Effective Dates: 6/14/2022 - Present

Identification Number:
SI 02301 TN 47
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Posteligibility Changes
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 023 – Posteligibility Events
Subchapter 01 – Posteligibility Changes
Transmittal No. 47, 06/14/2022

Audience

OCO-OEIO: CR, FCR, FDE, RECONE, RECONR;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This transmittal updates and clarifies the procedures for making an N20 (Failure to Provide Information) determination and applying a suspension. In addition, we added examples of situations in which Claims Specialists would apply a payment status other than N20.

Summary of Changes

SI 02301.235 Failure to Provide Information (N20)

Section A

Retitled the subsection as "Policy on when to apply the N20 suspension"

Clarified that Claims Specialists may also suspend a Supplemental Security Income (SSI) record due to a failure to comply with a request for information

Section B

Retitled the subsection as "Policy on when not to apply the N20 suspension"

Moved the contents of former subsection E (Procedure for handling undeliverable mail) here

Added examples situations in which to apply a payment status other than N20

Section C

Moved subsection I (Procedure before suspending SSI - N20) here and retitled it as "Procedure before applying the N20 suspension"

Added instructions for exhausting efforts to obtain requested information and documenting efforts

Added instructions for delivering an oral Privacy Act statement

Section D

Retitled this section as "Procedure for sending an initial written request

Added a link to the N20 Checklist

Added policy for when to send a new initial request

Section E

Formerly subsection F retitled as "Procedure for following up with nonresponders"

Added step-by-step instructions for telephone follow up

Added an oral Privacy Act statement

Updated policy to change follow-up times from 10 days to 15 days

Section F

Moved subsection G here and retitled it as "Procedure for handling personal follow-up contacts"

Added instructions for delivering an oral Privacy Act statement and a Privacy Act statement for face-to-face contact

Section G

Moved subsection H here

Updated policy to change the time to comply from 30 days to 45 days

Section H

Moved subsection J (Procedure to document and suspend SSI - N20) here and retitled it as "Procedure for documenting a record and applying an N20 suspension"

Added formats for Claims Specialists and management to document N20 determinations ans approve N20 suspension inputs

Added instructions for how to handle disapproved N20 determinations

Section I

Moved subsection C (Policy on effective dates of suspension and reinstatement - N20) here and retitled it as "Policy on effective dates for an N20 suspension and reinstating payments"

Clarified the policy to ensure Claims Specialists do not create overpayments due to N20 suspensions

Deleted subsection K "References", as references are shown throughout the transmittal

 

SI 02301.235 Failure to Provide Information (N20)

CITATIONS:

Section 1631(e)(1) of the Social Security Act;
20 CFR 416.701 through 416.714 and 20 CFR 416.1322

A. Policy on when to apply the N20 suspension

You may suspend a Supplemental Security Income (SSI) record using payment status code (PSY) N20 when a person fails to provide information needed to determine continuing SSI eligibility and payment amount. A person may not provide any or all of the requested information in response to an initial request. Therefore, you may have to request information more than once before you are able to determine that a recipient is ineligible because of failure to provide necessary information. Follow the instructions in SI 02301.235D through SI 02301.235G of this section to obtain the requested information. After following all of the instructions in this section, you may suspend SSI using PSY N20 when the person who fails to comply with our request for information is:

  • •

    a capable recipient; or

  • •

    a representative payee who is the parent with custody of a minor recipient; or

  • •

    a recipient’s legal guardian.

NOTE: A capable recipient or the representative payee must provide requested information for individuals listed in SI 01310.030 (Reporting Events in Deeming Cases). An N20 suspension may apply if we do not receive the pertinent requested information.

EXCEPTION: For a recipient who is a blind or disabled child living overseas with a member of the U.S. military (SI 00501.416), the proper payment status is N05 (not N20) when suspending SSI for failure to provide information.

IMPORTANT: Follow the procedure in SI 02301.235C before applying an N20 suspension.

B. Policy on when not to apply the N20 suspension

1. N20 suspension not applicable

Do not apply the N20 suspension when there is sufficient information to establish current SSI eligibility and payment amount. Sufficient information to establish eligibility and payment amount involves requesting primary and secondary evidence needed to determine the eligibility factor(s) at issue. Always try to obtain secondary evidence if the recipient, representative payee, or legal guardian is unable to provide the primary evidence or the primary evidence is not available. For more information on accepting evidence, see GN 00301.015.

In addition, do not apply the N20 suspension when:

  • •

    It appears that the representative payee is missing, no longer acting for the recipient or is uncooperative. Instead, develop for a successor representative payee or consider direct payment (see GN 00504.100 and GN 00504.105). Suspending payments for payee development is only permissible in limited situations. Determine whether the recipient is capable (see GN 00502.001 through GN 00502.070) and develop for a representative payee if necessary (see GN 00502.085 through GN 00502.302). If appropriate, consider whether to suspend payments during payee development (see GN 00504.105 through GN 00504.110). Make paying the recipient directly your first consideration and only suspend payments as a last resort because you determine that substantial harm would result from direct payment. Follow instructions in GN 00504.110, which describe when you can suspend SSI payments;

  • •

    There is a need to develop for capability because there is an indication that the recipient cannot manage or direct the management of his or her benefits. (see GN 00502.020);

  • •

    The U.S. Postal Service (USPS) returns an initial written request to the field office (FO) as undeliverable and you cannot locate the person (see SI 02301.240); or

  • •

    A third party not listed in SI 02301.235A such as a neighbor, household member, employer or financial institution fails to comply with a request for information; or

  • •

    You are unsure about a past period of ineligibility. If you are unable to confirm eligibility for a past non-pay period (that is, no payment issued), suspend SSI for the closed period using payment status N05 (see SI 02301.220).

CAUTION: Do not misuse or overuse the N20 suspension. Be careful to apply the appropriate payment status.

2. Examples of when the N20 suspension is not applicable

The following are examples of some situations in which to apply a payment status other than N20.

EXAMPLE 1 - Unable to Locate: The USPS returns an initial written request as undeliverable and the FO cannot locate the recipient. The FO learns later that the recipient changed his address but did not notify the FO. If you are unable to locate the recipient, then follow the instructions in SI 02301.240 and apply the S06 suspension if appropriate. If you obtain the correct address and locate the recipient, then send a new copy of the initial request (see GN 02605.060).

EXAMPLE 2 - Capability Development Needed: The FO does not receive a response on the initial and follow-up requests, but you receive information that suggests the recipient may be incapable and direct payment may cause substantial harm. The recipient’s neighbor informs the FO that the recipient is recovering from a serious accident and is experiencing slight memory loss. The recipient may need a representative payee because direct payment is not possible. Develop for capability and consider the S08 suspension (GN 00504.105).

EXAMPLE 3 - Payee Development Needed: The FO does not receive a response on the initial and follow-up requests. The recipient informs the FO that her current representative payee has been in a nursing home for more than 60 days. Consider whether there is a need for a change in payee (see GN 00504.105 and GN 00504.110).

C. Procedure before applying the N20 suspension

Before you apply the N20 suspension make sure you use all evidence to establish current eligibility and payment amount. Follow these steps to exhaust all efforts to obtain the requested information.

  • •

    Verify the address - check the SSR (and MBR, if applicable) for a current address.

  • •

    Call the recipient, representative payee, or legal guardian.

    • –

      Check the SSR (and MBR, if applicable) and other SSA records

    • –

      Check online for directory assistance (e.g., Anywho.com)

    • –

      Call at different times, leave messages when possible, and allow time for return calls.

    • –

      Establish the identity of the individual you speak with consistent with GN 00203.020.

  • •

    Contact an interested third party or information source (e.g., employer, benefit source, medical treatment source, or a homeless shelter). If there is no third party or source that could provide the information, indicate that conclusion on the SSA-5002.

  • •

    If the recipient has direct deposit, contact the financial institution for a current address.

  • •

    Send Form SSA-L2001 to the servicing post office. EXCEPTION: It is not necessary to send the form if the post office returned the initial request as "Undeliverable" or "Moved/Left No Forwarding Address".

    NOTE: For failure to cooperate in medical continuing disability reviews (CDR), prior to applying an N20 suspension, follow procedures in DI 13005.025 and DI 13015.005.

Thoroughly document your efforts to locate and contact the recipient, representative payee, or legal guardian on the Report of Contact (DROC) screen in MSSICS (see MSOM MSSICS 022.010) or paper Report of Contact SSA-5002 faxed into NDRed for non-MSSICS cases. Be sure to date stamp each contact attempt.

The requested information does not need to come directly from the recipient, representative payee, or legal guardian. If we have information in our records or obtain the information from other sources to establish current eligibility, then an N20 suspension does not apply.

D. Procedure for sending an initial written request

Follow the instructions in sections SI 02301.235D through SI 02301.235G when requesting information, documenting a recipient's record, and following up with a recipient, representative payee, or legal guardian. In conjunction with following these instructions, complete the mandatory N20 Checklist in section H.1.

SSI records may show the recipient, representative payee, or legal guardian has a history of providing incomplete or incorrect information. Therefore, when requesting information, always consider the person's:

  • •

    Understanding of, and agreement to comply with reporting requirements; and

  • •

    Knowledge of the occurrence of events that should have been reported; and

  • •

    Ability to comply with SSA’s reporting requirements and any efforts to report information.

1. When to send an initial written request

Send an initial written request each time you request new information, evidence, or an action that you did not request before. Allow 30 calendar days after the date of the request for the recipient, representative payee, or legal guardian to comply with the request.

EXAMPLE 1: You send an initial written request dated April 1 asking the recipient to call in for a redetermination (RZ) interview. You complete the RZ interview by telephone on April 24 and need evidence of a special-needs trust. You send an initial written request to the recipient dated April 24 allowing her through May 24 to provide the requested evidence.

EXAMPLE 2: You send an initial written request dated April 1 asking the representative payee to come in for an RZ interview and bring evidence of wages. On April 24, the representative payee comes in and provides the evidence. He reports that the recipient also has income from self-employment. You hand the payee an initial written request dated April 24, which allows the representative payee through May 24 to provide evidence of the self-employment income.

2. How to send an initial written request

Follow these steps to send an initial written request:

STEP

ACTION

1

Complete only one of the following notices (in English or Spanish). No other notices are approved for this use.

  • •

    SSA-L3074-U2 (Supplemental Security Income Notice of Appointment), SI 02305.019

  • •

    SSA-L3075-U2 (Supplemental Security Income Notice of Appointment (1619(b)), SI 02305.019

  • •

    SSA-L8202-F4-INST (Important Facts about Your Supplemental Security Income), SI 02305.020

  • •

    SSA-L8009-U3 Supplemental Security Income Important Information (The SSA-L8009 is used to request information during PE events)

2

NOTE: You may use eMailer to request proofs and follow up on outstanding requests for proofs, but this option does not replace the requirement to send one of the above notices by U.S. mail.

Address the request to the recipient, representative payee, or legal guardian.

3

Date the request the same day you mail it (or hand it to the person).

4

Enter a due date (month/day/year) that gives the person 30 calendar days after the date of the request to comply.

NOTE: Form SSA-L8202-F4-INST contains preprinted language about the 30-day period.

5

Retain a copy of the request in the Online Notice Retrieval System (ORS). If you generate the notice outside of StaRZ and StriPEs- The Next Generation (SSTNG) or the Document Processing System (DPS), fax a copy of the written request to the Non-disability Repository for Evidentiary Documents (NDRed) or retain the paper folder, if applicable.

NOTE: It is not necessary to fax a copy of the request to the NDRed if SSTNG or DPS produces the request. The ORS stores the request.

3. When to send a new initial written request

You must follow up on the initial written request as instructed in SI 02301.235E. However, if you have not made contact or followed up with the recipient, representative payee, or legal guardian, and 75 calendar days have elapsed, issue a new initial request. Document all request attempts on the DROC screen in MSSICS or a paper SSA-5002 faxed into NDRed in non-MSSICS cases. Include the date of the new initial request.

In situations where the USPS returned an initial written request to the FO as undeliverable and the FO located the recipient after whereabouts unknown development, send a new initial request to the new address in record. See SI 02301.240 for instruction on whereabouts unknown development.

E. Procedure for following up with non-responders

1. When to follow up

Follow up on an initial written request when the person:

  • •

    does not respond within the 15 calendar days after the date on the written request; or

  • •

    fails to comply with a scheduled appointment date on the written request.

Follow up by telephone and, if unsuccessful, follow up by mail.

2. How to follow up by telephone

Follow up by telephone using these steps:

STEP

ACTION

1

Check the SSR (and MBR, if applicable) and FO records for a current telephone number. If a telephone number is shown on the recipient's record(s), proceed to Step 2. If not, STOP. Go to SI 02301.235E.3 in this section on how to follow up by mail.

2

Attempt to contact the person by telephone (see GN 00203.020 to establish the claimant's identity when you contact the person by telephone) to remind them of the information we need and the due date. NOTE: In some situations, you may be able to collect the needed information via the telephone follow up call. For those situations, follow the appropriate POMS instructions for collecting and processing the information. If existing policies do not reference delivery of oral Privacy Act Statement, give an oral summary of the form SSA-5000.

If contact is not made, for example, if the phone line is busy or there is no answer, consider following up at a later time. When possible, leave a message to remind them of the information needed and the due date.

CAUTION: When leaving a message, be careful not to disclose any Personally Identifiable Information (PII) about the recipient. For example, leave a generic message saying: "It is important that he responds to our request for information by XX/XX/XX." Do not say anything specific such as, "I'm calling about his SSI check." The fact that a recipient is receiving a benefit from Social Security is PII.

3

If the follow-up call is unsuccessful, follow up by mail (see SI 02301.235E.3).

4

Document attempts to follow up by telephone on the DROC screen or a paper Form SSA-5002.

NOTE: The Development Worksheet (DW01) (MS 04422.004) lists and records follow ups on requesting evidence.

3. How to follow up by mail

Mail a written follow-up request using these steps:

STEP

ACTION

1

Complete steps 1 through 3 in SI 02301.235D.2 in this section

2

Enter “SECOND REQUEST” on the notice.

3

Use the same due date from the last written request if it gives the person at least 15 calendar days left for the person to comply. If less than 15 calendar days remain, extend the due date and fill in the new date which gives the person 15 calendar days after the date of the follow-up request to comply (SI 02301.235G.2). Change references to the 30-day period in the text to 15 days.

4

Mark/Handwrite on the envelope with this statement “RETURN SERVICE REQUESTED” and mail the request.

5

If the USPS returns the mail:

  • •

    with a “FORWARDING ADDRESS,” complete and mail another written follow-up request using steps 1–4 in this chart.

  • •

    as undeliverable, assume the person received the initial written request if there was no address problem Follow the instructions in SI 02301.240 and apply an S06 suspension if appropriate.

6

Document attempts for written follow-up requests on the DROC screen in MSSICS or a paper SSA-5002 faxed in NDRed in non-MSSICS cases.

Retain a copy of the request in the ORS. If you generate the notice outside of SSTNG or DPS, fax a copy of the written request to the NDRed or retain the paper folder, if applicable.

NOTE: It is not necessary to fax a copy of the request to the NDRed if SSTNG or DPS produces the request. The ORS stores the request.

F. Procedure for handling personal follow-up contacts

For each telephone or face-to-face contact involving a request for needed information, take these actions:

  • •

    Remind the person of the information we need and the due date.

  • •

    Explain to the recipient, representative payee, or legal guardian that the recipient may lose other benefits based on receiving SSI such as Medicaid, food stamps, State Medicare buy-in (SMIB) and public housing if he or she does not comply with the request.

  • •

    Consider the need for a representative payee (see GN 00502.020) if the recipient does not understand the request or the possibility of losing SSI eligibility.

  • •

    Arrange for an interpreter if the person has limited English proficiency (LEP) or is hearing-impaired (see GN 00203.012).

  • •

    Offer to help obtain the information (see SI 02301.200).

  • •

    Grant more time to comply with the request if needed.

  • •

    Discuss voluntary termination (PSY N19) if the person does not want to pursue SSI eligibility (see SI 02301.230).

  • •

    Stop telephone or face-to-face efforts and mail a follow-up notice if the person is hostile or abusive (see GN 00203.013).

  • •

    Document attempts for each telephone and face-to-face contact on the DROC screen in MSSICS or a paper Form SSA-5002 faxed in NDRed in non-MSSICS cases.

G. Procedure for extending the time to comply

1. The person needs more time

When the person needs more time to comply with a request for information, grant the time if the person has a good reason for needing it. Discuss the time needed and grant:

  • •

    The number of days agreed on; or

  • •

    Another 45 calendar days if the person is trying or willing to comply and is uncertain how much longer he or she needs.

Grant additional extensions if the person appears to be cooperating. Offer assistance in obtaining the information and additional time to comply if appropriate.

2. When more time is required

If a person has less than 5 calendar days to comply after a personal contact (telephone or face-to-face) or would have less than 5 calendar days to comply after the written follow-up request, extend the due date to:

  • •

    5 calendar days after the personal follow-up contact; explain the new due date to the person; or

  • •

    10 calendar days after the date on a written follow-up request (see SI 02301.235E.3 in this section).

EXAMPLE : You attempt to contact a recipient by telephone, but do not speak with the recipient and can only leave a message and send a written follow-up request. The recipient returns your telephone message 2 days before the period to comply with the request ends. You explain that he has until (month/day/year that gives him 10 additional business days after the initial due date) to comply or his SSI payments may stop.

H. Procedure for documenting a record and applying an N20 suspension

1. Claims Specialist documents an N20 suspension

Complete the mandatory N20 Checklist to document that all of the required actions are taken before requesting management approval of an N20 suspension. Sign the technician approval section (electronic signatures and /s/ signatures are acceptable) and forward to the designated member of management when requesting management approval of the N20 suspension. Click the PDF file, save the checklist, and complete it.

View In PDF

Document N20 suspensions on the DROC screen in MSSICS (MS 04422.010) or on a paper Form SSA-5002 faxed into the NDRed in non-MSSICS cases using the following format:

SUBJECT: N20 Determination-Claims Specialist/Claims Technical Expert

ACCURATELY DEVELOPED AND DOCUMENTED THE RECORD (Include results of ALL initial written requests, follow-up attempts and steps taken to exhaust all efforts and the outcomes): Y/N

REASON FOR N20 SUSPENSION:

EFFECTIVE MONTH FOR N20 SUSPENSION: MM/YY

N20 CHECKLIST COMPLETED, SIGNED AND STORED IN EF/NDRed: Y/N

DATE N20 CHECKLIST GIVEN TO MANAGEMENT: MM/DD/YY

NAME OF MANAGEMENT OFFICIAL REVIEWING REQUEST:

***CERTIFICATION***

I HAVE DEVELOPED AND DOCUMENTED THE RECORD ACCURATELY AND CONFIRM THE USE OF N20 SUSPENSION IS APPROPRIATE. I CERTIFY THIS ACTION MEETS THE REQUIREMENTS OF SI 02301.235.

2. Management approval required to apply an N20 suspension

After you document all unsuccessful efforts to obtain the needed information and determine that an N20 suspension is appropriate, you must obtain approval to apply an N20 suspension from a member of management (i.e., management support specialist (MSS) or above).

A member of management must document approval to apply an N20 suspension using a separate DROC screen in MSSICS (MS 04422.010) or on a paper Form SSA-5002 faxed into the NDRed in non-MSSICS cases using the following format:

SUBJECT: N20 Approval-Management

CS/CTE's DOCUMENTATION AND DEVELOPMENT HAVE BEEN REVIEWED FOR ACCURACY: Y/N

N20 CHECKLIST HAS BEEN COMPLETED, SIGNED AND STORED IN EF/NDRed BY THE CS/CTE: Y/N

N20 CHECKLIST HAS BEEN COMPLETED AND SIGNED BY MANAGEMENT: Y/N

N20 CHECKLIST HAS BEEN FAXED INTO EF/NDRed: Y/N:

***AUTHORIZATION***

I HAVE REVIEWED THIS CASE AND CERTIFY THAT THE INPUT OF N20 SUSPENSION IS APPROPRIATE IN ACCORDANCE WITH THE TERMS ABOVE PER SI 02301.235. I AUTHORIZE THE USE OF N20 SUSPENSION.

3. How to apply an N20 suspension-Management

Management must take the following actions to apply an N20 suspension:

  • •

    review the employee development of possible N20 suspension, including the checklist;

  • •

    document the approval on a DROC and the checklist;

  • •

    Fax the completed and signed checklist to the EF/NDRed;

  • •

    input the N20; and

  • •

    build the N20 suspension to the SSR.

Suspend N20 in Consolidated Claims Experience (CCE) SSI Payment Status page (MS 08125.008) or 1719B in non-MSSICS (SM 01305.001).

Suspend N05 if the recipient is a blind or disabled child of military personnel stationed overseas (SI 02301.220).

4. N20 Disapproval-Management

If management disapproves the N20 determination due to incorrect development or insufficient documentation, management will not apply the N20 suspension and must document the DROC and include the reason for the disapproval.

I. Policy on effective dates for an N20 suspension and reinstating payments

1. Effective dates for N20 suspension

Suspension is effective the first month after management approves an N20 suspension that you can stop payments under Goldberg/Kelly (GK) procedures (SI 02301.300). Do not create an overpayment due to an N20 suspension under any circumstances.

IMPORTANT: If a case is not documented thoroughly, DO NOT apply the N20 suspension. Thoroughly review the record for incomplete documentation following the instructions in sections SI 02301.235D through SI 02301.235G, and update the record accordingly.

NOTE: During the GK temporary period, the system can reduce the following month's payment automatically and issue the GK notice timely if you input the required selection in the Goldberg/Kelly Screen (DBGK) (MS 04502.002). Outside of MSSICS, the system can produce an online GK notice in most cases. For exceptions and manual GK notice instructions, see SI 02301.307.

2. Reinstating payments after an N20 suspension

Reinstatement is effective the first month of an N20 suspension or a later month (or earliest day in a month) that information establishes eligibility and payment amount. See SI 02301.205 on when to take a new application to reestablish SSI eligibility for recipients who are in payment status N20 and N05.

SI 02301 TN 47 - Posteligibility Changes - 6/14/2022