PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 004 – Disaster ProceduresSubchapter 10 – Processing Claims and Payments in DisastersTransmittal No. 8, 08/10/2020
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure
Summary of Changes
GN 00410.010 Application and Evidence Procedures in Disasters
Replace "800# Appointment and Referral System” with “enhanced Leads and Appointment System (eLAS)”.
The Office of the Regional Commissioner (ORC) or delegate, decides to invoke the disaster procedures. If it is apparent that the event will affect the entire country the Associate Commissioner, Office of Income Security Programs (OISP) may authorize the implementation of emergency evidentiary procedures.
800 Number Agents should schedule claims and appointments through the Workload Support Unit (WSU) or the Field Office Support Unit for individuals within the Region affected by disasters.
Consider sending staff on site or to Disaster Recovery Centers (DRCs) to take claims, if appropriate. Follow normal claims taking procedures.
If an individual filing as a direct result of a disaster visits a field office (FO) anywhere in the country, immediately process applications, using the designated Unit Code, issued as part of the Emergency Message, in the Development Worksheet (DW01) screen.
GN 00201.000, Program – Related Claims Practice - Table of Contents
GN 01010.000, Adjudicative Policy and Standards - Table of Contents
MSOM MCS 005.001, Title II DADE Application Screens - Overview
There is a potential loss of benefits to survivors, who may not be aware of the number holder's death, or emotionally unable to apply for benefits in time to permit full retroactivity. This is particularly true for aged widow(er)s because of the limited retroactivity available.
Use a blanket protective writing covering all individuals potentially eligible for survivor benefits. If any survivor applies for benefits after the date where he or she can receive full retroactivity, as evidence of a protective filing date, field components should cite Processing Payment Actions in Disasters GN 00410.010D.1.
Input a unique unit code for all initial claims filed because of disaster. This special unit code facilitates the identification later of any claim generated because of the disaster.
All initial claims, both Title II and Title XVI that are filed as a result of disasters and the aftermath, should be identified by placing the date (month and day) of the disaster in the last three digits of the unit code on the DW01. For disasters that have occurred in the months of October, November, or December, code the first position “O” (for October), “X” (for November) or “R” (for December) and the second and third positions be the day of the month.
Follow your standard local procedures for the first three digits of the six-digit unit code.
While the use of the Unit Code is limited to individuals filing as a direct result of the disaster, you may apply a designated indicator to the record of any individual affected by disasters. The purpose of these indicators is to alert technicians to the need for special handling.
If an MBR is established and there is no message in the Special Message Code field, enter a Special Message Code. The message should read “DISASTER PROCEDURES APPLY FOR BIC(S) (followed by the applicable BIC(S)”.
Follow the instructions:
SM 00510.075, Special Message (SP MSG 1) Data Line
SM 00514.035, Special Message Data
MSOM T2PE 002.005, Special Message (PESM)
Add the designated CG field indicator to the SSR as needed. Follow procedures in, Case Redetermination Data - CRZD SM 01601.460.
CRs or WSU adjudicators may sign applications when there is a potential loss of benefits. In cases where payment is initiated based on a CR or WSU signature, obtain an application signed by the applicant post-adjudicatively and use Witnessed Signature procedures. Follow guidelines for alternative signature methods in GN 00201.015.
Follow normal instructions to complete the claim in MCS and process these claims quickly by using MCS and Earning Computation (EC). If the application is completed off-site and SSA systems are not available, take a paper application and enter it into MCS.
In some situations, the applicant may not have all the information needed to adjudicate the claim. For fields in MCS that accept a “?” entry and still allow adjudication, develop the missing information post-adjudicatively. Annotate the RPOC screen. For other fields, use the following guidelines:
Use an IDN code of “P” on the Numident as proof of age for claims purposes. If the IDN code on the NUMI is “P”, enter a Proof of Age code of “B” with a Proof Type of “O”.
If the Numident coding is sufficient evidence of age, enter a code “F.” Do not request additional evidence from the applicant.
Follow the instructions in
RM 10235.005, Parts of the Basic Numident Query Response
GN 00302.030, Tolerances for Developing Evidence of Age
If the applicant does not have complete information about prior filings for Title II, Title XVI or Medicare, answer each question “No.” Add information about any knowledge of prior filings on the RMKS screen.
If the applicant does not know the date the marriage began, enter a date one calendar year from date of application (if prior marriages terminated before that date) and annotate remarks that the actual date is unknown.
For surviving divorced spouses, the duration of marriage must be at least 10 years see, Child-in-Care RS 00208.005. Ensure the screens show a marriage duration that allows benefits to be paid, if the claimant alleges the marriage lasted at least 10 years.
The marriage duration requirement does not apply to surviving divorced mothers or fathers per RS 00208.010.
In all cases, enter a “P” code. If you did not review the proof and the Numident is not sufficient, annotate the RPOC screen.
If “U.S. Citizen” is answered "Y" and neither “Enumeration” nor “Title XVI” apply, enter “Y” for “Title II/XVIII.”
If you did not review the proof, annotate the RPOC screen.
NOTE: Establish U.S. citizenship from the following SSA sources
U.S. place of birth is shown on the Numident, and
the evidence code in the IDN field on the account line of the Numident is “P;” or
the IDN code is “C,” “D,” or blank (absent), and the cycle date (CYD) on the Numident is more than 5 years before the current date.
If “U.S. Citizen” is “N” on CLCZ but the applicant does not know when the individual started living in the U.S., enter a date 30 days prior to the event, or the date of the event in the Alien Status Start Date.
If the date entered is 30 days prior to the event, annotate the remarks screen that the exact date is unknown and, under penalty of perjury, the individual has been in the U.S. lawfully for at least the last 30 days. (The applicant will “sign” via attestation or if SSA systems are not available, sign a paper application.)
If the date of the event is entered, annotate the remarks screen that the exact date is unknown.
NOTE: Only use this procedure if electronic sources (SAVE, NUMI, MBR, etc.) do not contain this information.
For a mandatory MCS field, which the applicant does not know the answer (e.g., Active U.S. Military, Worked for the railroad),
enter an “N”, and
annotate the RPOC screen for this entry.
Establish the claim on MCS, with a “?” for the Claimant SSN field, if you anticipate entering a representative payee applicant in RPS.
Indicate the need for appropriate proofs (age, citizenship) on the MCS screens. MCS automatically establishes an issue of “CLUNK” on the DW01. Leave the receipt date blank.
If you will be entering a representative payee application for a beneficiary whose SSN is unknown, on the Representative Payee Main Menu (RPMM) screen, you must answer the (following question) in the “BENEFICIARY/RECIPIENT SSN” field. The question is “OR UNKNOWN (Y/N) __ “. You must answer this question with a “Y”. The RPS path will then prompt you to show the NH's SSN, and describe the beneficiary. You will not be able to adjudicate the RPS application with the unknown SSN.
To adjudicate the claim, a member of management must enter the “Management Override” function, which is #27 on the MCS System Menu (MENU) screen. The override must be #3, “CLMT SSN UNKNOWN.”
If you cannot process the case via EC, prepare an A-101. On the BCRN screen, enter the remark: “Disaster Survivor Claim - expedite per (cite this section GN 00410.010)”.
Adjudicators may encounter situations where the deceased number holder's name shown on the application differs from that shown on the Numident. In these situations, adjudicators may use information provided by anyone as proof of the number holder’s married or currently used name and use the Numident as proof of the maiden or prior name.
All custody development is post-adjudicative for payee categories except a natural parent with custody. In the event of a widespread disaster, do not initiate follow-up custody development for a natural parent who has custody. Follow normal procedures for local disasters. The undue hardship exception to the face-to-face interview requirement applies to any representative payee applications completed.
When a potential representative payee does not have a SSN, do not process the payee application in the Representative Payment System. Payees residing in the U.S. must have a verifiable SSN before they can be appointed as payees. Issue an SSN to any payee applicant who is entitled to have one but does not. If the applicant is not entitled to be issued an SSN, develop alternative payee applicants.
EXCEPTION: If the applicant is a parent filing to be payee for his or her minor child and cannot be issued an SSN, appoint the parent as payee, if otherwise suitable, take a paper SSA-11-BK representative payee application and complete the paper SSA-101 to adjudicate the claim.
GN 00502.113, Interviewing the Payee Applicant
GN 00502.117, Verifying Information Provided by Payee Applicants
If the claimant is completing his or her application in a teleclaim interview, have the applicant sign the application via attestation.
If the applicant refuses to sign via attestation, and the interviewer believes, there is a potential loss of benefits,
print two copies of the application from MCS. The Claims Representative (CR) must sign one copy permitting SSA to initiate payment immediately.
Mail the second copy to the applicant for signature.
Advise the applicant that he or she must sign and return the application as soon as possible.
Set a diary for the return of the application signed by the applicant.
Claims adjudicated using applications signed by a CR or WSU still require additional evidence and development:
Advise the applicant that payment will be effectuated based on the information provided. The applicant needs to submit a signed application, missing information or evidence as soon as possible.
Diary the claim; annotate any diaries on the DECI screen for proofs needed and the signed application (set the month and year for 3 months in the future).
When not all of the information or evidence is available or you adjudicate the claim based on a CR or WSU signature, annotate the RPOC screen with the following:
Adjudicated per (cite this POMS Section)
The following evidence is needed: (List needed evidence)
The following information is needed: (List needed information)
Enter the date the CR signed the application in the DW01 receipt field for the application. Do not X out the application issue on the DW01. Annotate the RPOC screen "Ap. Mailed."
Follow normal procedures for obtaining evidence. Consider making personal contacts to expedite development, if appropriate.
Obtain evidence in the following order:
In addition, consider:
emergency evidentiary procedure which permits partial adjudication based on secondary evidence
preliminary payment procedure
GN 00308.000, Sources and Fees for State and Local Vital Statistics Records
GN 00301.060, Emergency Evidentiary Procedures
RS 02807.005, Applicability Requirements
GN 00201.015, Alternative Signature Methods
If the authorities find the body, obtain evidence as follows:
The usual evidence of death should be available. If primary evidence is not available, obtain secondary evidence. Follow the instructions, Preferred Evidence of Death GN 00304.005.
Secondary evidence may include a passenger manifest or a newspaper account listing the identified victims. Follow the instructions, Secondary Evidence of Death GN 00304.015.
Assemble any evidence common to all or most of the disaster victims and prepare information for use on the Evidence (EVID) screen in Shared Processes as documentation for each claim.
If the authorities cannot find the body, obtain evidence and prepare a special determination as follows:
Secure statements from the claimant and a disinterested party covering the facts of the disappearance. The facts should establish
the presence of the individual at the scene of the disaster,
that imminent peril existed, and
there was little likelihood of survival.
GN 00304.025, Circumstantial Evidence of Death
Secure statements providing information that has a bearing on the activities of the missing individual on the day of the event. This information may contribute to establishing whether he or she may have died as a result. You may use secondary evidence to establish the likelihood of death.
Obtain primary evidence of wages and/or self-employment income (SEI) if readily available.
RS 01403.010, Primary Evidence of Wages
RS 01403.044, Variance Between Total Wages and Social Security Wages Shown on Forms W-2/W-2c
RS 01804.050, Acceptable Evidence of SEI - Policy
Obtain secondary evidence of wages if applicable.
If no evidence of wages is available:
Determine whether you can credit the wages and the appropriate amount to credit
Prepare, if appropriate, Form SSA-553, Special Determination and
Enter in the Earnings Modernization Item Correction (ICOR) System or the Report of Contact (RPOC) screen for the lag period
Follow instructions for establishing SEI if tax returns are not available.
RS 01403.050, When Development of Secondary Evidence of Wages May Begin
RS 01403.060, Employee’s Own Record of Wages
RS 01403.061, When Evidence of Wages Cannot Be Obtained
RS 01804.150, Establishing SEI for Prelag Years, and
RS 01804.165, Establishing Unposted Prelag SEI-Tax Returns Destroyed by IRS
Follow normal procedures for developing lag earnings.
RS 01404.005, Lag Period – and Lag Earnings
RS 01404.018, Evidence of Lag Wages
Use the lag SEI (as with any SEI) in the computation only if a tax return has been filed with IRS.
RS 01804.100, Establishing Lag SEI
RS 01804.110, Establishing Current Year SEI
If a claimant completes an application in person and has all required evidence in his or her immediate possession:
review the evidence,
record the evidence on the “Shared Process” screen, and
adjudicate the claim according to normal procedures
Fully develop the relationship to the number holder before adjudicating child's claims involving children born out of wedlock.
Follow normal procedures to determine if the child has inheritance rights under State law and qualifies under Section 216(h)(3).
Use Numident records to establish a parent-child relationship for a victim's natural legitimate child if:
the parents' names are shown in the appropriate fields on the Numident;
there is no evidence in file that the child was born before the parents' marriage; and
there is no other evidence showing that the child is not the number holder's natural legitimate child.
Exercise caution before establishing marital relationship based on allegations. A spouse must allege a marriage lasting at least one continuous year, unless an alternative or exception applies.
For claims requiring a dependency determination (i.e., one-half support for parents and stepchildren or contributions of support for some other types of children), complete the necessary forms to obtain the information needed to make the determination (i.e., Form SSA-760 for parents, Form SSA-783(s) for children).
RS 01301.150, Completion of Form SSA-760-F4 (Certificate of Support)
RS 01301.165, One-Half Support – Corroborating Statement and Other Evidence
Process the claims as follows.
If the applicant initiated the contact with SSA, obtain the signed form(s) (along with the application) before processing the claim.
If anyone other than the applicant initiates contact process the claim based on the information on the form(s), obtain the applicant's signature on the form(s) and the application post-adjudicatively.
In both situations, obtain any necessary documentary evidence of support post-adjudicatively.
In disaster cases, evidentiary requirements for Proof of age remain the same as for other cases. If neither an IDN code of “P” nor the proof of age tolerance procedure applies, develop evidence of age. Develop a material discrepancy for proof of age.
See D etails
GN 00302.050, Evidence Required for Claimants Under Age 73
GN 00302.100, Developing Evidence of Age When There is No Preferred Evidence
GN 00302.125, Combination of Documents Which Eliminate the Need for Further Development - Age
GN 00302.160, Material Discrepancy - Age
Consider all income and resource exclusions, as well as special exclusions of assistance provided to claimants of presidential-declared disasters (including deemors, as appropriate), before you take an action to adversely affect a beneficiary.
Seek guidance on excluding support and maintenance, processing SSI address and living arrangement changes, and determining State of residence for individuals displaced by disasters. Support and maintenance in cash and in-kind, regardless of the source, is excluded from income for individuals who meet the criteria.
SI 00835.050, Living Arrangement Changes for Victims of Presidentially Declared Disasters
SI 00820.500, Earned Income Exclusions - General
SI 00830.099, Guide to Unearned Income Exclusions
SI 01110.210, Excluded Resources
SI 00830.620, Exhibit of Form SSA-8006-F4
POMS provides for a developmental tolerance when information/evidence is not available from the claimant, recipient, or a third party. This includes situations where documents were destroyed, an employer is no longer in business, the records are inaccessible, etc.
A "disaster" is not required for the tolerance to apply; however, the situation increases the likelihood that evidence of income and resources may not be available for those persons affected by the disaster.
If complete POMS development requirements are not possible because of situations created by the disaster, use the claimant or recipient’s best available evidence or relevant allegations for development of income and resources. Document the file with the reason why required POMS development is not available.
SI 00601.100, Information/Evidence – General
Individuals affected by disasters and previously denied Title XVI benefits due to excess income or resources, or whose pending claim we would deny on that basis, may now meet the Title XVI eligibility requirements.
In many cases, changes in income or resources may be a direct result of the disaster and we must pay special attention to ensure that these individuals receive benefits for which they may be eligible.
A notation in the Special Message field of the MBR or a code in the CG field of the SSR will identify most affected claimants. In addition, if the SSR does not show the code but the caller alleges being a victim from the affected area, accept the allegation and follow the procedures. If an individual affected by the disaster contacts the 800 number or the FO for any reason:
Check the system to see if there is a SSID.
Determine whether the individual had a Title XVI claim denied for excess income/resources (N01/N04).
The determination for a denial of a claim for excess income or resources prior to the disaster was most likely correct when made. However, due to the drastic changes brought about by disasters, the individual may be eligible now.
Filing an appeal request will extend the life of the application, allowing SSA to develop for current eligibility and approve the case based on the prior application. For information on the life of an application, see SI 00601.010C.2.
Follow normal screening procedures to determine whether the individual now appears to be eligible for Title XVI based on the loss of income and resources.
If the individual appears eligible
Schedule an appointment using the enhanced Leads and Appointment System (eLAS) initial claims calendar, select the claim type relevant to the ID code on the SSID.
Annotate the individual’s contact information, i.e., address, phone number, alternative contact person, if appropriate.
Annotate in REMARKS, “Disasters, Appeal on Title XVI claim recently denied for excess income (N01) or excess resources (N04).”
If the individual is within the 60-day appeal period of the notice of Title XVI denial for excess income or excess resources, process an appeal.
If the individual is outside the 60-day appeal period, determine if good cause applies. Good cause applies to individuals who could not file an appeal because of a disaster. Others may have another reason (e.g., hospitalization) for not filing an appeal.
If the request is outside of the appeal period and good cause cannot be found, take a new application, using the date of contact with the 800 number as the protected filing date. If the determination was not correct when made, consider reopening within the limits of Administrative Finality.
NOTE: For these cases, a request in writing is not required. It is not necessary to send the appeal form to the individual unless he or she insists on completing the form.
GN 03101.020, Good Cause for Extending Time Limit
SI 04020.020B.3, Requests for SSI Reconsideration
A disaster may drastically affect the applicant’s eligibility.
SSA will re-examine:
a denial of a claim for excess income or resources
pending claims for unprocessed technical denials
Follow normal screening procedures to determine whether the individual now appears to be eligible for Title XVI based on the loss of income or resources.
If the individual appears to be eligible based on the loss of income and/or resources:
Schedule an appointment using the enhanced Leads and Appointment System (eLAS) initial claims calendar, selecting the claim type relevant to the ID code on the SSID.
Annotate in REMARKS, “Disasters, Title XVI claim recently denied for excess income (N01) or excess resources (N04).”
For these individuals the possibility exists that a technical denial for excess income or resources may no longer be correct.
Carefully consider reopening or revisiting the determination to deny the claim.
Contact the individual and develop for reopening. Normally, we would not reopen during the appeal period, however, for these cases, we allow reopening rather than an appeal. Use error on the face of the evidence as the basis for reopening. Our affirmative action in writing is the contact with the individual.
Consider an appeal if we made the correct determination but the individual’s income or resources are now lower, as a result of the disaster.
SI 04070.010F.5, Title XVI Administrative Finality – General Reopening Policies
SI 04070.015, Reopening SSI Determinations
Exclusions may apply to disaster-related assistance whether or not the beneficiary is in a presidential-declared disaster area. Consider all pertinent income and resource exclusions before you complete an adverse action on an initial claim or post-eligibility event involving a person affected by the disaster. Apply the following tolerances and exclusions when processing initial claims or post-eligibility actions involving a person affected by the disaster:
Cash or in-kind items are not income if provided to replace or repair a lost, damaged, or stolen resource. Cash and in-kind receipts from any source for the replacement or repair of lost, damaged, or stolenexcludedresources are themselves not treated as resources for 9 months from the date of their receipt. In the case of presidential-declared disasters up to 30 months (a 9-month initial period, a 9-month good cause extension, plus an additional 12-month good cause extension) may be granted.
SI 00815.200, Conversion or Sale of a Resource
SI 01130.630, Cash and In-Kind Items Received for the Repair or Replacement of Lost, Damaged, or Stolen Excluded Resources
Be alert for situations where a former resident of the area alleges ownership of real or personal property damaged or destroyed by the disaster. Property owned by a victim of the disaster may have a reduced current market value (CMV) or no CMV at all. Property does not cease to be a resource simply because it has no CMV; however, the resource does not affect eligibility if it has no CMV and cannot be sold. See Details
SI 01110.100, Distinction Between Assets and Resources
SI 01110.400, What Values Apply to Resources
SI 01120.010, Factors that Make Property a Resource
SI 01140.044, Resources with Zero Value
The value of any non-cash items received (other than in-kind support and maintenance) is not income if they would become a partially or totally excluded non-liquid resource if retained into the following month.
SI 00815.550, Receipt of Certain Noncash Items
In-kind support and maintenance is excluded, and the one-third reduction does not apply for an individual who stopped living in his or her home due to the disaster.
Do not charge ISM for an individual made homeless by this disaster. Any food and shelter the individual receives is excludable whether provided in a private home, a shelter, or any other temporary housing arrangement resorted to because of the disaster.
We exclude HEA/SMA from income if it is
certified by the State as provided based on need, and
provided in-kind or in cash (by a private nonprofit agency or a supplier of home heating oil or gas, a rate-of-return entity providing home energy, or a municipal utility providing home energy)
SI 00830.605, Home Energy Assistance and Support and Maintenance Assistance (HEA/SMA)
SI 00835.331, Treatment of Home Energy Assistance (HEA) and Support and Maintenance Assistance (SMA) in Determinations of Inside ISM and Cash from Within a Household
Loans of cash or in-kind support and maintenance that the borrower is obligated to repay are not income.
SI 00815.350, Proceeds of a Loan
SI 00835.482, Loans of In-Kind Support and Maintenance
SI 01120.220, Cash Loans
Exclude the first $30 of earned income and the first $60 of unearned income received in a calendar quarter that is received either infrequently or irregularly per SI 00810.410.
Medical and Social Services are not income per SI 00815.050.
A third party payment of an individual's bills for an item other than food or shelter is not income per SI 00815.400.
In-kind gifts of clothing are not a form of income or in-kind support and maintenance for all SSI beneficiaries and deemors beginning March 9, 2005.
SI 00815.001B, What Is Not Income - General
SI 00835.400B, In-Kind Support and Maintenance (ISM) to One Person
Help with labor, third party payments for repairs, and materials for improvements and repairs to an existing resource are not income, e.g., home or car repairs.
SI 00815.500, Weatherization Assistance
The value of personal services is not income. Examples can include personal care services, transportation, cleaning, etc. per SI 00815.150.
Exclude from income assistance based on need, which uses income as a factor of eligibility and which a State, county, or local government wholly funds county or local government per SI 00830.175.
Continue to exclude a previously excluded home, even if it is uninhabitable due to the disaster, if the former resident intends to return to the home. Also, continue to exclude the home if a spouse or dependent relative continues to reside there, or, if sale of the home would cause undue hardship due to loss of housing for a co-owner. See Details
SI 01130.100, The Home Exclusion
Exclude from income in the month of receipt any educational grant, scholarship, fellowship, or gift established for children affected by a disaster.
Exclude from resources for 9 months after the month of receipt, if the child will use it is used it for paying current or future necessary educational expenses such as tuition and fees at any educational institution.
This income and resource exclusion does not apply to any portion of the funds set aside or actually used for food or shelter. Funds maintained and administered by a public or private organization, third-party trust, or Uniform Gift/Transfer to Minors Act account and only paid out at the time of need may not be a resource.
SI 00830.455, Grants, Scholarships, Fellowships, and Gifts - Income
SI 01130.455, Grants, Scholarships, Fellowships, and Gifts - Resources
Exclude from income any death benefits used by a person to pay the expenses of a deceased person’s last illness and funeral expenses. Any amount of death benefits that remain after the last illness and funeral expenses are paid is income to the recipient or deemor.
Exclude from resources for one month following the month of receipt any death benefits that will be used to pay a deceased person’s last illness and funeral expenses.”
SI 00830.545, Death Benefits
SI 01120.115, Death Benefits for Last Illness and Burial Expenses
Pay benefits for disaster casualty claims based on allegations and obtain the necessary evidence post-adjudicative, including evidence of school attendance for student benefits.
If a claimant is in dire financial need for immediate payment see, Immediate Payment (IP) Criteria and Process RS 02801.010.
If the claimant does not meet the requirements for immediate payment, process the claim through MCS using normal instructions.
If a claimant alleges, the systems-determined payment cycle date will cause a hardship, change the payment cycle using POS. Once the MBR is established, make an input to the PECY screen to change the payment cycle:
Select #17 (Pay Cycle) from the PESL screen (the POS selection list), you must select this option for ALL (i.e., you cannot apply it to an individual on the record).
On the PECY screen, select Requested Cycle #1 (3rd of the month), and Request Reason #2 (SSI payments).
This action changes the payment cycle the following day. For example, if a beneficiary was entitled in March, you must issue the April payment for March as soon as possible.