Effective Dates: 4/26/2023 - Present

Identification Number:
SI 02006 TN 17
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Windfall Offset and Effect on Title XVI Payments
Type:POMS Full Transmittals
Program:All Programs
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. 17, 04/26/2023

Audience

FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

We are updating our offset policies to provide more comprehensive guidance. We provide instructions for field office technicians coding and processing cases involving unknown or unresolved fees. We create a standard process for handling complex offset cases which replaces the former commonly used “penny process.” This transmittal reminds technicians to use all of the representative fee including some auxiliary fee’s, which has been overlooked in the past.

 

Summary of Changes

SI 02006.204 Field Office Processing Instructions for Concurrent Cases Involving Unknown or U

This is a new section that provides instructions for field office technicians coding and processing cases involving unknown or unresolved fees.

SI 02006.204 Field Office Processing Instructions for Concurrent Cases Involving Unknown or Unresolved Representative Fees

A. Overview

We are required to perform Title II windfall offset calculations on concurrent awards that have an overlapping past period of eligibility. Authorized fees and out-of-pocket expenses can affect windfall offset calculations by reducing the total amount of Title II past-due benefits that we count as income in the windfall period.

Cases with representative fees that are unknown or unresolved at the time of effectuation add additional complexity. When the fee determination is delayed, you may need to first calculate the windfall offset before the fee is authorized or approved and hold back past-due benefits for direct fee payment. This section describes how to process cases with unknown fees at the time of effectuation. When performing the offset, do not temporarily show a fee of $.01 (i.e. the obsolete penny process).

NOTE: 

The e4345 application does not allow for a blank fee amount, so technicians may still see e4345s showing a fee of $.01. Do not route back to PC until after the Representative fee has been resolved. Leaving fees unresolved allows the system to set an RF diary, explained in SM 01005.800C.

B. Identifying cases with unknown or unresolved representative fees when the claim is ready for effectuation

1. Identify unknown or unresolved fee cases

a. Apply these instructions to cases with all the following characteristics

  • •

    Individual is awarded concurrent benefits with an overlapping past period of eligibility,

  • •

    At least one representative is involved, eligible to charge a fee, and did not waive the fee, and

  • •

    The total amount of the fee is unknown or unresolved at the time of effectuation.

b. Some examples of unknown or unresolved fee situations include the following

  • •

    There is a fee agreement in the file but no fee agreement decision on record;

  • •

    The fee agreement is disapproved;

  • •

    There is no fee agreement or fee waiver on file and a fee petition has not been submitted;

  • •

    A fee petition has been received but not yet decided;

  • •

    We received an intent to file a fee petition, but the representative has not filed a fee petition yet;

  • •

    Administrative review is pending for the authorized fee decision or amount;

  • •

    Administrative post-award actions ( i.e. workers compensation development) still needs to be completed to determine the amount of the past due benefits and resulting fee amount;

  • •

    At least one representative may be eligible for fees for services before the agency and 206(b) fees for services before a court, but at least one of these issues is not resolved; or

  • •

    There is at least one auxiliary claim pending and the auxiliary has not appointed a representative, see GN 03920.035B.2.

c. Assume a representative will file a fee petition if the representative:

  • •

    Has not waived the fee and did not file a fee agreement before the favorable determination or decision; or

  • •

    Submitted a fee agreement and we disapproved it.

If a representative submits a fee petition to the FO at any time during this process, follow receipt and routing instructions in GN 03930.025.

C. FO deadline for adjusting the SSR when the representative fees were unknown or unresolved at the time of effectuation

Once you know the total amount of the representative fees authorized by the agency per section 206(a) of the Act, or the court per section 206(b) of the Act, you must:

  • •

    update the Title XVI record with the authorized fee information; and

  • •

    adjust the SSR to account for the total Title II and Title XVI authorized fees.

Complete these actions within 120 days of the final fee authorization.

IMPORTANT: The total T2 fees include any additional fees paid on an auxiliary beneficiary’s claims when the auxiliary beneficiary has not appointed a representative. See GN 03940.050A.4 NOTE 2 & GN 03920.035B.2 When auxiliary claims are involved, the PC computes the total fees by adding the NH’s fee and any auxiliaries’ fees. Once the PC computes the total Title II fees, the PC communicates this information to the FO through a high priority (HP) modernized development worksheet (MDW). The FO then has 120 days to complete any necessary fee adjustments to the windfall offset data.

D. Procedure for annotating SSI screens when the representative fees are unknown or unresolved:

Step Action
1 Review the representative’s information for accuracy on the screen UATH

2

Annotate the UFEE screen:

  • •

    Show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE”

  • •

    Ensure that Direct Payment Waived is answered “N” on the UFEE screen if the representative is eligible for and has not waived direct pay.

3

Add a SSR remark:

  • •

    Go to Claim determination path in CCE

  • •

    Select clearance menu

  • •

    Select SSR special messages

  • •

    Enter the following remark "MM/DD/YY UNRESOLVED FEE CASE WAITING ON FEE AUTHORIZATION"

4

Effectuate the claim (i.e., calculate benefits and pay ongoing benefits)

NOTE: 

In certain situations, you may be able to release the past-due benefits we are withholding for fee purposes on the T16 record. Follow underpayment procedures per SI 02101.002.

Compute and set an amount in the Estimated Fee Withholding (EFW) field whenever the representative is eligible to receive direct payment.

Have a reviewer complete the prepayment review if the case meets the requirements for a prepayment review in SI 02101.025.

The simulated SSR should show:

  • •

    UPV of V, 2, B or A if there is an underpayment remaining after the initial retroactive payment is posted to the SSR.

  • •

    RF diary to control for fee development if there is an EFW set.

5

Code the CCE development worksheet as follows:

  • •

    Set a “FEEAUTHPEND” issue with a follow-up date for 60 days (120 days for federal court cases) on the CCE development worksheet or MDW for non-MSSICS cases. This issue will control for the receipt of the fee authorization.

  • •

    Set a “FEE UPDATE” issue on the CCE development worksheet or MDW for non-MSSICS cases with a follow up to match the “FEEAUTHPEND” issue. This issue will control for adjustments you need to make to the SSR after you know the total amount of the representative fees authorized. DO NOT receipt in this issue until you have successfully adjusted the SSR to account for the total representative fees authorized, including any fees resulting from an award of auxiliary benefits for which the claimant is responsible, see GN 03920.036B.2.

  • •

    add the phrase, “See Report of Contact” to the corresponding remarks lines for both issues.

6

Establish a Report of Contact:

  • •

    On a new Report of Contact page, type the phrase “FEE AUTHORIZED–ADJUST SSR” in the subject line. Then, copy and paste the following text into the Report Text:

    • –

      "This case contains a period of windfall offset as well as potential fees for representation."

      *** Do not receipt in the “FEE UPDATE” issue until you have successfully adjusted the SSR to account for the total representative fees authorized, including additional fees from an auxiliary claim when the claimant is responsible for those fees. SEE GN 03920.036B.2***

7

Once the “FEEAUTHPEND” issue has matured, check all possible locations for fee information to determine if a fee has been authorized. This includes:

  • •

    Modernized development worksheet (MDW),

  • •

    Master Beneficiary Record (MBR),

  • •

    Online Retrieval System (ORS),

  • •

    Evidence Portal (EP),

  • •

    Case Processing and Mangement System (CPMS),

  • •

    Electronic Viewing System (eView) and

  • •

    Processing Center Action Control System (PCACS).

If you do not find anything indicating a fee has been authorized, update the CCE development worksheet or MDW to extend the Tickle date another 60 days and repeat as necessary until you receive the fee authorization. See GN 03930.030.

NOTE: If we do not receive a fee petition from the representative, the PC will follow the instructions in GN 03930.090. However, for cases involving a pending fee petition, auxiliary claim, or court fees, FO technicians must continue to monitor the status of the fee.

E. Initial windfall offset computation for concurrent cases involving unknown or unresolved representative fees

Continue to process an “initial” offset while waiting on the resolution of all fees in fee petition and some fee agreement cases (i.e. auxiliary benefits).

What is an “initial offset”? In some cases, it is possible the payment center (PC) can take the second day action to post an offset computed without fees and release some of the Title II past-due benefits while waiting on the fee authorization. In other cases, they may not complete processing of the “initial offset” because after applying windfall, there may not be enough Title II past-due benefits left to allow for 25% withholding, see GN03920.036.

Determine if the system was able to compute the initial windfall offset automatically. Check the Windfall Indicator (WIN) codes on the SSR to determine if the offset was completed, see SM 01320.021.

  • •

    Clues the PC could not complete the "initial" offset include a pending 6W diary windfall coding in the MBR history segment, a pending e4345, and no offset entry on PHUS.

  • •

    If a limitation or exclusion prevented automation of the initial windfall offset, an offset diary (e.g., 5W, 7W, etc.) will post to the SSR. If an offset diary posts, to take any necessary action, follow the instructions SM 01320.010 .

  • •

    If a 2L diary posts, to resolve any discrepancies between the fee statuses posted to the MBR and the SSR, follow instructions SM 02001.217 . If after ruling out all other possibilities for the 2L diary and the only discrepancy is that the SSR correctly reflects a fee status of unknown or unresolved, delete the 2L diary, and send to the SSR.

Once you have resolved any diaries preventing windfall automation, review SI 02006.210 & SM 01320.001 to locate any further instructions you may need to complete the initial windfall offset.

F. Procedure for annotating and adjusting the record once fee is authorized

After you receive notification from the PC, OHO, or OAO of the total authorized fee, update the fee data for the offset as soon as possible but no later than 120 days after the final fee authorization.

Step

Action

1

Locate the “FEEAUTHPEND” issue on the CCE development worksheet or MDW. Type the date the PC, OHO, or OAO notified your office of the fee approval in the Received date column.

NOTE: 

PC should contact the FO through a HP MDW when auxiliary claims with a fee are adjudicated.
2

 

If you have everything you need for fee adjustment proceed to step 3;

If you are still waiting for a fee decision for an auxiliary claim, set a Tickle date for the “FEE UPDATE” issue 60 days in the future. You will need to continue to follow up with this case every 60 days until all fees for all associated claims have been finalized. When all fees for all associated claims have been finalized, receipt in the “FEE UPDATE” issue and go to step 3 below.

NOTE: You must proceed to step 3 in this chart before 120 day the deadline established by section SI 02006.204C, above

3

Update the UFEE screens to reflect the total authorized fees and send the updated information to the SSR. If the initial windfall offset was previously posted to the SSI and processed on the MBR so that the MBR WIN is B, C or E, ensure the Type U unearned income posted to the SSR correctly in the UMIH segment representing the monthly amount fees to be deducted from the retroactive monthly Title II payment amounts posted as type W unearned income on the SSR.

If the initial windfall was not done at all or if the windfall offset was posted to the SSR but the PC has not processed the windfall on the MBR to release past-due benefits, then proceed to step 4.

If the Type U unearned income is posted correctly, move on to step 5 in this chart

If the initial windfall offset is complete but the Type U income did not post properly, you need to adjust the Type W income on the UW02 screen to account for the missing or incorrect Type U income.

  • •

    Use the SSA-2894 Fee Decrement worksheet to help you calculate the adjustment to the existing windfall data.

  • •

    Record the changes you made to the UW02 screen on a Report of contact and explain why the changes were necessary including your math for determining an adjustment was necessary.

  • •

    Upload the completed SSA-2894 into the claimant's electronic folder using the Evidence Portal.

  • •

    Transmit the update to the SSR and confirm the system is properly considering the adjusted Type W unearned income. Either the Type U or manually decrementing the Type W will allow the system to apply the fee exclusion and calculate any underpayment due.

  • •

    Send the appropriate notice as explained in SI 02006.010E.6

  • •

    Proceed to step 5 in this chart.

4

Manually compute the Title XVI fee per GN 03920.031B.2

  • •

    Post a concurrent total fee (Title II NH and AUX fees plus Title XVI) to UFEE

  • •

    Post the manual windfall offset.

  • •

    Confirm the UMIH segment on the SSR shows type U unearned income equal to the total amount of excludable legal expenses. If the type U is correctly posted, process the windfall offset and go to step 5. If the type U does not post correctly, exit the processing system (PF3 out) and continue to the next bullet.

  • •

    Use the SSA-2894 following SI 02006.210 to manually decrement the total fee from the retroactive Title II income, beginning with the first month in Section III, column A (the first month of Title II eligibility) and going forward.

  • •

    If Title II is due prior to the Title XVI date of entitlement (DOE), make note of the total of the gross Title II during the windfall period *

  • •

    Re-enter the offset path and post the windfall using the entire Title II retroactive amount as the WPA/WTA and the adjusted type W income.

  • •

    Review the simulated SSR and deduct the offset amount from the RCRD segment from the total of the gross Title II due during the windfall period figured above. *to The result is the correct non-countable income (NCI/WNC) per SM 02101.240.

If this amount is the same as the WNC shown in the RCRD segment, send the computation to the SSR.

If this amount is not the same as the WNC shown in the RCRD segment, send the computation to the SSR then;

  • •

    Return to the windfall pathway and change the offset from automated to manual.

  • •

    Correct the WNC amount per SM 02101.240 and page through the remaining screens

  • •

    Upload the SSA-2894 into the claimant’s electronic folder using evidence portal

  • •

    Continue to step 5.

5

Locate the “FEEAUTHPEND” issue on the DW01 or MDW. Type the date you complete the adjustment to the SSR in the RECEIVED column.

If there is an e4345 for the case you are working on, follow the e4345 FO User Guide to complete the e4345.

G. Examples

Example 1 – This example illustrates a scenario where the fee is unknown or unresolved when the Title XVI decision is effectuated.

Tom was awarded concurrent benefits with an overlapping period of past eligibility. Tom had an appointed representative who was eligible to charge a fee. Tom’s representative did not submit a fee agreement before Tom’s case was awarded.

A claims specialist (CS) in Tom’s local FO, processed Tom's case, following policy in SI 02006.204. The CS coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE” and established the “FEEAUTHPEND” issue on the CCE development worksheet when the CS processed Tom’s award.

32 days later, the CS received notification via HP MDW from PC that Tom’s representative was authorized to charge and collect a fee. The CS followed the instructions in SI 02006.204F to update Tom’s record. The CS noted the initial windfall offset had automated with no exceptions. The CS updated the UFEE screens and sent the update to the SSR. The simulated SSR showed:

  • •

    UMIH with Type U income; and

  • •

    PMTH showing the system released an underpayment that takes into account RMA and corresponding months of Type U income.

Once the CS confirmed the system accounted for the fees and computed the underpayment, the CS typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue.

Example 2 – This example illustrates the steps needed when a fee is unknown or unresolved when the Title XVI decision is effectuated and the total amount of the fee is delayed for an extended period because of additional fees due from an auxiliary claim.

Jeff was awarded concurrent benefits with an overlapping period of eligibility. Jeff had an appointed representative who will to charge a fee. Jeff’s representative submitted a fee agreement, which the ALJ approved. A CS in Jeff’s local FO, processed Jeff's case. The CS noticed Jeff had two auxiliaries listed on the record, a spouse and a child. The CS realized that because the two auxiliary claims had not been processed yet, the CS did not know the total amount of the authorized fees.

The CS coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE” and established the “FEEAUTHPEND” issue and a “FEE UPDATE” issue on the CCE development worksheet. The CS receipted in the “FEEAUTHPEND” since the fee agreement was approved by the ALJ. The CS set a TICKLE for 60 days for the “FEE UPDATE” issue. The CS completed a PERC with Jeff, closed the event, and updated the SSR. The system successfully computed the initial windfall offset.

61 days later, The CS was checking the TICKLE list in WAC and noticed the “FEE UPDATE” issue on Jeff’s case had matured. One of the auxiliary claims on Jeff’s record had been processed, but the other had not. The CS extended the TICKLE for the “FEE UPDATE” issue another 60 days.

20 days later, the CS received notification from the PC of the authorized fees for the Title II claims via a HP MDW. The PC had processed both auxiliary claims to completion and determined the fee amounts for both claims. The CS now knew the total authorized fee amounts. The CS updated the UFEE screen on Jeff’s record and sent the update to the SSR. The simulated SSR showed:

  • •

    UMIH with Type U income; and

  • •

    PMTH showing the system released an underpayment that takes into account RMA and corresponding months of Type U income.

Once the CS confirmed the system accounted for the fees and computed the underpayment, the CS typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue. 

H. Helpful Links

e4345 2.0

SSI eComputations

RASR

I. References

GN 03910.050 Contacting a Represented Claimant

GN 03920.031 Representative’s Fee – Title XVI Past-Due Benefits

GN 03920.035 Title II Past-Due Benefits Subject to Withholding

GN 03930.025 Receipt and Routing of Fee Petitions

GN 03930.030 Title XVI - Adjudicating Claims and Posteligibility Actions Involving Representatives Who May Petition

GN 03930.032 Direct Payment to the Appointed Representative Under the Fee Petition process for Title XVI and Certain Title II Concurrent Cases and Windfall Offset Calculation

GN 03930.090 No Fee Petition or Fee Authorization Received By PC or FO Before Diary Matures and SSA is Withholding Past-Due Benefits – Non-Court Case

GN 03940.050 Title XVI – Field Office Processing of Fee Agreements on Favorably Decided Concurrent Title II and Title XVI Claims

MS 00302.014 Representative Fee Update Data (UFEE)

MS 00304.018 Underpayment Processing (UOUP)

MS 03509.004 Clearance Menu (CMEN)

SI 02006.200 Title II and Title XVI Offset Cases – Subtraction of Authorized Fees from Title II Retroactive Payments

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

SI 02101.010 – Past-Due Benefits Payable - Individual Alive Under Age 18 with Representative Payee - Dedicated Account Required

SI 02101.020 Large Past-Due Supplemental Security Income (SSI) Payments by Installments – Individual Alive

SI 02101.025 Basic Requirements of Supplemental Security Income (SSI) Underpayment (UP) Review

SM 01311.662 Processing Interim Assistance Reimbursement (IAR) from an SSI Underpayment

SM 01320.001 Finding Windfall Offset Related Instructions

SM 01320.010 Windfall Offset Diaries and Alerts - W1, 3W, 4W, 5W, 6W, 7W, 8W, 9W

SM 01320.021 Windfall Indicator (WIN) Codes Used in the Automated Offset Process

SM 01320.400 Recomputation of Title II Offset

SM 01901.005 When to Use One Time Payments (OTPs)

SI 02006 TN 17 - Windfall Offset and Effect on Title XVI Payments - 4/26/2023