PROGRAM OPERATIONS MANUAL SYSTEMPart SI – Supplemental Security IncomeChapter 020 – Benefits and PaymentsSubchapter 03 – Interim Assistance PaymentsTransmittal No. 16, 08/05/2020
In 2010 the eIAR (electronic Interim Assistance Reimbursement) system was implemented, this made the SSA-8125 form obsolete. The form and manual explanation for completing the form remained for pipeline cases. After 10 years there are no more pipeline cases.
Summary of Changes
SI 02003.040 Manual Preparation of the SSA-8125 and SSA-L8125-F6, Notice to the State for Exception Cases and Proration Cases
Removed the instructions for completing form SSA-8125 which is obsolete.
SI 02003.050 Exhibits of Forms SSA-8125 and SSA-L8125-F6 for Exception Cases and Proration Cases
Removed the example of the SSA-8125 which is obsolete and updated the link to the new fillable SSA-8125-F6.
Complete the following pages of the SSA-L8125-F6 for IAR exception and proration cases:
A. Page 1 - State Agency Identifying Information
B. Page 3 – Claimant Information
C. Page 4 - 6 – Retroactive Amount Due Summary
Enter the name and address of the State agency receiving the IAR check.
Enter the date the notice is prepared.
Enter the social security number (SSN).
Enter the State and county code of the State agency receiving the IAR check - the same date posted to the SSR.
IAR PAYMENT PENDING CASE:
Enter the complete address of the servicing FO.
Check if applicable.
Check only if future instructions require it.
Enter the recipient's name.
Enter the recipient's SSN.
Representative Payee Name
Enter the payee's name if applicable.
Date of SSI Eligibility
Enter the date (MM/DD/YY) of SSI eligibility in both IC or PE claims.
NOTE: Also enter deceased (MM/DD/YY) if the recipient dies before payment is made. Leave blank if IC/PE denied.
Amount of SSI Retroactive Benefits Due
Enter the amount of SSI retroactive benefits due being sent to the State. If no underpayment due enter "0".
Amount and Month of Recurring SSI Payment
Enter the amount and month of recurring SSI payment. Enter "0" if no recurring payment due.
Under the block labeled (TO: Social Security Administration Address) Record the servicing FO address.
Date Returned to SSA
Enter date servicing FO received SSA-L8125-F6 from the State.
Enter the GR Code.
NOTE: State completes all other items in this section.
SSA Telephone #
Enter the SSAFO telephone number.
Amount of reimbursement check(s) released to the State
Enter the date the last IAR check was released to the State.
Enter the name of the FO worker completing the SSA-L8125-F6. Enter no check due if claim denied or no IAR due.
Enter the months covered by the retroactive check and the dollar amounts per month equal to the retroactive check. When the amount for consecutive months are equal, show the beginning date of the first consecutive month (MM/DD/YY) and the ending date of the last consecutive month (MM/DD/YY) plus the per month dollar amount ($000).
Enter any prorated dates for a PE case on a separate line.
Use the instructions to process the eIAR exception cases described in SI
To access the form click link to SSA-L8125-F6:
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