Identification Number:
SI 02101 TN 16
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Title XVI (SSI) Underpayments
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 021 – Title XVI (SSI) Underpayments
Subchapter 01 – Title XVI (SSI) Underpayments
Transmittal No. 16, 07/14/2020

Audience

OCO-ODO: CST, CTE, CTE TE, RCOVTA, RECONR, RECOVR;
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 provides instructions for using a nationwide MACRO that assists technicians in documenting SSI underpayment reviews. The new MACRO is available via the OQA Toolbar Remarks Tool.

 

Summary of Changes

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

We made editorial revisions throughout the section revisions include:

Subsection.E.3 Updated step 10 of the chart to include the use of the remarks functionality under the SSI Underpayment Review- Adjudicator.

Subsection E.4 Updated step 4 of the chart to include the use of the remarks functionality under the SSI Underpayment Review- Reviewer.

Subsection E.5 Added instructions for accessing the SSI Underpayment Review Adjudicator and Reviewer remarks functionality via the OQA Toolbar Remarks tool.

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

A. Introduction to underpayment review

Adjudicators must review large SSI UPs to ensure that we develop all factors of eligibility. There is a high risk of error in these cases because of the large payments.

B. Definitions for terms used in underpayment review

1. Prepayment review

A prepayment review is a review of the non-disability eligibility factors before authorizing payment.

2. Low risk cases (LRC)

Low-risk cases (LRC) are those SSI initial claims (ICs) with characteristics that are not error-prone.

3. Underpayment (UP) at risk

UP at risk is the SSI UP amount, minus the potential Title II offset for the UP period per SI 02006.100.

4. Adjudicator

An adjudicator is a claims specialist (CS) or above, who performs the prepayment review. The adjudicator can be the person who made the original determination.

5. Reviewer

A reviewer is a CS or above, and is someone other than the adjudicator. The reviewer examines the file after the adjudicator completes the prepayment review, but before the release of the UP. The reviewer completes the Underpayment Process (UOUP) screen to release the UP.

C. Prepayment review policy

1. When a prepayment review is required

Conduct a prepayment review for any SSI case (initial claim (IC), or post eligibility (PE)), if an UP of $5,000 or more is due through the month prior to the current computation month (CCM). For a definition of the CCM, see SM 02101.001.

Do not conduct a prepayment review if the case:

  • involves Title II offset and the SSI UP “at risk” is less than $5,000 per SI 02006.100; or

  • is a low-risk criteria (LRC) case as described in SI 02101.025C.2.

2. Criteria for LRCs

A case meeting LRC criteria has all the following characteristics for all months of the UP period:

  • an initial claim;

  • an individual record (TMR = DI, BI, etc.);

  • an automated computation;

  • the payment status code is C01 or E01; and

  • any one of the following:

If the living arrangement is:

AND there is no chargeable income, or there is:

And there is:

“B” continuously

Earned income less than $65 per month

Type A (Title II benefits)

Type G (Title II benefits)

Type W (Title II benefits)

Type I (deeming allocations)

Type J (systems posted VTR)

Type RL (rental/lease),

Type RH (royalties/honoraria)

Type RI (interest/dividends), totaling $5 or less per month)

No other income

“A” continuously

Any countable income that is listed for living arrangement “B”

General assistance grant reimbursement (GA/GR) involvement and no State supplement category

Congregate Care (as defined in SI 01401.001C.3.)

Any countable income that is listed for living arrangement “B”

No other income

3. Who performs the prepayment review

An adjudicator and a reviewer perform the prepayment review.

4. Administrative finality

The rules of administrative finality apply to UP cases; however, failure to release an underpayment is not an initial determination and is not subject to administrative finality. For administrative finality rules, see SI 04070.010 and SI 04070.070.

D. How the system processes UPs of $5,000 - $49,999.99

1. UP withheld

When the system computes an UP of $5,000 - $49,999.99, it holds the UP and sets a U2 diary until the technician releases the UP.

After the prepayment review, the reviewer accesses the Direct SSR Update to provide authorization for release of the UP through the UOUP screen. To view the UOUP screen, see MS 00304.018. The reviewer releases the UP to the recipient or representative payee unless one of the following criteria is met:

  • Interim Assistance Reimbursement (IAR) applies, per SM 01311.662;

  • Direct fee payment to an authorized representative, per SM 01311.664;

  • Installment only payments (the system will automatically release the payments), per SM 01311.668; or

  • Dedicated account case (the system will set all appropriate diaries, issue an alert and release an automated notice to the representative payee), see SI 01130.601 and SM 01300.667.

NOTE: For UPs of $50,000 or more, see SI 02101.055.

2. UPs released

The system releases an UP of $5,000 or more (except in dedicated account cases) after

  • Completion of the UOUP screen. For UOUP screen information, see MS 003044.018 and SM 01311.661 (PE);

  • Force due(s). For instructions on when to use force due procedures, see SM 01701.001; or

  • One-Time Payment(s) (OTPs). For instructions on the OTP process, see

    SM 01901.001 and MS 00303.022 - MS 00303.025

3. Cases involving Interim Assistance (IA)

For cases involving IA, see the following instructions:

  • SI 02003.020 Field Office Processing of IAR Authorization

  • SI 02003.022 Processing eIAR Field Office Intervention Cases

  • SI 02003.023 Processing eIAR Exception Cases

  • SI 02003.025 IAR Payment Processing for Exception Cases and Proration Cases

  • SM 01005.623 Grant Reimbursement (GR) Field

  • SM 01005.627 Exception Processing (GR)

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

4. Cases involving dedicated accounts

For cases involving dedicated accounts or installment payments, see the following instructions:

  • 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

  • SM 01301.450 Special Action Code (SZ)

  • SM 01311.661 How to Resolve a U2 Diary to Release Underpayments of $5,000.00 or More

5. Alerts and diaries for underpayment review

The system generates the following diaries and alerts associated with underpayment reviews:

Diary

Condition

U1

UP is greater than $4,999.99 and less than $50,000; option ‘RELEASE UNDERPAYMENT/LOW RISK' selected from the Underpayment Processing (UOUP) screen; and the Low Risk Profile (LRP) criteria were not met.

U2

UP is greater than $4,999.99 and less than $50,000.

U3

UP exceeds $49,999.99 after the second installment payment has been issued.

U4

NOT AUTOMATED DEATH

Indicates the record contains a verification code of ‘U' in the UPV field of the MPMT segment (UPV: U).

AUTOMATED DEATH

Posted when a record's composition changes from eligible couple to eligible individual due to the death of one member of the couple.

After the reviewer selects the appropriate code from the UOUP screen, the system may set additional diaries and generate additional alerts for installment and/or dedicated account cases as shown in the following chart:

Diary

Condition

EA

Dedicated account - awaiting account establishment and payment.

IN

Dedicated account - Installment – automated one-time payment (AOTP) required.

I9

IAR FO Intervention

Within 25 workdays from the FO transmission of the UOUP transmission and the IA agency eIAR transmission, eIAR requests FO intervention (assistance).

eIAR detects possible missing/erroneous SSR computations. eIAR is awaiting the FO review and corrections, if applicable, to the IAR Automated One-Time Payment (A-OTP) One-Time Payment Amount (UPOP) utility screen.

Alert

Condition

E1

Dedicated account - EA diary
pending - awaiting account establishment and payment.

I6

Dedicated account - Installment - IN diary pending AOTP required for installment payment.

For instructions on resolution of these diaries and alerts, see the following instructions:

E. Procedure for management, adjudicator, and reviewer responsibilities

1. Management responsibilities

Take the following steps to process UP alerts:

  1. a. 

    Control UP alerts using a control log until payment reflects on the SSR; and

  2. b. 

    Make employees aware of their responsibilities in the process.

NOTE: For an example of the control log management is required to use, see SI 02101.110.

2. Adjudicator responsibilities for prepayment review

Conduct a prepayment review if the UP is $5,000 or more, unless:

  • Title II offset reduces the UP at risk to less than $5,000, see SI 02006.100F.2 for documenting no money at risk; or

  • The LRC criteria outlined in SI 02101.025C are met.

3. Adjudicator responsibilities for preparing UP for release

Follow these steps to prepare the UP for release:

STEP

ACTION

1

Determine if all benefits due on the record can be paid without delaying the recurring check.

  • If YES, go to step 2.

  • If NO, release the recurring payment. Go to step 2.

2

Determine whether the case meets the LRC criteria:

  • If YES, go to step 4.

  • If NO, go to step 3.

3

Conduct the prepayment review. Query the Office of Child Support Enforcement(OCSE) online databases to determine if there are any undisclosed wages,unemployment compensation, or "new hire" information according to MS 05203.015 through MS 05203.018.

The query should include the individual and deemors. Follow the procedures in SI 00810.550. Go to step 4.

NOTE: If the FO receives an S2 alert for wages or U5 alert for unemployment compensation because of a central office database match, NEGATIVE VERIFICATION IS NOT REQUIRED.

4

Determine whether there is an interim assistance reimbursement authorization (IAR).

  • If YES, go to step 5.

  • If NO, go to step 7.

5

Determine whether a GR code is in the GRC field of the MPMT segment of the SSIRD.

  • If YES, go to step 7.

  • If NO, go to step 6.

6

Enter appropriate GR code and go to step 7. For grant reimbursement information, see MS 04423.006 and SM 01005.623.

7

Determine whether the UP must be released using A-OTP procedures per SM 01311.667, and SI 02003.023 and SI 02003.025 for IAR cases.

If YES, and this:

If NO, go to step 8.

8

Determine whether the case involves an attorney.

  • If YES, complete the UFEE screen. Go to step 9.

  • If NO, go to step 9.

9

Determine whether the system automatically generates a notice. If not, prepare a manual notice. Go to step 10.

10

Document the review using the SSI Prepayment Review - Adjudicator OQA Toolbar Remarks Tool. For more information on how to access the OQA Remarks Tool, see SI 02101.025E.5 in this section.

MSSICS cases:

  • Create a MSSICS Report of Contact screen (DROC), and document your review.

  • Lock the DROC to protect the contents.

Non-MSSICS cases:

  • Create an SSA-5002 (Report of Contact) and document your review.

  • Store the SSA-5002 in the Non-Disability Repository for Evidentiary Documents (NDRED) or Certified Electronic Folder (CEF).

11

Direct the case to the reviewer to verify and release the UP.

4. Reviewer responsibilities

Follow these steps for reviewer's responsibilities:

STEP

ACTION

1

Review the determination of the UP amount. Go to step 2.

2

Review the manual notice. Go to step 3.

3

Correct any deficiencies. Go to step 4.

4

Document the review using the SSI Prepayment Review - Reviewer OQA Toolbar Remarks Tool. For more information on how to access the OQA Remarks Tool, see SI 02101.025E.5 in this section.

MSSICS cases:

  • Create a MSSICS Report of Contact screen (DROC), and indicate that the reviewer completed the review.

  • Lock the DROC to protect the contents.

Non-MSSICS cases:

  • Create an SSA-5002 (Report of Contact) and indicate that the reviewer completed the review.

  • Store the SSA-5002 in the Non-Disability Repository for Evidentiary Documents (NDRED).

Go to step 5.

5

Complete the UOUP screen to release the UP by entering the appropriate code on the UOUP screen. For UOUP data, see MS 00304.018.

Go to Step 6 if IAR is involved and the MPMT UPV of “V” is set.

Go to Step 7 if no IAR is involved.

6

After 25 work days from the date the UOUP screen was transmitted (UP $5,000.00 or more) and eIAR has not released the IAR payment, then:

  • Determine if there is an I9 diary and process accordingly;

  • If UPV of “V” is set and no I9 diary, do not delete the GRC; contact the RO.

7

The system releases the UP.

5. OQA Toolbar Remarks

The OQA Toolbar Remarks tool allows users to paste the required language into the MSSICS DROC screen. Remarks propagate to the PCOM screen at the point of the cursor. For the SSA-5002 open the Remarks tool to copy and paste the text to the form.

Access the Remarks Tool via the OQA Toolbar. For the SSI underpayment workload, follow these steps:

  1. a. 

    Open the OQA Toolbar

  2. b. 

    Open the Remarks application using the RMKS button. NOTE: The Customizing the Toolbars page contains instructions for adding buttons to the Toolbar.

  3. c. 

    Select the POMS Remarks category from the drop down menu and select either:

    • SSI Underpayment Review - Adjudicator or

    • SSI Underpayment Review - Reviewer

      Tip: Begin typing "SSI Underpayment" in the Search field to filter entries, enabling you to find the remark quickly.

  4. d. 

    Paste into the DROC or the SSA-5002:

    • To paste into MSSICS DROC navigate to the DROC screen. Select the Send to PCOM button (ALT + P). The text will appear in the screen.

    • To paste into the SSA-5002 open the SSA-5002 form. Select all text shown in the Remark box on the right side and copy it by right-clicking and selecting Copy or by using CTRL + C. Paste the text into the form.

  5. e. 

    Delete a PPR_ADJ or PPR_Rev button on your PCOM Toolbar by right-clicking each button and selecting Delete Item. Remarks replaces the functions of both PCOM macros.

 


SI 02101 TN 16 - Title XVI (SSI) Underpayments - 7/14/2020