PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 022 – OverpaymentsSubchapter 50 – Waiver Provisions for Title II and Title XVIII OverpaymentsTransmittal No. 32, 08/13/2019
The updates to this transmittal does not change or introduce new policy or procedures. We are updating this transmittal via the Quick Action Transmittal (QAT) process. We clarified the instructions to ensure field office (FO) technicians properly annotate the Debt Management System (DMS) remarks according to policy. We made minor editorial changes to comply with the agency’s plain language standards.
Summary of Changes
GN 02250.301 T2 Waiver Decisionmaker
Subsection A - We updated the subsection to:
Change Claims Representative to Claims Specialist;
Change Payment Center to Processing Center;
Change Service Representative to Customer Service Representative; and
Update the sentence to comply with the agency’s plain language standard.
Subsection B - We updated the subsection to:
Include the name and acronym for the Center for Disability and Program Support;
Clarify the instructions to ensure technicians properly annotate remarks; and
Waiver determinations are made in the field office (FO) by claims specialists (CS) or higher-graded employees. The Processing Center (PC) can also process waiver approvals, for PC instructions refer to GN 02201.023. Customer service representatives (CSR) can make waiver determinations when an overpayment is $1,000.00 or less, which meet the criteria outlined in GN 02250.350. When a waiver determination is subject to management review for compliance with documentation requirements and regulations, the final decision on waiver rests with the decisionmaker and not the reviewer.
If the material gathered in the initial waiver interview supports a waiver approval, make the determination based on that material. Review of the electronic or paper folder is not required in this situation. However, annotation of your decision is required in the Debt Management System (DMS) remarks.
If waiver cannot be approved based on the material initially gathered, follow the instructions in GN
The amount and disposition of an overpayment waiver approval determines the level of review that is required. Use the chart in GN 02250.301.B.6. to determine the level of management review that is required when fraud is not involved. For fraud development, see GN 02201.050.
If the reviewer determines that the waiver approval does not have proper documentation or is not in compliance with regulations or SSA procedures, the reviewer will return the case to the decisionmaker for correction. Once correction is made, if the decision is still to approve waiver of recovery, the decisionmaker will re-route the case to the appropriate reviewer for sign-off. If waiver of recovery cannot be approved, follow the procedures in GN 02270.000.
Whenever the amount of the overpayment is $20,000.00 through $74,999.99, the overpayment dispositions must be reviewed by office management (MSS or higher) in order to insure the decision is both technically accurate and in conformance with POMS instructions
The Decisionmaker will:
Use his or her own PIN to enter the initial decision.
Document the decision on DMS and on the SSA-635 Form, per GN 02250.315. Prepare a brief write-up of your rationale in DMS.
Submit to a member of management for review if required by GN 02250.301B.6.
Office management (MSS or higher) will:
Review the decision for technical accuracy and conformance with POMS instructions.
If management approves, they will input the decision on the Review Waiver Disposition (DRWR). (MSOM DMS 006.005) and annotate DMS remarks of the action.
Return to the decisionmaker for notice completion and release.
REMINDER: Follow your regional instructions to determine if any further review is required.
Management review is required when the overpayment balance is $75,000.00 or more.
Document the decision on DMS and on the SSA-635 Form, per GN 02250.315.
Submit to a member of management for review and transmission to ARC-MOS and the Center for Disability and Program Support (CDPS).
The management official will:
Review for technical accuracy and conformance with POMS instructions.
Send an email to CDPS mailbox for the ARC-MOS-CDPS for review.
If a paper folder is relevant to the ARC-MOS-CDPS waiver review, forward the file to the Regional Office (RO) Attn: CDPS, note the paper file transfer in the email to CDPS, transfer folder location to the RO on PCACS and annotate DMS remarks of actions taken.
If there is no paper folder, the management official will annotate that there is no paper folder in the email to CDPS.
Regional Office ARC-MOS-CDPS actions:
Annotate DMS regarding the receipt of email and folder, if appropriate.
Review the decision to ensure it is both technically accurate and in conformance with POMS instructions.
Document DMS with your decision.
Complete the second PIN action on the Review Waiver Disposition (DRWR). (MSOM DMS
006.005). This must be done by a Supervisory Social Insurance Specialist due to PIN restrictions.
Respond with the ARC-MOS-CDPS decision to the management official by email.
The ARC-MOS-CDPS will return the folder to the FO, if applicable and input PCACS folder movement to transfer the file back to the FO.
FO Decisionmaker will:
Annotate receipt of the ARC-MOS-CDPS email on DMS remarks.
Take the appropriate action in DMS in accordance to the ARC-MOS-CDPS final decision.
Release the notice.
Fax a copy of the ARC-MOS-CDPS email in the electronic folder. For paper folders, place a copy of the ARC-MOS-CDPS email in the paper file.
Decision Maker/ Reviewer Requirements
$1,000 or less
CSR or higher – No Review Required
$1,000.01 or more but less than $2,000
CS or higher- No Review Required
$2000 or more but less than $20,000
CS or higher (Deciding) and CS or Higher (Reviewing)
$20,000.00 or more but less than $75,000
CS or higher (Deciding) and MSS or higher (Reviewing).
$75,000.00 or more
CS or higher (Deciding) and management official (Reviewing). Send the case to the ARC-MOS-CDPS for review.