Identification Number:
NL 00703 TN 86
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Exhibit and Dictated Letters
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part NL – Notices, Letters and Paragraphs
Chapter 007 – Letters and Paragraphs for Title II, Title XVI, and Title XVIII
Subchapter 03 – Exhibit and Dictated Letters
Transmittal No. 86, 04/07/2022

Audience

PSC: BA, CA, CCRE, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, NPR, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, BTE, CC, CDT, CR, CTE, EIE, ERE, FDE, PETL, RECONR, RECOVR;
OCO-ODO: BET, BTE, CCE, CR, CST, CT, CTE, CTE TE, DE, DEC, DS, DSE, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR;
FO/TSC: CS, CS TII, CS TXVI, CSR, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

When the field office (FO) finds that a payee did not misuse a beneficiary's benefits, the FO is required to send the notice in NL 00703.202 to that beneficiary and their current payee. We are removing language about appealing misuse determinations from GN 00604.001, GN 00604.035, GN 00604.040, and GN 00604.045. The current GN 00604.035 policy states, "When a beneficiary or a third party alleges misuse of benefits, it is an implied request for restitution" and "restitution requests are initial determinations subject to appeal by the beneficiary or his authorized representative." NL 00703.202 has language about this appeal for restitution policy.

No law, regulation, or policy as it relates to the determination of no misuse, other than the current GN 00604.035 and GN 00604.040, states that a misuse allegation is an implied request for restitution. A finding that misuse occurred or did not occur is not an initial determination. Where SSA finds that misuse did not occur, no restitution is payable, so there is no initial determination on restitution to be appealed. See GN 03101.070 for a list of initial determinations that have formal appeal rights.

We will change the UTIs for NL 00703.202 to remove language about the implied request for restitution and the appeal for restitution. We will simplify the language to state that in determining there was no misuse, we decided the payee used the benefits for the beneficiary. We will add language to add a 30-day period during which the beneficiary can request informal review of the determination before the FO closes the misuse case.

Summary of Changes

NL 00703.202 Misuse Not Established — Notice to Beneficiary or Representative Payee

  • Changed title to Misuse Not Established—Notice to Beneficiary and/or New Representative Payee

  • Simplified information regarding replacement of benefits for improved clarity

  • Removed replacement of benefits paragraph that included appeals language

  • Replaced appeals language with informal review language notices in order to streamline instructions.

 

NL 00703.202 Misuse Not Established — Notice to Beneficiary and/or New Representative Payee

(GN 00604.040)

Document Identifier for Word Processor: E3202

A. EXHIBIT LETTER

We are writing to you about the (1) benefits we sent to (2) on (3) behalf. We looked at how this payee used the benefits and found (4) used the money for (5).

How We Reached Our Determination

(6)

Information About Replacement of Benefits

A representative payee must use any benefits we pay for (7). If the payee misuses the money, we will ask them to pay it back. This only applies to cases where a payee misuses the benefits.

Since this payee used the benefits for (8), (9) not qualify for replacement of benefits.

If You Disagree With Our Determination

Please contact us within 30 days of the date you received this letter if you disagree with our determination that (10) payee used the benefits for (11). We assume you got this letter 5 days after the date on it. Please present any new facts and the reason you think our determination is wrong. We will close the case in 35 days if we do not receive a request for review from you. We will treat any new facts received after 35 days as a new case.

If You Have Any Questions

CTDO-Domestic
3901D - Foreign

B. REQUESTING INSTRUCTIONS

The FO will send this notice to the beneficiary and/or the new representative payee when misuse is not found.

Fill-ins:

  1. (1) 

    Social Security/Supplemental Security Income/Social Security and Supplemental Security Income

  2. (2) 

    (payee name)

  3. (3) 

    your/(beneficiary name, possessive)

  4. (4) 

    he/she/they

  5. (5) 

    you/(beneficiary full name)

  6. (6) 

    narrative explanation of the misuse determination

  7. (7) 

    you/(beneficiary full name)

  8. (8) 

    you/(beneficiary full name)

  9. (9) 

    you do/they do

  10. (10) 

    your/(beneficiary name, possessive)

  11. (11) 

    you/(beneficiary full name)


NL 00703 TN 86 - Exhibit and Dictated Letters - 4/07/2022