00 12/2018 – 11/2019
    Total Paid = 52,000.00 Total Payable = $20,600.00

    Therefore, you are overpaid $31,400.00.

  2. 2. 

    The right to request reconsideration of the overpayment determination. An individual may request reconsideration if they disagree with the fact or amount of the overpayment.

  3. 3. 

    The right to request waiver of recovery of the overpayment, and the automatic scheduling of a personal conference if we cannot approve a request for waiver after initial review of the request and accompanying documentation. We may grant a request for waiver if:

    • The individual was not at fault, and

    • Repaying the overpayment would mean they could not pay necessary living expenses (defeat the purpose of the Social Security Act) or would otherwise be unfair (against equity and good conscience).

  4. 4. 

    Language requesting full and immediate refund.

  5. 5. 

    Proposed adjustment if we do not receive the refund within 30 days and adjustment is available (see GN 02210.010).

  6. 6. 

    The availability of:

    • Installment payments, when refund is requested and adjustment is not currently available;

    • Cross-program recovery, when refund is requested and the individual is receiving another SSA payment (e.g., Title XVI); and

    • A different rate of withholding, when we propose full withholding (see GN 02210.030).

      NOTE: If the overpayment was the result of fraud (as determined by the Office of the Inspector General (OIG)) or similar fault (as determined by SSA), a different rate of withholding does not apply.

  7. 7. 

    The requirement to notify the field office (FO) promptly if the individual requests any of the following:

    • Different rate of withholding,

    • Installment payments,

    • Waiver, or

    • Reconsideration.

C. Disability benefit continuation cases

An individual who receives a medical cessation determination may elect to continue receiving Title II disability payments while a request for reconsideration or for a hearing before an Administrative Law Judge (ALJ) is pending. We call these payments Statutory Benefit Continuation (SBC) payments.

When an individual appeals a medical cessation determination at the reconsideration or ALJ hearing level, they have 15 calendar days (10 days plus 5 mailing days) from the date of the medical cessation notice to elect SBC. Upon an individual's timely request for SBC, disability payments continue while we make the reconsideration determination or hearing decision. For more information on SBC election and processing, see DI 12027.010.

SBC payments stop after an ALJ issues a medical cessation decision even if the individual continues the appeal process and requests Appeals Council (AC) review or review in federal court.

SBC payments are not overpayments until the medical cessation decision is final. The medical cessation decision becomes final when the individual does not request further review within the appeal period (and does not have good cause for a late appeal) or has exhausted all levels of appeal. Therefore, we send an initial overpayment notice to begin recovery of SBC payments only if one of the following conditions is met:

  • At the reconsideration level: the individual does not appeal an unfavorable medical cessation reconsideration decision to the ALJ hearing level, the 65-day (60 days plus 5 mailing days) appeal period has expired, and there is no good cause for a late request for a hearing;

  • At the hearing level: the individual does not request AC review of an unfavorable ALJ medical cessation decision, the 65-day (60 days plus 5 mailing days) appeal period expires, and there is no good cause for a late request for AC review. In this situation, the ALJ will return the folder (electronic file) to the appropriate office, after the 65-day period for requesting AC review expires;

  • At the AC level: the AC denies a request for review, but the individual does not request judicial review of the ALJ decision and the 65-day (60 days plus 5 mailing days) period to do so expires, and there is no extension or good cause for late request for judicial review. In this situation the AC will return the folder (electronic file) to the appropriate office, after the 65-day period for requesting judicial review expires; or

  • At the federal court level: the individual requests judicial review and the court(s) affirms the ALJ decision. The technician will receive the final court decision.

    NOTE: If the federal court remands the case and the AC then vacates the ALJ decision and remands to the ALJ for another hearing and decision, please follow instructions inDI 12027.060 (Title II cases) andDI 12027.065 (Title XVI and concurrent cases).

    IMPORTANT: Before making any manual inputs to initiate recovery and issue an overpayment notice related to SBC payments, technicians must review the individual's records to confirm an appeal is not pending at the reconsideration, ALJ, AC, or federal court level (including at the ALJ level after an AC remand) and that all the appeal time periods have expired.

D. Form SSA-3105 (Important Information About Your Appeal, Waiver Rights, and Repayment Options)

The overpaid individual may use Form SSA-3105 to do the following:

  • Request reconsideration of the overpayment;

  • Request waiver of the overpayment;

  • Request an explanation of the overpayment;

  • Request partial benefit withholding;

  • Enclose full refund of the overpayment; and

  • Request installment payments to refund the overpayment.

This form must accompany each initial overpayment notice. The form has a tear-off portion that the overpaid person may complete and return to SSA (either to the program service center (PSC) or to the (FO)) to choose one or more of these options. To view a copy of the SSA-3105, see GN 02201.010.

E. Individual has a representative

If the overpaid individual has a representative (e.g., an attorney or non-attorney) to act on his or her behalf, send a copy of the overpayment notice to the representative as well.

For instructions on who is a representative, see GN 03910.020.

For instructions on contacting a representative, see GN 03910.050.

F. Debtor is in a foreign country

There are differences in the preparation and delivery of the overpayment notice when the individual is located in a foreign country.

Follow instructions in GN 02215.001 - GN 02215.015.

G. Advance notice

The recovery date (i.e., the date full refund is due and, if appropriate, the date adjustment will begin) must be at least 30 days after the date of the overpayment notice. However, we send the individual an overpayment notice 60 days before initiating recovery (i.e. the "due process" period) (see GN 02210.001). This advance notice ensures that we grant the overpaid individual a meaningful opportunity either to contest the correctness of an overpayment determination or to establish the criteria for waiver.

NOTE: The automated system, as well as MADCAP, calculates this date automatically depending on the debit run date (see SM 00610.715, Recovery when the Overpaid Person is in LAF C or D).

If the individual responds within 30 days of the date of the overpayment notice, the FO must stop collection activity to ensure that we continue benefit payments (see MS 01106.019). If we cannot ensure the 30-day period, the PSC must extend any proposed adjustment for a longer period (see MS 01106.003).

H. Exception to advance notice

Advance notice is not required if the overpaid individual has already received advance notice with respect to the overpayment.

EXAMPLE: In February 2009, we sent an overpayment notice to Sally Jones, who is no longer entitled to benefits. Sally subsequently became re-entitled to benefits in March 2010. A new advance overpayment notice is not necessary and we initiate immediate overpayment recovery in the current operating month (COM).

In addition, advance notice is not required if:

  • An incorrect payment results because a payment(s) is directly deposited into a joint bank account after the individual's death and the surviving joint account owner is not entitled on the deceased’s record for the month before the month of death (see GN 02201.001F, Social Security Act §204(a)(2), and GN 02201.007F); or

  • Benefits are incorrectly paid for the current year based on a current year work estimate of earnings (see GN 02201.001F).

NOTE: Even where an exception to the 30-day advance notice required by GN 02201.009G applies, due process considerations may still require us to provide notice to the individual before suspending his or her benefits. For more specific instructions, see GN 03001.005.

If advance notice is not required, adjustment begins effective COM. However, if the individual appeals or requests waiver, stop recovery and follow normal instructions, depending on the type of appeal requested.

I. Failure to give adequate notice

If notification is deficient (e.g., we did not send a notice, the content of the notice was inadequate, or the individual did not receive notice at least 30 days before adjustment action), send a new notice with all of the required information specified in the above subsection, GN 02201.009B. Repay the individual any money that we withheld to recover the overpayment. Update the overpayment balance and due process recovery date another COM plus 2 months.

J. Undeliverable notice

If you receive a returned overpayment notice as undeliverable, follow instructions for skip tracing in GN 02210.213C.


GN 02201 TN 52 - General Information Title II, Title XVI, and Title XVIII Overpayments - Part I - 3/17/2021